The Future (and Past) of Ocularistry, Part 2 of 3

Before I dive into the future of ocularistry, it might be interesting to look at how the artificial eyes have evolved in the past. The materials and techniques we use in ocularistry today (in America and most other countries) were developed after WWII. Contrary to most conventional beliefs, prosthetic eyes are no longer made from glass.

Throughout the history of prosthetic eyes, materials have changed based on their availability and the abilities of civilizations to work with them. The oldest artificial eye, dated to the Middle Stone Age about 7,000 years ago, was composed of an earthy clay material called ochre. Over centuries, the material of choice shifted to metal. Eventually a sophisticated design emerged, consisting of gold, silver, porcelain, and glass.

It wasn't until the late 1500s that Venetians began to craft prosthetic eyes using glass. The Venetians kept their materials and methods secret until the end of the 18th century, although for a brief period in the 17th century the French made improvements to the materials and techniques. The center for prosthetic eyes shifted to Paris and the French word "oculariste" is now used to describe ocularists.

German glassblower Ludwig Müller-Uri

German glassblower Ludwig Müller-Uri

In the early 1800s, German glassblower Ludwig Müller-Uri created a glass eye for his son who had lost an eye. Müller-Uri originally made glass eyes for dolls but would spend the next 20 years perfecting the glass eye. Later in the century, Herman Snellen developed the Reform eye design to restore lost volume and increase comfort.

(Interesting fact: My mentor's former mentor, third-generation ocularist Phillip A. Danz, is a distant relative of Müller-Uri. Mr. Danz is in the midst of preparation for an upcoming exhibit at UCSF that includes research into his family history. Just yesterday I saw a family tree tracing him all the way back to Mr. Müller-Uri.)

During WWII, shortage of German glass occurred in the U.S. In 1943, U.S. Army dental technicians created the first impression-fitted acrylic eyes using dental materials that were new at the time. These early acrylic eyes were ill-fitted and not completely polished, which led to irritation of the sockets. (Glass eyes are still being made in Germany. See this video)

Since the early acrylic eyes did not perform well, companies returned to the Snellen eye designs and began to mass produce acrylic shapes in twelve common shapes to be used as stock eyes.

In 1969, Lee Allen and Howard E. Webster described in the American Journal of Ophthalmology the Modified Impression Method, based on techniques they had used since the mid-1950s on approximately 2500 patients. In addition to prompting the proper fit and comfort to the wearer, Allen and Webster also described techniques for correcting common eyelid problems that can enhance the appearance of the prosthetic eye in an anophthalmic socket. These new techniques yielded much better results and eliminated the market for stock eyes (at least in the U.S.). In fact, the American Society of Ocularists does not permit a Board Certified Ocularist to fit a patient with stock eyes. We look at stock eyes like an ugly past.

Today, Modified Impression Method remains an industry standard. It has been 45 years since the paper was published and these methods remain virtually unchanged. How can ocularists continue to improve in the future? Will the acrylic eye eventually be completely replaced by another material, such as living tissue? Any thoughts?


Comfort, Fit, Aesthetics

"Presuming that the Ocularist has mastered the technique of custom fabrication, it would be difficult indeed to obtain a finer result in these aspects; namely, comfort to the individual, a properly fitted prosthesis meeting the physiological demands of the socket anatomy, a color match of the iris and veining structures of the sclera, that in total, provides the individual with a prosthesis that offers him the finest possible artificial replacement."
Today's Ocularist, 1971
Marvin H. Maurer

References

Allen, L. & Webster, H. E. (1969) Modified Impression Method of Artificial Eye Fitting. American Journal of Ophthalmology, 67(2)

Enoch, J. M. (2010). A Proud Heritage: Ancient Artificial Eyes Found In Situ in Exhumed Bodies in Spain and Iran. Journal of Ophthalmic Prosthetics, 15(1), 23-29.

Heller, Harold L. "Facial Materials." Fundamentals of Facial Prosthetics. Ed. Robert E. McKinstry

Maurer, M. H. (1972) Why Custom Fabrication. Today's Ocularist, 1(1), 4-5.

http://artificialeyeclinic.com/history.html
http://www.dallaseye.net/history-of-artificial-eyes.php
http://www.madehow.com/Volume-3/Artificial-Eye.html
http://www.flexiglasseye.com/timeline.html