OCULARIST - DEFINITION
An Ocularist is a trained professional who fits and manufactures Custom Designed Ocular Prostheses (artificial eyes). An Ocularist is also qualified to fit Scleral or Haptic Shells (an artificial eye shell which fits over a blinded eye). The Ocularist's domain is the eye socket and blinded physicul eyes.
THE OCULARISTS ASSOCIATION OF SOUTHERN AFRICA
The association represents the co-ordinating body for disciplines related to the rehabilitation of patients suffering from all forms of Ocular and Orbital trauma resulting in either blindness or loss of either one or both eyes.
The Ocularists aim is, through an eye prosthesis, not only to restore lost orbital and ocular contours and function, but also to buoy the spirit of the patient.
The association aims to endeavor to sustain and further develop the working relationship held with Optometrists, Ophthalmologists, Plastic and Reconstructive Surgeons and Maxilo-Facial Surgeons in order to achieve the best possible treatment in holistic rehabilitation of patients.
The Ocularists Association of Southern Africa makes use of the Optometric Ombudsman, care of the Executive Officer of the South African Optometric Association, Mr Harry Rosen.
They are available to both Ocularist and patient alike in order to maintain an open and honest work ethic in Ocularistry.
Polishing of your ocular prosthesis on an annual basis will extend the life of the material of your prosthesis.
An ocular prosthesis needs replacing every -five to eight years as the material deteriorates and therefore has a limited lifespan. If not replaced, this Will lead to recurring discharge from the socket and resultant irritation to the socket.
If the shape of your socket changes due to aging or damage, a new prosthesis is often considered Mr better comfort and cosmesis. Bear in mind, that when fitting a child, a new prosthesis is required at regular intervals during the growing years so that the socket and prosthesis keep pace with the changes occurring in the facial bone structure.
It is very important to replace your prosthesis with socket changes as damage to your eyelids and socket may occur if the prosthesis fit is not aligned to that of the socket.
While there are many various types of implants fitted surgically by the Ophthalmologist, the ocularist is trained to manufacture the correct prosthesis irrespective of implant type.
An ocular prosthesis is often called a 'glass eye'. While there arc still one or two companies worldwide who tit blown glass ocular prostheses, the world trend for the past number of years is the use of MethylMethacrylate, an acrylic. All registered members of the Ocularists Association of Southern Africa use MethylMethacrylate in the manufacture of your prosthesis.
In order to achieve the best results, one should exercise patience with fittings and manufacture processes as these are very time consuming and all attention is paid to achieve the best final result possible. The fitting period may extend over a few months to ensure that the eye prosthesis is going to be accurately and symmetrically reproduced to resemble your remaining eye.
A custom designed ocular prosthesis is a prosthesis taken from an impression moulded shape, which then corresponds with the socket shape in order to achieve best comfort, movement and lid shaping.
The stock prosthesis is not hand made for an individual patient and one is usually chosen from a fitting set held by the Ocularist. A stock prosthesis can be adjusted for a better cosmetic result.
The ocular prosthesis falls under the non-surgical or external appliance section of your medical aid fund. Most Ocularists can assist you in getting the proper authorisation for manufacture and fitting of your ocular prosthesis.
Always take note of package inserts on medication used with your eye prosthesis, as some eye medications are contra-indicated for hard/gas-permeable contact lenses (which are also made from Methyl Methacrylate) and would therefore be contraindicated for your eye prosthesis. Your eye prosthesis should be removed for the duration of the course of medication prescribed to prevent deterioration of the material. Ask your doctor, if he is able, to prescribe an alternate medication which will not affect your eye prosthesis.
Ocularists often are asked similar questions by many of their patients. The following questions may clear up some of the things you have wondered about, and their answers will help you understand more clearly what takes place.
WILL I BE ABLE TO SEE OUT OF MY PROSTHESIS?
No. You will newer be able to see out of that socket again, at least not in the foreseeable future. Perhaps some day a transplant or some type of biotechnical invention may be developed, but there is nothing available at the present time.
WILL MY ARTIFICIAL EYE LOOK LIKE A REAL EYE?
WILL THERE BE A DIFFERENCE?
The answer is definitely yes, because the two eyes were not symmetrical to begin with. In fact, if it were possible to match exactly the contour of the lid of the good eye, people who know you best would sense something was different. In fact, no person is exactly symmetrical.
Try this simple test for fun and to prove this point. Ask a couple who have been married for several years or two long-time close friends to face away from each other. Then ask each partner to describe the facial features of the other. If they are able to tell you that one eye is smaller than the other, the mouth is higher than the other, and finally, one ear is lower than the other, they are exceptionally observant. Only one person in 10 000 is aware of these differences. So again, because your eyes were not the same to begin with, it is highly un likely that anyone will notice a difference.
WILL THE ARTIFICIAL EYE BE ABLE TO MOVE?
This depends on how you lost the eye, and on what surgical procedure was performed. If you had an evisceration, which means the wall of the globe was retained and only its contents were removed, and if you are custom fitted, the answer is yes. There will be excellent movement. If you eye was enucleated, then the entire globe was removed, and hopefully the muscles were kept. If the surgeon was able to replace the lost volume with an implant, then the answer again is yes. Not quite as much movement will be present, as in the first case, but movement will be quite good. If it was necessary to perform an exenteration, in which the socket contents and surrounding tissue, such as eye lids, part of cheek, and nose were removed, there will be no movement at all, but an illusion of motion may be achieved by using special optics over the prosthesis.
HOW LONG WILL THE PROSTHESIS LAST?
The average length of time that an acrylic artificial eye will fi properly is about 5-10 years. It is not that the prosthesis will change, but rather the configuration of the socket changes, which results in the need for a new fitting and usually by 10 years and the acrylic will have deteriorated to the point that a new prosthesis will be needed.
The socket may change for reasons. The most common cause is atrophy of the fat in the socket. Other causes include weight gain or loss, enough of a problem to warrant a replacement o an adjustment. An adjustment may mean the addition or removal of material to change the size or shape in one dimension or another.
It is especially important for a child with monocular vision to be fitted with prosthesis during the growing years. In children, the bony socket is in a constant state of change, as its component parts do no fuse until puberty, consequently prosthetic replacement could be a monthly affair. The presence of the appliance alone is not sufficient to stimulate growth of the socket, so the largest ball which can be used should be inserted. If the socket is left empty or if the prosthesis is not replaced frequently enough, before puberty, the bony socket will not form normally.