The ‘Art’ Of Prosthetic Eyes
August 24, 2011
By Doss Tannehill
Doss Tannehill
Ocularist
Where did you receive your schooling and training?
I’m a Kamehameha Schools graduate and I went to college at Colorado State. I learned ocularistry from my dad.
How long have you been an ocularist?
I started going to work with my dad when I was 8 years old. Our main business was contact lenses, and he was quite an innovator. After I graduated college, I started doing ocularistry it’s been 39 years.
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Are you one of the few ocularists on the island who make prosthetic eyes?
I’m the only one who lives and works in the state who does this.
At what point does someone come to you after losing an eye?
If the eye is removed which is called an enucleation usually six to eight weeks after the surgery the patient will come to see me, when the healing is completed and most of the swelling is down. For people who have diabetes or who are older, that process can take longer.
Is it common for diabetics to need an enucleation?
Diabetic retinopathy is quite common in Hawaii, as diabetes is very prevalent. And oftentimes the eye will become blind, at which time I can fit a thin prosthesis called a sclera cover shell over that eye, or if the eye has to be removed, then I fit a regular prosthesis.
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When might the eye need to be removed?
If there’s pain or pathology. But if those things are not there, there’s no reason to remove the eye. You get less sunkenness and better motility when the eye is there, albeit blind and usually shrunken. You get a better result from my end, and the patient doesn’t have to go through the trauma of surgery and losing a body part. That’s huge.
The eye is part of the body, and the subject of losing it is so private that most of them don’t want to talk about it. It’s a very personal thing. When you talk with someone, you look each other in the eye, so it’s about judging someone’s character. There’s also psychosexual connotations -
when you make googoo eyes at someone, you look them in the eye. When you have loss or disfigurement of an eye, patients feel like there’s a loss of self-esteem.
Even though in their logical mind they know they’re no less of a person. It’s a far bigger loss than fingers or sometimes arms or legs. Eyes are what we use to communicate. It’s not nearly so much about the loss of vision, because with sight out of one eye you can still do many things. In fact, there was a guy who played professional football with one eye.
To what extent do you help patients deal with the psychological trauma?
I talk to them about it and I encourage them to get counseling if they’re struggling. Usually you can tell when you’re fitting the patient and painting the iris, I say “Look at me,” and they don’t want to. But once you break the ice and let them know you’re on the same side I say, “I’m not going to insult you and tell you I know how you feel. I don’t know how you feel, I have two eyes. But I probably know a little bit more about how you feel than the average guy on the street because of what I do for a living.”
You literally look at them and paint one eye to match the other?
Yes.
How realistic is the prosthesis?
If there’s been no lid or facial damage and it’s just a problem with the eyeball and you have a good surgeon, you can expect a good result. The people the ocularist is trying to “trick,” are the ones you meet for the first time, not family and friends. They know they went through the whole ordeal with you.
Are you working with an empty socket, and does the eyeball still move and look natural?
When the surgeon removes the eyeball, they want to fill up some of that space, otherwise the prosthesis is going to be heavy. They attach the existing extraocular muscles to the implant to get motility within the socket. The tissue that’s inside of your socket is mucus membrane, the same thing that’s inside of your mouth.
The most commonly used implants nowadays are made out of a coral that’s only found in Tonga and is very much like human bone. The doctors sew the muscles to it so you get a lot of motility in the socket.
What kind of care or upkeep is needed?
The eye needs to be cleaned and polished every six months. Once a month, take it off and take a look to be sure there’s nothing different going on in your socket or your eye.
Does it last for life?
For seven years, and not because the prosthesis falls apart, it’s because the socket with the eyeball will change, necessitating a refit.
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When someone comes to you, what next?
I take an impression by injecting alginate. If you’ve ever had an impression of your teeth, it’s the same stuff; ours is more refined. Also in that first visit I paint the iris.
With the impression, I make a wax pattern and I fit it for size and symmetry. Then I make a mold and put the iris that I painted in there surrounded with white plastic, which is like your sclera, the white part of your eye. The next time they come in I put the veins on and paint the sclera, and then I put it back in the mold with a clear overlay and process it. Next time they come in I deliver it.
Can you talk about your work with patients from Kalaupapa who had Hansen’s disease?
You know what, they’re all gone (chokes up). This brings out my emotions. My dad used to go there and fit them because there were plenty, but the last one died a year ago. Neat people, many of them. That’s a chapter that’s closed. Another one that will be coming to a close in time will be the 100th Battalion, 442nd special guys. The young ones are in their late 80s, so that will be another group I soon won’t be working with anymore.