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Frequently asked questions

Anyone, rich or poor, old or young, male or female. In New Zealand, prosthetic eye wearers lost their eye due to accidents (61%), medical conditions like cancer or glaucoma (30%) and congenital disorders such as microphthalmia (9%). Men lost their eyes more frequently than women (62% versus 38%) and at a younger age (the median age for men is 22 years and women 56 years). Right eyes are lost marginally more frequently than left eyes (55% versus 45%). The causes of eye loss are changing however as significantly less people are now losing their eyes through accidents. This is because of safer roads and better workplace practices.

About 3000 people wear prosthetic eyes in New Zealand – one in 1440 people in the general population.

When patients first lose their eye their initial problems involve getting used to judging distance and reduced side vision, and getting good advice. Patients whose occupations involve face to face contact with the public are more concerned about their appearance and reduced visual range than those whose jobs do not involve the public. After a couple of years the initial problems become less important and concerns about socket discharge (sleep in the eye) and shrinkage of the orbital tissues take their place. The good news is that modern surgical techniques are available to counter the shrinkage and good prosthetic eye care reduces the discharge.

Adults should replace their artificial eyes every 5 to 8 years to keep pace with changes to the socket. Childrens’ eyes are replaced every 2 or 3 years to keep pace with growth.

Not more frequently than monthly and not less frequently than six monthly.

For Three hundred years prosthetic eyes were made of glass and fitted by optometrists. When plastic was invented in the 1930s it was quickly adopted by dental technicians as a denture base material. It was then found to be a better material than glass for making prosthetic eyes. This is why most prosthetic eyes today are made and fitted by members of the dental profession rather than by members of the optometry profession.

I was fortunate to have the opportunity to train as a maxillofacial prosthetist while employed as a dental technician at the Plastic Surgical Dental Unit at Middlemore Hospital in Auckland. I trained for a further year at Queen Mary’s Hospital, East Grinstead, England. This is where New Zealanders Sir Archibald McIndoe and then Sir Harold Gillies pioneered many plastic surgical techniques when treating wounded soldiers in WW1 and WW2.

I’ve always been enthusiastic about ocular prosthetics and later completed a BSc in psychology to help me give proper advice to patients. I have also completed a PhD thesis entitled “The Response of the Anophthalmic Socket to Artificial Eye Wear” and written a book entitled “Clinical Ocular Prosthetics”

Modern prosthetic eyes are made of (poly) methyl methacrylate (PMMA) – a medical grade of perspex. Denture bases are made of the same material. Glass eyes are still manufactured in Germany, Austria and Switzerland and the debate over which material is better is ongoing.

An Ocular Prosthetist is a carefully trained professional skilled in the arts of fitting, shaping, and painting prosthetic eyes. In addition to creating it, the Ocular Prosthetist shows the patient how to handle and care for the eye, and provides long-term care through periodic examinations.

Prosthetic eye-making has been practiced since ancient times. The first ocular prostheses were made by Roman and Egyptian priests as early as the fifth century B.C. In those days, prosthetic eyes were made of painted clay attached to cloth and worn outside the socket. See the history tab for more detail.

“Stock” or “ready-made” ocular prostheses are mass-produced. Since a “stock eye” is not made for any particular person, it doesn’t’ fit any particular patient. A “custom” ocular prosthesis, on the other hand, is made by your Ocular Prosthetist to fit you and you alone.

The prosthetic eye, like hard contact lenses, needs to be polished yearly in order to restore the surface finish and ensure the health of the surrounding tissues.

The cost for a prosthetic eye is currently $4,000 plus GST and $4,500 plus GST for a scleral shell. Fortunately, most eyes are fully funded by the MoH, ACC, local DHBs or by private health insurers. Where no funding is available (for example, when a prosthesis is lost and there is no household content insurance) the NZ Prosthetic Eye Service will negotiate an affordable fee that takes into account the financial circumstances of the patient. Nobody in need is ever denied a prosthetic eye.

Surgical techniques have evolved, even over the past 20 years and modern-day orbital implants coupled with well-fitting prosthetic eyes deliver excellent movement. However, the movement is usually not quite as good as the lost natural eye but good enough to deceive casual observers. Scleral shells generally move better than prosthetic eyes.

With the loss of an eye, your depth perception and visual range is greatly affected. Objects that are closer than 8 meters will be more difficult to adjust to than those at greater distances.

Start by practicing driving in an empty parking lot when no other cars are around.  It will pay to have somebody with you as initially, the driving experience is very different from what you have been used to and you can expect to be quite uncomfortable.  Negotiating narrow streets and threading your way between parked cars is particularly difficult and made more so when driving against oncoming traffic.  Try to have somebody with you when you attempt this for the first few times as they will spare you unwanted stress (and loss of paint).  When possible follow the car in front and do what it does.  If there is no car to lead you, get your passenger to concentrate on one side while you concentrate on the other.

Parking your car presents challenges of a different sort but there are a number of tricks that will help, such as placing a mark on the wall of the garage or hanging a rope so that the free end touches your windscreen when you arrive at your predetermined position.  When parking close up to a wall in front of you might try turning on the headlights and taking note of how the pattern the light moves across the wall as you get closer.

Parking your car

Use the pattern of your headlights to judge distance when parking.

Every year new motor vehicles deliver more and more advanced technology.  Much of this technology actually benefits monocular drivers more than binocular drivers.  Examples include: gap sensing cruise control that keeps the car a constant distance behind the vehicle in front, automated parking programs, sensors that detect close objects and follow central road markings, rear vision video and wide-angle driver adjusted mirrors.  New car technologies have virtually cancelled out monocular driving concerns and created a level playing field for all drivers, individual differences notwithstanding.

A prosthetic eye can be worn during any sporting activities. However, when swimming you need to be aware there is a chance the prosthesis will be flushed out and lost – especially when swimming in the ocean. Goggles will help.

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