1) What is a certified ocularist?
To be a certified ocularist, one must be a member of the "American Society of Ocularists" (ASO). Based in the United States, it is a non-profit organization that is in existence since 1957. Mr. François Gordon is a member of the ASO since 1988 and a certified ocularist (BCO) since 1993. To obtain certification, ocularists must follow courses offered by physicians, ophthalmologists, psychologists, paramedical professionals, as well as ocularists colleagues.
After passing the examinations and a minimum of five years of practice under the supervision of a certified ocularist, as well as a predetermined number of credits earned, we are eligible to get a degree from the ASO. Thereafter, we continue with the certification process with the "National Examining Board of Ocularists" (NEBO), an agency independent of the ASO and regulated by a federal agency of the United States, NCHCA (National Commission for Health Certifying Agencies). We are a small group of 225 members from 15 different countries, but mainly from the United States and Canada, and that is why we have this type of training known as "compagnonnage" or "apprenticeship" in English.
Our certification is valid for six years and we are obliged to undergo continuous training with courses, exams and accumulation of credits, etc.. This training ensures the best professional service possible with constant evolution.
2) What is the recommended maintenance for an ocular prosthesis?
The golden rule is simple: handle your prosthesis only if the need arises. The less you handle your “artificial eye”, the better the tissues of your orbit will be. However, as each individual is unique, there may be exceptions that prove the rule. With our experience, we can say that most patients remove their prosthesis to clean with water and soap three to five times per year. If you have any eyelash or dust in your orbit or if smoke has irritated your eye, it is recommended to remove the prosthesis and clean it. It may even be necessary to make an ablution with water inside the orbit.
3) How to remove and replace the prosthesis for cleaning?
Of course, it is required to wash one's hands with water and soap and rinse thoroughly before handling the prosthesis.
The instructions are for right-handed persons, hands should be reversed for left-handed persons. To remove the prosthesis, with the index finger of the left hand, pull the lower eyelid down to the eyelashes.
Find the lower edge of the prosthesis with your right hand fingers or use a suction cup on the anterior surface of the prosthesis.
With the thumb of the left hand, lift the upper eyelid to remove pressure on the prosthesis.
Finally, remove the prosthesis by moving it forward with the fingers of the right hand. Try as much as possible not to let go of the prosthesis. Clean the prosthesis using the fingertips with warm water and soap. Rinse well and do not dry. To replace the prosthesis, with your left thumb, firmly hold the upper eyelashes on the eyelid, and raise the eyelid to create space. Hold the ocular prosthesis with the right hand and insert the upper portion of the prosthesis in the space created by the left hand. When the prosthesis is in place in the upper part of the orbit, continue to hold the prosthesis with the right hand and with the left index finger, pull down the lower eyelid to the eyelash. Finally, with the right hand, push the prosthesis firmly in the orbit and release the lower eyelid.
4) What is the lifespan of an ocular prosthesis?
Although each case must be analyzed individually, the lifespan of a normal ocular prosthesis varies between five and seven years, depending on the patient's environment, orbital changes, the patient's prosthesis maintenance, the health of the patient, etc.... This frequency optimizes comfort and the aesthetic of the prosthesis.
5) When should I visit my ocularist?
It is strongly recommended to visit your ocularist at least once a year to check the status of the "artificial eye", the tissues of the orbit as well as the fitting of the prosthesis in the orbit. And more importantly, the ocularist will proceed with the polishing of the ocular prosthesis to get rid of any trace of protein deposition, of salts in tears, and possibly bacteria and other microorganisms that are found in the normal secretions of the orbit. This polishing will instantly give you optimal comfort and aesthetic and the visit usually last only for 30 minutes. The frequency of these visits is variable for each patient and some need to come every six months. An annual visit is recognized and recommended in the ophthalmic milieu.
6) Are there any surgical options for patients with ocular prosthesis to improve comfort, aesthetic, or both?
You understand that we are discussing about a medical subject and the ocularist not being a "doctor", we will do all that is possible with the ocular prosthesis to improve your comfort and aesthetic to avoid surgery. However, our expertise allows us to guide you to the appropriate specialist and, in most cases, the specialist is the ophthalmologist "oculoplastic surgeon". When assessing, these specialists can, among other things, correct drooping eyelids, restore the "trough" of the orbit at the upper level and also, exceptionally, replace the orbital implant in place.
There are not many ophthalmologists oculoplastic surgeons and they are generally found in large urban areas such as Montreal and Quebec and are usually affiliated with university hospitals. The costs incurred to consult these specialists as well as the surgeries are generally covered by the Régie d'Assurance Maladie du Québec (RAMQ), save for some exceptions.
Contact us on the matter, a free consultation at our office will guide you through this process.
7) When making a new prosthesis, what is the waiting period before I get my new prosthesis and how many appointments will be necessary?
In our clinics, you will have your appointment for a new prosthesis usually within two weeks. Depending on your schedule and your availability, in most cases, we will make your new ocular prosthesis the same day. The manufacturing is done in three steps, with pauses of about one hour between each step. The day begins at 9 am 9:30 am, the first step is the taking of measurements, the imprint of the orbit and the reproduction of the iris.
The second step is the reproduction of the "sclera" ("white" of the eye) and modification of the iris. The third step is the fitting of the ocular prosthesis, the evaluation of comfort and aesthetic, and we make the necessary adjustments and the final polishing. Usually, the day ends between 15: 00 and 17:00 and you can walk out with your new prosthesis. We give you the old one in a practical container made of sturdy plastic.
8) Does my new prosthesis have a manufacture warranty?
Yes, we guarantee your new prosthesis for a full year without any other charges, even if your orbit changes naturally. However, for children, it is possible that there are additional charges for in that period of growth of the child, several changes in the orbit occur and there must be more regular monitoring. This follow up is to encourage the greatest possible symmetry of the face in synergy with the growth of the orbital tissues. Each case will be individually discussed with the parents.
9) Are there different prices for different grades or categories of ocular prostheses?
No. We offer only one quality, guaranteed by a certified ocularist since 1993. There are however, two types of ocular prostheses offered at different prices: the prosthesis of regular type (eye enucleated or eviscerated) and "cornea-sclerotic shell" that covers an eye that is atrophied, off-centered, discolored, with no useful vision. The ocular prosthesis of "shell" type is a bit more expensive. It is more difficult to manufacture as it is usually very thin.
This type of prosthesis requires expertise and experience to get the desired results, being made for an "eye" still present and therefore is more sensitive.
Besides, it is strongly recommended to make a tailor-made "test shell", by imprint, with clear plastic, especially for the first ocular prosthesis that the patient will use.
10) Is it possible to modify, alter, repair or enlarge an ocular prosthesis?
Yes. In most cases, it is possible to modify, alter, enlarge or repair an ocular prosthesis until the prosthesis has four years and sometimes a little more. However, each situation must be evaluated on an individual basis and sometimes it happens that we are unable to make this kind of change owing to early plastic deterioration or significant changes in the orbit.
Rarely, the iris or the sclera of the natural eye change "color." This is due to the taking of medication or following a surgical or therapeutic intervention on the natural eye (glaucoma, diabetic retinopathy, corneal implant, cataract, etc..). If such a situation arises, we can still change the color of the existing prosthesis, always taking into account the general state of the "artificial eye".