The people who will make your artificial eye are known as "Ocularists" (pronounced: "Ock-You-Lair-Ists") and are engaged in the practice of "Ocularisty". There is an American Society of Ocularists, and research of new techniques and product development, stressing the benefits of custom-made ocular prosthetics and product development, is published in the Society's annual Journal of Ophthalmic Prosthetics.
Although the first artificial eyes were made of glass (thus, "glass eye"), for about the last fifty years most artificial eyes have been made out of plastic, typically Methyl Methacrylate. These plastic eyes are typically molded by the Ocularists to provide you with the greatest possible level of comfort. With proper care and cleaning, they can last as long as a decade.
You will wear your first artificial eye only for about six months. The reason for this is that the muscles and tissues in your eye socket will slowly adapt to the new eye. After six months, your Ocularist will fit you with your permanent eye.
For days after I first learned of my cancer, I worried about having to take my artificial eye out and clean it every night before I went to bed, and of leaving it out when I slept. These fears were completely unjustifiable. Modern artificial eyes are mean to be left in as much as possible, and slept in. In fact, you are only supposed to take the eye out every so often for cleaning (some people do this every couple of weeks, others may do this only every few months!), and you are supposed to put it back in as quickly as possible to protect it.
You should visit your ocularist at least once a year (more like every six months) to have your new eye cleaned and checked by your ocularist, and modified in any ways that you believe will make your new eye more comfortable.
Your real eye had muscles attached all around it, that kept your eye in the socket and moved it around. When your eye is removed, the surgeon inserts what amounts to a small ping-pong ball sized insert into your eye, and ties the muscles up around it in. So, what you have in your eye is a small ball which is surrounded by muscle tissue. Your muscles continue to move around this ball, similar to how they moved when your real eye was in.
Your new eye will NOT be -- contrary to popular expectations -- round like your real eye. Instead, it will be sort of in the shape of a bottle cap (although very smooth) and will fit OVER the ball of muscle with the ping-pong sized insert inside.
The making of your new eye takes about a day to accomplish, and can either be done in one session or in several depending on the preferences of your ocularist. My ocularist (name and contact info below) generally gets the job done the same day -- although it is certainly a full-day affair.
Your new eye will be created in a multi-step process. It is not painful, though it is tiring and towards the end you will probably be worn out (I was) and your eye socket slightly irritated.
Going to the ocularist your greatest fear will be that you will experience severe pain in the fitting of your new eye. This will not happen, although you will get some very weird (though not painful) sensations. The problem is that psychologically you are not accustomed to somebody sticking something into your eye socket. You've gone your whole life protecting the eye in the socket, and your mind and body is geared to reject anything in the socket.
You can -- and must -- overcome these fears simply by reminding yourself that there is nothing in the socket that can be harmed. You have to psych yourself up that it will feel weird, but there will be no pain.
The first step is that your ocularist will place a "plunger" into your eye socket. The plunger looks very much like those suction-cup arrows that shoot out of a child's toy. You really will not feel the plunger in your eye, but you will get a weird sensation because of your eyelids resting on the portion that it sticking out.
This doesn't hurt, but psychologically it feels very weird. It takes a few seconds to get used to, but you will do so as quickly as you realize that it doesn't hurt, it just feels weird.
Next, your ocularist will insert some plastic-like materials through the plunger into your socket. This doesn't hurt either, but it also feels weird. You have to sit there for a couple of minutes while the plastic-like materials hardens. Then, when the ocularist removes it, the sensation is gone.
Psychologically, this portion is the hardest part, not because it hurts, but just because it is weird. Fortunately, this entire process only takes about 5 minutes and IT DOESN'T HURT. Again, just weird.
What the ocularist does with the plastic is create a wax impression similar to the cavity in your eye. He will then take the wax impression and place it into your eye to see how it feels. You probably won't feel some parts of it, and other parts will cause pressure inside your socket. You will tell your ocularist which parts are causing pressure, and he will take it out and smoother wherever, and then reinsert it.
Your ocularist will primarily be smoothing and reshaping the wax so that the impression is the right shape for your eyelids to rest properly when your eye is open, and then to close properly when you blink. He will also be trying to shape the wax so that it fills out certain areas around your socket to give your eye a natural look.
The ocularist will insert and take out the wax impression several times during this process. It is not painful, although your eye socket may get a little irritated. My eyelids in particular got irritated, but not by the wax but by one of the lubricants the ocularist was using. When he switched to a heavy silicon lubricant, the irritation went away (so don't hesitate to tell your ocularist if your socket is irritated as he can probably do some to lessen this).
After the ocularist has your wax impression right, the plastic insert will be made. This takes about an hour and you end up with a plain white piece of plastic the same shape as the wax. The ocularist will place and take this out of your socket several times, adjusting the shape for comfort and so that the eyelids rest and close properly. The plastic is completely smooth -- and tough! My ocularist probably dropped mine on the floor a half-dozen time during this process (it is slick because covered with lubricant) with nary a scratch or dent!
After you and the ocularist are satisfied with the shape of the insert, and how your eyelids rest, the ocularist will take a few seconds to draw on the insert how the eye hole should be aligned.
