CONTINUING EDUCATION, 1 CE Credit – $9.99, 1 Hour, General Knowledge, Level 1, Release date: October 2007, Expiration date: October 31, 2012

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Understanding the Artificial Eye

There is a fascinating history surrounding the artificial eye and its development. During Egypt's ancient times, bronze and precious gems were placed upon the eyes of dead people of means and importance. Artificial eyes were also made of painted clay attached to cloth and placed over the socket. Romans decorated statuary with silver artificial eyes. During the years of the 1500s the first description of an artificial eye prepared to fit an eye socket was revealed by Ambrose Pare, a well known French surgeon. They were made of gold or silver. One style was worn in front or under the eyelids. Enucleation was not a very popular procedure until much later so that the artificial eye was not implanted in the eye socket but placed directly over the blind eye.

A few decades ago, many eye care providers were occasionally called upon to render a service to patients who experienced enucleation. Today, they are few and far between. The specialists who fit, design and make prosthetic eyes are called "ocularists." At present, improved surgical procedures, preventative eye care techniques and improved safety measures in the industry account for a reduced number of eye removals.

Joseph LeGrand Jr. is a prominent ocularist in charge of a firm that was started by his father in 1953. He explained to me that independent fitters are sought by surgeons and patients since they demand service from well-educated and trained personnel. The ocularists are a well organized, cohesive group and have not surrendered to external influences or control. The American Society of Ocularists has been the focal point for their group activity and is well supported. Some eye care professionals might find a valuable lesson in this.  

The background regarding creation of the modern era artificial eye is most interesting. Prostheses made of enamel (1820-1890) were not very durable but somewhat more attractive than those which preceded it. German and Venetian technicians were credited with inventing a formula for making a type of glass whose color was easily adapted for glass eye use. A tube of this special glass was heated at one end until a molten ball was produced and glass blowing skill was applied to achieve the desired effect. Various colors of glass were used in combination to imitate the colors of the eye to be matched. The process of creating artificial eyes was handed down as family secrets from one generation to the next.

Germany records a special history of fabricating doll eyes, Christmas ornaments and prosthetic eyes. German craftsmen were so well advanced in this field that they were the first to be designated professionally as "ocularists." These gifted artisans began to tour the United States and other areas throughout the world. Once anchored in a location they proceeded to fabricate eyes and fit them to the patients in that particular area. They also fitted artificial eyes by mail order. Hundreds of pre-made eyes might be kept in stock so patients could be fitted right out of the drawer. The fitters were often referred to as "eye doctors."

In the 1850s several German founded companies made artificial eyes in New York City and sold eyes to local practitioners. Sometimes they would supply semi finished custom eyes to individuals. United States fitters continued to use glass for the artificial eyes until World War II. German imports were limited and German glass blowers were no longer touring the U.S. The U.S. army and national fabricators along with private practitioners began using acrylic plastic polymers and oil pigments. These basic concepts, with accrued improvements, have become the best choices for developments in the ocular prosthesis field.

Plastic eyes are molded by the ocularist to provide the best cosmetic effect and excellence of comfort and fit. If the patient complies with the instructions regarding care and cleaning, it is possible for the artificial eye to last as long as a decade. However, Mr. LeGrand informed me that the average life is 5-7 years based on possible cosmetic changes. The muscles and other tissues in the eye socket will adapt to the post operative circumstances. New developments with artificial eyes allow them to be left in place as much as possible. This includes sleep schedules. Some patients remove the eye for cleaning every few weeks. Others perform this task only every few months with no adverse results.

An ocular implant replaces the removed tissue of the eye. The first record of an implant was in 1841. They have been made of many different materials, shapes and types over the years. They are made to aid the artificial eye to have some degree of natural movement. The surgeon, following the enucleation procedure, will attach the remaining musculature to the implant. Mr. Legrand reports, "Porous implants made from coral, newly developed plastics or other materials were introduced around 1987. They generally provide superior motility with fewer complications when compared to early plastics or glass spheres."

This allows the muscles to move the artificial eye in a manner that is similar to the action of a normal eye. The reader will be surprised to know that the new eye is not rounded in shape as you would expect in comparison with your normal eye. It is shaped, more or less, like a bottle cap and is fitted over the implant. The fitting and dispensing of the artificial eye may take only one day. However, depending on the ocularist, it may require more than one or two sessions. The new eye is made in several steps. While it is not painful, it is tiring and may leave the eye socket a bit irritated.

Once the wax impression is fashioned and finalized, the plastic insert is made. Further adjusting and smoothing may be necessary at this stage of the fitting. The ocularist is attempting to mold the impression in such a way that the eyelids will rest properly when the eye is open or closed. He merely removes it, adjusts it and reinserts it. Some ocularists use a special lubrication to help prevent the irritation that is sometimes caused by frequent removals and insertions of the impression. The ocularist will then draw a sketch on this implant to determine how the eye hole should be aligned. He will drill a hole in the material to meet the necessary alignment measurement. He will insert the colored area of the artificial eye via a "button” that closely resembles the alternate eye. This is placed over and around the implant in preparation for the painting process. The small red blood vessels may be copied by attaching small strands of fabric on the plastic. In the hands of an expert the new eye should be a close match to the remaining eye.

The patient must understand that as a result of losing the eye, the orbital tissues and muscles recede and change. The change is very profound from the first to the sixth week and no attempt should be made for a fitting before that period of time. The appearance of the new eye will match the opposite eye exactly. There are several solutions to the expected unequal movement of the artificial eye. Sunglasses or mildly tinted eyewear can be helpful to disguise the imbalance of movement. Recently reported developments regarding digitalized coloring of the artificial eye may help substantially in the manufacturing process, although Mr. Legrand does not endorse digitalized coloring since the long term results are not known at this time.

The vanguard of ocularists is discovering how to use modern approaches to advance their profession and intend to ride the crest of the wave into the future. Eye care providers everywhere will wish them the best in their endeavors on behalf of the monocular public.

Elmer Friedman, O.D.

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