NOA 2024: The dos and don'ts of prosthetic eye care

Whether seeing or non-seeing, prosthetic eye patients should be treated from the chair the same as patients without prosthetics, according to Philip Aitseboamo, OD, PhD. He outlines his talk, "Ocular Prosthetics for Seeing and Non-seeing Eye," which he presented at the National Optometric Association Convention this year, in an interview with Optometry Times.

Video transcript

Editor's note: This transcript has been lightly edited for clarity.

Jordana Joy:

Hi, everyone. I'm here today with Dr. Philip Aitsebaomo, associate professor at the Rosenberg School of Optometry. He's here to chat about a talk he gave on ocular prosthetics at this year's NOA Convention in Philadelphia, Pennsylvania. So welcome, it's a pleasure to have you today.

Philip Aitsebaomo, OD, PhD:

Thank you.

Joy:

Awesome. So first, could you give an overview of your presentation.

Aitsebaomo:

I'm talking about prosthetic eyes, and I know, a lot of us don't do prosthetic eyes and that's why I thought this was important to share. We do see prosthetic eye patients in our practice. I want to make sure that nobody is scared to see them, just like I was when I started. I wouldn't like to push anyone to take it out, because I would have to figure out if I could put it back. So just to get us familiarized with the whole prosthetic eyes situation and to be very comfortable with it.

Joy:

Absolutely. So you said that you do see those with prosthetic eyes, how common would you say that that is and how do you manage your treatment of those patients?

Aitsebaomo:

It's not very common. But when you do see 1, they are very appreciative that you are able to provide service to them, because quite often, they are lost, they don't know where to go to. And so if they know you know how to do it, they'll be very happy to come to you.

Joy:

Absolutely. So what are the most important things to consider or the key takeaways from your presentation on taking care of these patients?

Aitsebaomo:

Key takeaway is don't be scared, be comfortable. These are eyes; we are used to treating people with eye diseases, so if they take it out, they have an infection, treat it like you would otherwise. They're like contact lenses, like gas permeable lenses, so how do you take care of a gas permeable lens? That is the same way you take out this. Of course you tell the patients, "Don't sleep in them," but I have yet to find 1 that does not sleep in their prosthetic eyes for years. I'm not talking about days, they're sleeping in them for years. Also, respect their privacy. I've heard stories of people that were married for 30 years, and the spouse had no idea that person wears a prosthetic eye. I personally know of somebody that has had that sort of situation. So people are very private about this, and so don't let people just barge into the offices or in a waiting area, say "Oh, how's your prosthetic eye? How's your false eye?" We don't want things like that. So if they come with someone else, don't just invite their partner into the exam room, because you have no idea if that person knows that this is going on. Okay, these eyes, if you can look at them as eyes, I think we will all be very comfortable.

Joy:

So it sounds like it's important to keep patients comfortable while they're at the office. What are ways to keep them comfortable when they leave and to make sure that they continue to come back for exams or other checkups?

Aitsebaomo:

Like everyone else, somebody that comes in and gets a gas permeable lens, you tell them about dos and don'ts about the contact lens. Same thing here: dos and don'ts. Again, 1 aspect is I know they really don't even care to listen to you about is: don't sleeping your lenses. So how do you take care of the of the of the lens? How do you take off your eye? You have to be familiar with the types of prosthetic eyes to say, "Well, if this is not working, this is the other thing we can do." So give them a take home message to say if this happens, come back to me and I'll see what we can do to try and resolve the situation for you. So however we take care of our regular patients really is the same way we take our prosthetic eye patients.

Joy:

Right, absolutely. So what are some of those options for prosthetics now and what would you say are some of the most exciting newer prosthetics maybe that are on the market?

Aitsebaomo:

We have soft contacts, and that's what we all like to fit, we all like to fit contacts. But by the way, gas permeable lens might not be a good option — the corneal gas permeable lens — because they don't cover enough. So a soft lens, we have these opaque lenses that we fitted to people who are willing to change the color of their eyes. Those are options, but sometimes they are not dark enough. Let's suppose somebody has a malformed pupil, it may not be dark enough to solve that problem. So you will have to have somebody basically paint a lens for you. There are people out there who can paint a soft lens for you, custom paint it and have what is called an Onda print to prevent stray light from getting in. So those are options.

My first prosthetic eye patient was 1 that was wearing 1 of those lenses, but he really wasn't very happy with the lens because it was moving to the side and he just didn't like it. Then I gave him a what is called a shell prosthetic, which is the false eye that is just a piece of plastic that has been custom painted. I mean, this gentleman was so happy, he could not believe that this thing is working out well for him. So we have the shell prosthetic, then we have the thicker prosthetics too. Those are the ones that I'm really excited about, but the soft lenses are out there. You can get a set of lenses that have already been made that you can try out just like you try on any soft lens in your practice and you can figure out which one works better for the patient. The darker is a lot easier to fit but the lighter eyes are just so hard to match the existing eye. So soft lenses are a great option, and that's what most of us are going to fit. But then the shell prosthetic and the uniform prosthetic, if you want to really dive deep into this whole thing, you can fit those. But those are only for non-seeing eyes, by the way, because you can fit a prosthetic eye for someone who can see and somebody who cannot see. So if you have light perception and not poor vision, you will not qualify for the shell prosthetic or the uniform prosthetic.

Joy:

Yeah, absolutely. That definitely makes sense. Were there any other points that you wanted to make that we haven't touched on yet?

Aitsebaomo:

I say we should attempt to get into this whole thing of not just recognizing the people that fit prosthetic eyes in our local area. We fit a lot of phosphate scleral lenses, and some of us don't. If you don't, find somebody who fits them so you can refer your patients to them. Some of us don't treat glaucoma and you don't, you send your patient to a glaucoma patient. So it behooves us to look for people who can do this. And so when a patient comes in, we'll be able to send them in the right direction. Also have some familiarity with this thing so that you, again, you don't get scared when a patient comes in. I used to say, "Don't take it out," because I can put it back in or you may not be able to put it back in. And really some of them don't take it out because they don't know how to put it back in. So if you are comfortable with it, I think you can lessen the patient's discomfort and they'll be very happy with you.

Joy:

Absolutely. Okay. Well thank you very much for the time, Dr Aitsebaomo, it's been a pleasure.

Aitsebaomo:

Thank you so much. Have a wonderful day.

Joy:

You too.