Q: What is an impression moulded scleral ocular prosthesis?
A: It is a flush fitting plastic shell type artificial eye with varying thinness. It is made to cover an (acquired) blind, scarred, disfigured, phthisical, deviated and/or dysfunctional globe. They can also be categorized as a full thickness scleral cover shell prosthesis for congenital microphthalmic conditions.
Q: Does the scleral ocular prosthesis have any therapeutic purpose?
A: Yes, it can provide physical comfort and relief to patients with dry eye syndrome, photophobia, and trichiasis. It also provides a lifelike duplication of the fellow eye, which is psychologically comforting to the wearer.
Q: What if my health insurance plan won't cover this fee for a scleral prosthesis claiming it is strictly cosmetic?
A: Of course, the end result would certainly be a cosmetic improvement, which is part of the ocularists goal, but the primary purpose of the scleral ocular prosthesis is to provide physical comfort by restoring facial balance of the eyelids, and psychologically comforting because it provides acceptance by oneself and peers. Besides this it is a 'cost effective' procedure, since the alternative for the health insurer would be provide coverage for:
- surgical evisceration or enucleation of the eye of the dysfunctional globe,
- implantation of a motility implant,
- the hospital and operating room expenses,
- post-operative antibiotic medications,
- impression moulded plastic ocular prosthesis.
Q: Are there any other benefits derived from wearing such a cover shell over a dysfunctional globe?
A: Yes, it can prevent surgical disruption (evisceration or enucleation) of the orbital contents. It can also non-surgically relieve the external adnexa by elevating a pseudo blepharoptosis (sagging upper eyelid) caused by global volume loss (phthisis), and in some cases reduce ectropion by providing support to a prolapsed lower eyelid.
Q: Are all of your scleral prosthetic referrals adults?
A: No, beside acquired conditions such as eye trauma, eye diseases and post-operative surgical events resulting in phthisis, disfigurement of the cornea or globe, we do have congenital anomalies. These are birth defects of the eye and can represent various stages of microphthalmos (incomplete development of the eyeball) and we work on children as young as 2 or 3 months old.
Q: What is the procedure to having a scleral ocular prosthesis?
A: The fabrication of the scleral prosthesis is done in two phases. Phase I is a flush fitting clear acrylic scleral trial shell. This procedure will assure us that you are a good candidate for this type of prosthesis. Phase II involves the intricacies of simulating your companion eye on and in the surface of the shell prosthesis.
Q: If I have a very sensitive cornea and cannot pass Phase I with wearing comfort, but I still want this type of prosthesis, what is my next option?
A: Using a Gundersen conjunctival flap to protect the cornea would be the next option. A conjunctival flap eliminates any corneal sensitivity, and you would be able to wear the completed scleral prosthesis all your waking hours. This matter can be discussed with your ophthalmologist.
Q: Is it possible to wear a soft cosmetic corneal contact lens over a blind disfigured eye?
A: Yes, if it is only the cornea that is scarred or disfigured. The best cosmetic result would also require no loss of global volume, and the eye have an aligned catoptric image (not be deviated).