A Trip to the Ocularist

I have a prosthetic eye. The last one I got was about twenty years ago, so I decided it was time for a new one. This is a write-up about my experience while it’s still fresh, and also to answer many of the questions I get. (Weak narrative structure here, this is somewhat stream-of-consciousness.)

Popular question: How much does it cost? My insurance covers 100%, so luckily it cost me $0. However, the receptionist told me that insurance normally approves in the neighborhood of $1200, and that for most people insurance covers 50% or 80% for medically needed prosthetics.

The process consists of three sessions, the last two of which can be done on the same day in the morning and afternoon. For scheduling reasons, I’m getting three separate sessions.

The first session is short, at least for a replacement: The ocularist makes a form with a crosshair for the iris, shaping it for comfort and look. I was complaining about how my lower lid droops with the current one, so he shaped the new one to put less weight on the center of my lid. I don’t have the new one yet, but I can tell already that there’s going to be an improvement there. This took about half an hour.

The second session, which was yesterday, is the long one: The ocularist tries the form again, makes any final adjustments, then makes the base of the actual prosthetic. Then there’s the painting process. Oof. I sit with him and he painstakingly paints the form to look as close to my functional eye as possible. There are some painting techniques so that the iris looks larger in low light than in high light. The veins are made with wisps of yarn. The idea is to make an eye that has reflectional symmetry with the functional one, and that’s quite a skill. This took about two hours.

Popular question: Can you take it out? Can I look at it or the socket? If you’re a close friend (which is a short list), I wouldn’t mind if you really want to see. Everyone else, that’s what the internet is for. My child has specifically asked me not to take it out around him, and that’s fine.

One of the first things I noticed was the smell. It’s been twenty years since my last one, and as soon as I entered the painting room, my sense memory yelled at me. The ocularist said that’s pretty common.

There’s a substance that looks like a clear acrylic epoxy that’s used to coat the paint and the veins, and I think that’s the smell: A sickly-sweet chemical smell, like someone mixed Crazy Glue with sugar and just a pinch of urine. Yummo.

I can’t imagine what it would be like to work with that. Just a few hours every twenty years is enough to engrain the smell on my brain. (And yes, I’m smelling it in my mind right now.)

At first, I was reading my book because I didn’t want to distract him, but then we started chatting, mostly at his lead.

My first prosthetic was made when I was fifteen months old. I knew it was somewhere in there, but he’d looked it up in my chart. June 1969; I got an eye for my brother’s fourth birthday. I don’t know how many I’ve had since then. I only remember getting one in my teens, and a second one back around the turn of the century.

I remember the one during my teens, made by a kindly old man with a German accent. He retired before the most recent one.

Popular question: How can you drive with one eye? You don’t have any depth perception! I have fine depth perception. The brain has quite a few things it uses to determine relative distances, such as overlaps between objects, knowledge about typical sizes, and relative object speed. I’ve been told that people who lose an eye struggle with depth perception for a few months, but usually adjust. I wouldn’t know, since I’ve had one eye since well before my memories started.

We talked about implants. There’s a titanium ball that can be grafted to the muscles, and then the prosthetic is placed on a peg. He said the surgery is long and painful, and the socket is then more prone to irritation. A significant majority of people who get it have it removed after a year or two. He also said it doesn’t really help the tracking considerably; the better strategy (which is what he’s trying) is to try to seat the prosthetic so the muscles are more effective.

I remember when I was younger, I was told to take it out regularly. I asked him about that, and he said the opinions have changed now. What I do (take it out about once a day for a quick clean) is fine, but leaving it out leaves the socket prone to irritation, as does touching the prosthetic.

These aren’t dentures. My father had to take his dentures out nightly for soaking. Prosthetic eyes are made to generally be cleaned the same way regular eyes are, through blinking and natural fluids. Because they can place pressure on the tear ducts, daily cleaning isn’t unusual, but take it out, rinse it off gently, and put it back in.

We talked about movies. He made a prosthetic prop for a movie that’s coming out soon (I won’t give the title).

I complained about the movies Captain Ron and Sing, where spherical prosthetics are a comedy device. Prosthetic eyes have never been balls; the shape they have now has been their shape pretty much for as long as they’ve been made, more or less. I did see a recent TV show that featured a properly shaped eye, plus there’s the film he made a prop for, so I’m glad that the entertainment industry is making an effort to fix this.

We also talked about famous people with prosthetics, particularly Peter Falk and Sammy Davis, Jr. I had some classist grumbling about how Falk’s eye improved dramatically, and how he probably had access to better services, but the ocularist said that really isn’t the case for this sort of prosthetic: The art is the art. He probably just got a higher quality eye made.

Popular question: How did you lose your eye? In late 1968 or early 1969, my retina detached. I was preverbal. The doctors were concerned that I had cancer in my eyes, which can be fatal in a matter of months, so they removed the eye. I did not have cancer, but given the state of medicine at that time, I’m not sure reattachment surgery would have worked (or even been available to a baby). I was officially diagnosed with Coats’ disease; my skepticism about that is a separate topic.

The third session is next week. It’s the final fitting, with any adjustments. This usually takes less than half an hour.

When I get my new prosthetic and I’m happy with it, I’ll post before/after photos of my new look. If you have any other questions, feel free to ask! I’ll answer anything, even if my answer is, “I’m not going to go into that.”

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