At Second Glance

When the look fits, experts in ocular prosthetics shine

[Editorial note from Peggy M.:] This article is very important to read if you have a blind or visually impaired eye that your ophthalmologist feels is untreatable and will most likely have to be removed. Eventually the increase of pressure , deterioration, color change, cataracts, redness and pain will lead to the decision to have the eye eneucleated (removed). This is not the end of the world and will not leave you scarred for life.

A caller to the 800 Line recently related her concerns about, "What happens after my eye is removed?" Her doctor said, "We will worry about that after the eye is removed." The fact is, the time to address the issue of an artificial eye (prosthesis) is before surgery -- with a Certified Occularist! There are decisions to be made about the choice of available implants.

As you will read in the following article, the type of implant determines the type of prosthesis. This needs to be a well informed decision between you, the Surgeon and the Ocularist. This is a very difficult time, but the better informed you are the better you will feel about your surgery. Once your eye is removed and you are fitted with a prosthesis, the positive change in how you feel about yourself is enormous. A good Ocularist will make you wonder why you waited so long. I know -- I have been there!

Dave Parrott lost his right eye when he was 2.

"We were living over on Vance, and I was across the street playing with some kids, and a 10-year-old kid had a bow-and-arrow set he’d gotten for his birthday," said Parrott, 42. "He was kind of playing William Tell, and he shot my eye out.

"I remember him in front of me, and I remember the arrow, I sure do. I do not remember the pain."

Readers, however, no doubt can feel Parrott’s pain: Ouch. But don’t cry for him, no matter how many good eyes you have left to produce the tears. Because one man’s injury is another man’s fashion accessory.

Parrott, in fact, flaunts his Cyclopean status with a series of "novelty eyes" that he wears most days instead of a more traditional artificial eye of matching brown.

"I’ve got a cat’s eye, with a vertical pupil," Parrott said. "That’s my favorite. And I have a black one, with an Egyptian god in the middle. I’ve got that one because I used to be in the Carnival krewe of Ptah.¹ And I’ve got my red one that I wear at Halloween that has a horizontal, gold-colored pupil.

"I do have a brown one that matches my remaining eye almost perfectly, but I’ll usually put that one in only when I’m out of town on business. Normally, the one I really wear out and about is my cat’s eye.

"I’m one of those people, if you’ve got a handicap, have fun with the darn thing. I have a blast."

The makers of these so-called glass eyes are Bob and Rob Thomas, a father-and-son team with offices at Kirby Parkway and Poplar. The father, 60-year-old Bob Thomas, is Tennessee’s only certified fitter and fabricator of "ocular prosthetics."

"It’s a fun place to work," said the son, 27-year-old Rob Thomas, brandishing an artificial eye that stared with a lifelike if glassy gaze through a dark pupil and a lovely hazel iris. The iris was set like a jewel inside a realistically veiny and discolored sclera (the white of the eye).

Although most people still refer to false eyes as "glass eyes," most artificial eyes since the late 1950s have been made from hard acrylic, not glass. Also, these prosthetics are not marble-like orbs that fit into the socket like a round plug. Rather, they are convex shells that fit over an implant in the socket like a fat contact lens.

In fact, the fitting and fabrication of artificial eyes is an art-cum-science similar to denture-making or the manufacture of other false body parts.

"Years ago, there used to be stock eyes," said Bob Thomas, a former president of the American Society of Ocularists² who has been making eyes for 39 years. "The patient would go into the eye fitter’s office, they would look in a drawer and pick out a pre-made eye to fit the socket."

Now, however, ocular prosthetics are painstakingly detailed to match the patient’s remaining eye as closely as possible – except, of course, when a patient like Parrott asks for a "gag eye" (gag as in joke, not choke, although Parrott admits that some who see his novelty orbs experience the latter reaction).

The American Society of Ocularists keeps no statistics on how many people in the United States wear artificial eyes, but the number is greater than most might think. The Thomases’ current patient roster includes more than 1200 people from the region and scores more from around the world, including many children from St. Jude’s Children’s Research Hospital who have lost an eye to cancer.

To meet the demand, Thomas Ocular Prosthetic Laboratories, Inc., operates satellite offices in Little Rock, Nashville, Jackson, Mississippi, and Johnson City, Tennessee. The main office, which opened in 1988 after Bob Thomas moved from Birmingham, is at 1900 Kirby Parkway.

The laboratory looks like a cross between an eye doctor’s office and a special effects studio. The Thomases wear doctor-style white coats and maintain a neat and magazine-laden waiting room, but the back offices reveal trays filled with sample eyes and plenty of tools for sanding, painting and mold-making.

Acrylic eyes were developed after World War II, when the world no longer was able to import German-made glass eyes. Nowadays, eyes are made through something ocularists call the "modified impression technique," which is similar to denture manufacture. Bob Thomas, in fact, was a dental technician in the Navy before he made the career shift to eyes, first working as an apprentice with a New York firm. Patients usually are referred to the Thomases about six to eight weeks after their "enucleation", the surgical removal of the damaged eye.

