Dori Hosek makes eyes.
As an ocularist, Hosek fits, designs and constructs artificial eyes for patients who have lost them due to injury or illness. Hosek is one of just three ocularists in the state of Wisconsin. After selling her company, Global Prosthetics, at the end of 2016, she plans to focus now on teaching and international oculist consulting.
Hosek spoke with the Cap Times about how she found her way into her career, how prosthetic eyes are made and why there are so few people who do what she does.
How did you get into this field? How does one become an ocularist?
It’s a five-year apprenticeship, and you need to be invited by a board-certified ocularist. There are about 200 board-certified ocularists in all of North America, so very few of us. There is no schooling where you can go to school and learn how to be an ocularist.
I went to school to become a medical illustrator — which is pretty much what we do, handcrafting a piece of art and a patient is wearing, basically, your art. I became a medical illustrator thinking that I would illustrate medical books. Interest in science and strong science background and love of art, so a combination of the things I loved. University of Illinois at the time was one of five schools that had a degree in medical art, so I went through that program and took one elective course in facial prosthetics. I was fascinated with prosthetics. The face is such an important piece of our bodies, when we communicate, and a piece of our psyche — not that a limb isn’t, but when you interact with people you look right at their face.
I had that background, and then I ended up being invited to Madison. I didn’t even know who made oculars for patients, and this job opened up and it was a very cool opportunity. So I came to Madison for five years to train —which is my hometown, by the way — did my apprenticeship and took my boards, and then I moved back to Chicago for most of my career.
People don’t know about the field. Unfortunately if you need it, or you know someone who needs it, you ask, "who makes these eyes anyway?" You come to find out, there are only three people in the state of Wisconsin that do. I got into this because of a phone call, so complete serendipity on the one side and an amazing fit on the other.
What is the prevalence of need for prosthetic eyes?
Most patients don’t Google us to find us. We usually come through your ophthalmologist, if you’re having your eye newly removed. You also have to have a new eye made every few years. I have patients I’ve been seeing for 30 years and new patients I’m meeting with today that I won’t be able to see for eight weeks. All the new patients I get are from referrals.
If someone is in a retina clinic and has diabetes and ends up losing their vision in their eye, that retina doctor will send them to the oculoplastic surgeon. It’s usually pretty obvious when an oculoplastic surgeon removes an eye. Those patients, really you can’t tell they’re wearing an eye. They move, they look amazing. It’s really quite remarkable, and Madison is just unique in that we have such a great medical community and that’s how 90 percent of our patients go.
Insurance will cover this every five years. Medicare allows a new eye every five years, and most insurance companies follow Medicare guidelines. Most patients won’t complain about their prosthesis — five years is on the early side. They’re made out of acrylic, and our socket is like a saltwater bath. It’s like a contact lens. They can slide the eye in and out, and take them out to wash them if they need to.
What brings people to you?
From newborn to age 5, it’s usually a cancer of the retina or an eye that doesn’t fully develop. From about age 5 to 40 or 50, it’s trauma, or ocular melanoma. Diabetes can take an eye. Once you get beyond 50, it’s more often diabetes that wasn’t managed, or if glaucoma gets really painful and they can’t manage it with drops.
We recommend patients wear glasses, and that is to protect their remaining eye.
I probably do somewhere between 100 and 200 eyes per year. That’s a combination of the new patients coming in and the replacements. You have to have your eye cleaned every six months, just like getting your teeth cleaned.
How do you make an eye?
When the patient comes in, we take an impression of the socket. There are some real parallels and similarities to dentistry.
Everyone does it a little differently. The way I do it is three appointments over two days. The first appointment is about two hours. The patient will sit down, I’ll put a little tray in their socket, slide it in, mix up the impression material and squirt it in there. It flows over the eye, and takes about two minutes to set. When you take it out, you’ve got this perfect mold of the patient’s eye. Then I go into my lab across the hall and make a duplicate in wax. Then I go back to the patient and start sculpting. We mark where the pupil is going to go, where the iris is going to go, the direction of the gaze. We discuss pupil size, so they get to choose what lighting they want to look their best in. I take that wax pattern, go back into the lab and the patient and I are done for the day.
That afternoon, I’m in the lab, and I make a brass flask and make a stone mold of the sculpted wax pattern that I have. That gets cured in a white acrylic, so the base color is white. When that comes out, I have to grind it all down and it’s ready to be painted. The patient comes back the next morning, and I have a two-hour painting session. I just sit and chat while I’m looking at the veins and the patterns. All of that is oil painted. It’s like painting a portrait, but it’s the eye.
They get a long lunch break, and I go back into the lab and cure a layer of acrylic over the top, which seals all the artwork in, and it also gives a nice cornea. Once the clear acrylic is cured on there, then it needs to be ground down and pumiced to a super high shine.
I think the anticipation is anxiety-producing, and the actual event is a little less stressful.
Do the eyes move?
They move beautifully if the surgeon is good, and if the reason they have their eye removed didn’t involve the muscles.
How does it feel for you, and for the patient, when the eye is all done?
I think the patients are thrilled. They come in with some apprehension, but by the time they have their replacement, they’re much more relaxed. They’re kind of anxious, and the process is kind of slow. I involve them as much as I can.
I’ve got letters upon letters from patients saying, “I got my life back.” They leave very happy, and there’s really nothing better than, at the end of my day, it’s a life changed. People leave with a smile on their face. We’re the end of the road, no matter what got them to us, it’s a long journey. It’s traumatic to lose a body part, especially an eye.
It’s really a privilege, I think, to be at that part.
Are there more people going into the field? It sounds like it’s difficult to get into.
Many ocularists are a family practice. If someone trains an apprentice for five years, which takes time and a big financial expense — if you train someone, there’s no way to keep them. Therefore, many ocularists’ practices in the country are family practices and they bring their child in.
It’s really hard. We have a really nice number of apprentices right now. I actually think there should be a school that at least trains for the first couple of years. I think we could use more ocularists.