The next step is for the ocularist to drill the eye hole in the plastic, and insert the colored area. The ocularist actually starts with something which looks like a button which is very close to your own eye (I was a "T-17" colored insert), and it fits over and around the hole which the ocularist has drilled.
You will then sit next to the ocularist as he paints your eye, looking closely at your remaining eye for a guide. The painting process is interesting, for instance the small red veins in your eye are duplicated by taking small strands of fabric and carefully placing them on the plastic. When completed, you new eye should pretty much exactly resemble your remaining eye.
There is a final fitting, and then you are done!
Your new eye should look and act very similar to your remaining eye, except that there will be some slight variation in how your eyelids rest, and your remaining eye will not have the movement of your remaining eye. If there is significant variation in how your eyelids rest, you may want to consult with your surgeon about making some slight alterations so that it blends in better.
Painful no, weird yes, tiring yes.
You should get used to your new eye in a couple of days, and probably won't think much about it after that. It will, for all practical purposes, look and be like your remaining eye -- but it won't see worth a darn (I'm told they are working on that!).
I'm writing this almost a year after I lost my eye and was first fitted for my new eye.
After you lose your eye, many of the muscles in you eye recede, since they have nothing to do. This is fairly dramatic for the first six- to eight-weeks, which is why you should not even attempt to go for a fitting until after this period.
However, even after you are first fitted with you new eye, you muscles will continue to shrink, although much more slowly. After about two months, I found that my new eye was way too loose, and on a couple of occasions was knocked sideways when I was sleeping, and in a couple of instances was accidentally knocked out.
So, I went back to my ocularist for a "second fitting". This, I learned, is where your new eye is really made to fit your socket.
Usually, your ocularist will not make you a completely new eye, but will merely add wax (and then permanent clear plastic), until the eye fits correctly.
Now my artificial eye fits perfectly, and there is no possibility that it will be knocked out of place or out. I feel that I can even surf with this modified eye without protective goggles (though I would be foolish to do such a thing). The fit is so good that it honestly feels exactly like my other eye.
Also, while I am writing, when you go for your second fitting, get your ocularist to make a "mold" of your modified eye, in case you accidentally lose it. This will hopefully keep you from having to re-start the eye making process.
From an appearance standpoint, your new eye should be indistinguishable from you other eye, except that your new eye will not move very much. The reason for this is that the muscles in your eye socket aren't attached to your new eye like they were to the old one. Probably most people will not even notice this (or care), but if you are self-conscious about it there are a few possible solutions:
First, you can wear sunglasses or have your eyeglasses slightly tinted. Since to protect your other eye you will want to wear some sort of protective glasses anyway, this is the easiest solution.
Second, you can have installed into your eye socket a special type of implant made of a porous material to which your muscles and other tissues will slowly connect. This implant will better interface with your artificial eye, thus giving the eye more natural movement. The implant was first approved by the Food & Drug Administration in 1989, and it is claimed that over 30,000 people have had this procedure done. There is a possible downside, however, and that is that the porous materials also make the eye socket slightly more susceptible to infection, so you will want to consult not only your ocularist but also your ophthalmologic surgeon about the benefits and risks.
Third, promising research is now being made into artificial eyes which will not require the implant, but will more closely interact with the muscles in your eye socket to provide natural movement. So, if you can wait for awhile, you might be able to take advantage of these new technologies.
Most insurance companies, Medicare and Blue Cross & Blue Shield, etc., will pay a percentage of the fitting fees for your new eyes, but you should check with your carrier in advance to see how much. Typically, your ocularist will assist you in submitting your claim to your insurance company.
Do you have to take your new eye out every night? Of course not! It is recommended that you take your new eye out and wash it with regular soap and water about once every couple of weeks, though I am probably remiss and do it only about once every couple of months.
The point of doing this is simply to remove enzymes and such which may build up on the eye, but my office is very close to my ocularist, and instead of me cleaning it myself I just take it to him to be polished.
At any rate, the care of your eye isn't a daily thing or even a weekly thing, and (believe it or not) you'll soon almost forget that you have the darn thing in there!
Even if it can't see, your artificial eye could still be very useful. Here are some things we would like to see available to be fitted into artificial eyes in the future:
- Miniature videocam (never be caught without)
- Miniature camera (approved for use by the CIA)
- Laser pointer (free up that other hand during presentations)
- Pager (never lose it again)
- Internet cam (broadcast to the world what you see, 24 hours per day)
- Small container (for miniatures of your passport and other important documents)
Send us your suggestions via our Contact Form as we would love to hear them!
The Artificial Eye Patient -- Text by the Ottawa Hospital about the development and fitting of artificial eyes.
American Society of Ocularists -- Lists all affiliated Ocularists throughout the United States, full list of available articles on all aspects of ocularistry, and lots of other good information. http://www.ocularist.org
Man, am I glad I found him! Mr. John A. Kennedy, Eye Design Ocular Prosthetics, 145 W. Main Street, Suite 120, Tustin, CA 92780, (714) 508-8565. John is a patient, caring guy, and he is really good with kids too. Highly recommended.