The surgeon inserts a spherical implant in the socket that "helps make up for lost volume," Bob Thomas said. The latest implants are porous, which allows blood vessels to grow into it, like roots growing into one of those styrofoam planters. This "vascularized" implant is able to move somewhat, in coordination with the remaining natural eye.

To measure a patient’s socket, the ocularist uses a small, hollowed device, shaped somewhat like a contact lens with a handle. While inside the socket, this device is injected with an alginate similar to that used by a dentist to make an impression of teeth. The resulting mold, which conforms to the shape needed for the artificial eye, is the first step in a series of processes that eventually result in a painted and cured "eye" that is converted from wax to acrylic.

During the process, a "pupil" – a tiny black plastic circle – is added to the mold. The iris and sclera are painted, which requires the Thomases to really shine as artists (little of the "white" of a person’s eye is actually white).

"Veins" are created through the use of minuscule red cotton threads. Said Bob Thomas: "We had one guy who said, ‘Put a few extra veins in there so I can have a few extra beers and my wife won’t know it."

Creating an artificial eye is a day-long process. The cost of an eye is usually about $1500, although novelty eyes aren’t as expensive because "they don’t have to be as exact," Rob Thomas said.

The Thomases also create other prosthetics, as necessary. Their scrapbooks are filled with before-and-after photographs of patients who have suffered through all sorts of injury. For instance, some customers have lost not just an eye but an entire facial region. This requires the manufacture of fake cheeks, brow ridges, noses and other parts. These often are attached to a pair of glasses, so they can be removed easily at home.

Artificial eyes basically are held in place through the pressure of the fit, and by the eyelids. They should be cleaned at home every few months with a mild facial soap. In addition, patients are asked to make a yearly visit to their ocularist, to have their artificial eye polished, sterilized and thoroughly cleaned of "protein buildup". A good eye should last five to seven years.

How are natural eyes lost? The causes are many, the Thomases said, including disease, infection, birth defects, gunshot wounds, yard darts, paperclips shot across classrooms and errant golf balls. "When your mother tells you not to run with scissors, listen," Bob Thomas said.

William B. Walls, 74, of Parkway Village, who visited the Thomases for his annual checkup last week, lost his left eye in 1985 after it developed malignant melanoma. "You have to learn to drive all over again, I’ll tell you that," he said of the change in depth perception, as Bob Thomas extracted the artificial eye from its socket with a tiny suction cup attached to a handle.

Now, however, Walls is perfectly comfortable with his artificial matching eye. "Nobody even notices it."

Walls, however, doesn’t go in for novelty eyes, unlike many of the Thomases’ patients.

Many people want eyes associated with their favorite sports team, Bob Thomas said. He said he has manufactured orbs decorated with the University of Tennessee logo, the fleur-de-lis of the New Orleans Saints, and a Texas longhorn.

Thomas said one person ordered a "formal eye" with a diamond for a pupil. Another asked for a matching eye to be installed inside a clear sort of window in his bowling ball, "so when he lined up to bowl, the eye was actually looking right at the center bowling pin."

He said an ocularist is something of a counselor as well as a craftsman. "You get people coming in here, they’re contemplating suicide, they refuse to look at themselves, they can’t imagine life with one eye," he said, "But after they get used to it, sometimes they have the opposite reaction."

He said new patients often learn to accept their loss by talking with satisfied veteran patients, like Parrott.

"Many times when someone loses an eye, especially as an adult, they’re kind of down about it," Parrott said. "It takes a while before you even feel like making a joke about it. I think it’s healthier to have fun with it, quite honestly.

"You get all kinds of neat reactions," he said of his novelty eyes. "You have people that will look at you and the first thing they want to do is grab you by both shoulders and say, "Don’t move – I want to look at that eye." And then you have other people that are frightened of you, they just shun away from you.

Human nature doesn’t change, but Parrott is glad technology does. He said one of his old matching artificial eyes, which he had owned for years, was a victim of good intentions. "The way you cleaned those things then was you boiled ‘em with a little saltwater. My wife, Monika, was doing it for me and forgot about it and left it on the stove. It melted."

1. The Annual Memphis Cotton Carnival features a parade with fanciful floats created by groups of friends, often with Egyptian themes echoing the name Memphis.

2. An ocularist earns certification by serving a five-year apprenticeship under a Board Certified ocularist. With modern methods of training and fabrication, the artificial eye is now a very natural looking device, hand-painted to match the remaining eye. A list of Board Certified Ocularists in the United States can be obtained from the American Society of Ocularists, 493 - 8 th Avenue, San Francisco, CA 94118, +1 (415) 221-5765; fax: +1 (415) 221-0755; e-mail: aso@zapsmith.com. For a listing of societies of ocularists in other countries, please see

http://www.generation.net/~ocuplast/wooc.htm. Special thanks to Bob Thomas of Thomas Ocular Prosthetic Laboratories, Memphis, for his help in the preparation of this article.