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SINGAPORE: For those who have lost one or both eyes, the work of the sole ocularist at the National University Hospital (NUH) gives them hope and confidence, allowing patients to avoid the stares of others.
Armed with a steady hand and attention to detail, Ms. Suriya Abu Waled manufactures prosthetic or artificial eyes for about 15 new patients each year. He has worked in the hospital for 16 years, 14 of them as an ocularist.
“I love the job because I can help patients regain their confidence and also gain the confidence (of others) and lead a normal life,” he said, speaking with reporters in an interview on Friday (December 18).
When an artificial eye is placed in the patient’s socket, some of the movement of a real eye can even be reproduced, said Dr. Gangadhara Sundar, chief and senior consultant for orbital and oculofacial surgery in NUH’s department of ophthalmology.
“When the eyes are removed, the eye socket is replaced with an implant that is usually attached to the patient’s eye muscles. Thus, when the other eye moves, the implant moves, this in turn transfers the movement to the ocular prosthesis, although not as perfect or the same as the normal eye ”, he added.
An artificial eye costs about S $ 2,000 for Singapore patients and S $ 2,500 for foreigners. Ms. Suriya also recommends that patients come in for polishing about once a year, with each session at $ 100.
Each prosthetic eye takes three to four days to make, he added, with a painstaking process that involves making multiple models and hand-painting the finest details of the eye.
Ms. Suriya Abu Waled is the sole ocularist at NUH. (Photo: Calvin Oh)
Making prosthetic eyes is “an art and a science,” said Ms Suriya, who trained in India for two months to become an ocularist. Previously, he was an imaging specialist in the department of ophthalmology.
“It is necessary to have a deep empathy for patients, a lot of patience and also an eye for detail.
“Usually they want to look their best for them. We understand that because, as a provider, I want them to be happy and comfortable wearing the prosthesis, so when they walk out my door they feel happy meeting people and seeing themselves they look so natural. That’s our goal. ”
Ms. Suriya demonstrates how she paints on a prosthetic eye. (Photo: Calvin Oh)
WHO NEEDS A PROSTHESIS?
In addition to helping patients’ lives return to normal, a well-fitting prosthesis is important to prevent sunken deformities in and around the socket after the eye is removed in a process known as enucleation, said Dr. Sundar.
It also helps preserve and restore orbital structure and function in anophthalmic sockets, or an eye socket that is missing an eyeball but has orbital soft tissue and eyelid structures.
Patients can lose their eyes for many reasons, including eye cancer, eye injuries, and sometimes failed eye surgeries, he added.
When attempts to save an eye fail, patients often “seek relief” from pain and disfigurement, choosing to remove the eyeballs and replace them with an implant in the eye socket. An ocular prosthesis is then fitted to restore patients to “their normal structural, aesthetic and psychosocial state,” Dr. Sundar said.
A collection of thank you notes from patients and their families on display in Ms. Suriya’s office. (Photo: Calvin Oh)
Ms. Suriya has seen patients as young as 18 months and as young as 85 years. One patient who has benefited from Ms. Suriya’s work is Claire Lim.
The 10-year-old was diagnosed with persistent hyperplastic primary vitreous, a random or sporadic developmental abnormality that usually appears in only one eye, when she was in preschool, Dr. Sundar said.
If not treated very aggressively and early, the condition can result in other complications, he added. So while it was difficult to restore Claire’s vision, NUH’s doctors opted for an artificial eye.
But because he had a very “sensitive” cornea, the doctors had to first use their own tissues to cover the cornea. After he recovered from the surgery, he had a prosthetic eye fitted and has worn one ever since, Dr. Sundar said.
Ms. Suriya with patient Claire Lim, demonstrating how she typically uses a suction tool to remove an artificial eye or prosthetic eye. (Photo: Calvin Oh)
“It was really painful when he had to push the eye in. It feels like stepping on a Lego, ”Claire said, describing her experience when Ms. Suriya fitted her with a prosthesis.
“A few hours later it was fine, but it was painful for a few minutes later. And I cried. ”
Claire does not remove her prosthesis, although she occasionally falls off. You should also use eye drops three times a day. “Because he said it’s hard to get it out and hard to put it back in, so I’m not going to go through the pain again.”
Claire’s father, Mr. Lim Sze Liat, said his daughter seems to feel more confident now, compared to preschool, before she started using the false eye.
“She wouldn’t want to go to school, she wouldn’t want to face her friends. Sometimes she would throw tantrums here and there, ”he added. When I went to school without the prosthesis, one eye was completely white, which attracted the stares of classmates and teachers.
“But when she got her prosthesis and walked around the school, people found that Claire looked normal. So everyone tried to play with her. The teachers also noticed that she was more confident (after that) in kindergarten, which was where she suffered the most. ”
HOW IT’S MADE
The patient is usually present throughout the manufacturing process of an ocular prosthesis. The first step is to take an impression of the patient’s eye socket. First, an alginate solution is injected into the eye socket with a syringe. After it hardens, it is removed from the eye socket and used to make the impression mold.
The next step is to make a wax model. Wax is poured into the impression, and once it hardens, the cast is inserted into the patient’s eye.
Ms Suriya makes marks on the wax cast to indicate where the patient’s iris should be and adjusts the cast based on the patient’s eye movements when looking around or opening and closing her eyes. There is also a pin on the wax model to indicate the natural direction of the iris.
Ms. Suriya Abu Waled demonstrates how to measure the size of a patient’s iris. (Photo: Calvin Oh)
Then the actual prosthesis construction begins. A black button, known as the iris button, is painted to match the base color of the patient’s other iris.
Using the wax model, then build an acrylic covering around the iris button that makes up the rest of the prosthetic eye, or the whites of the eyes.
A box of prosthetic eyes in Ms. Suriya’s office. (Photo: Calvin Oh)
Once the acrylic is cured, the first version of the ocular prosthesis emerges. Ms Suriya then spends time filing and polishing the iris button to make sure the size matches that of the patient’s other eye.
The patient is then positioned with the acrylic ocular prosthesis. At this point, Ms Suriya checks if the patient is comfortable with the prosthesis and if any changes to the iris size are necessary.
Then comes the part that is more art than science. Using pigments and a small brush, hand-paint the iris to make it look as natural as possible, matching the patient’s other eye.
She also wears thin red threads to mimic the look of blood vessels in the sclera or the whites of the eyes. After putting the finishing touches on the prosthesis, seal everything with a clear acrylic mixture with monomers and the acrylic eye heals again.
The last step is to polish the prosthesis to make it shiny and shiny. The patient receives the ocular prosthesis and the process is completed.
Ms Suriya said: “If the result is good, it is good and the patient feels comfortable and happy with it, of course it makes you very happy when you see the patient and (you have given him) confidence in himself.”
