In a world of mass production and high technology, an ocularist in Nottingham, United Kingdom, has inspired followers around the world with his high-touch approach to hand-crafting prosthetic eyes as portrayed in a couple of YouTube videos.
Dr John Pacey-Lowrie pioneered technical advances in the technique whilst demonstrating the importance of close relationships to his patients, according to one of the short films, a documentary about his work.
“These patients that you have for a long time become part of your family, in a way,” he says in The Ocularist (https://www.youtube.com/watch?v=RNUo76bjmpY). “There will be professionals who see this short film and think that might be less than ethically correct, but I disagree.”
The documentary by Philip Formby has been viewed over 7,900 times on YouTube. An instructional video featuring Dr Pacey-Lowrie in turn spawned another video, this one seen more than 1 million times, about an Australian oilrig worker inspired by his daughter’s microphthalmia to become Dr Pacey-Lowrie's apprentice.
Born with microphthalmia himself, Dr Pacey-Lowrie left school at 16 years of age and learned how to make artificial eyes from the Artificial Eye Service because he wanted to help people.
Though he was grateful for the technical skills he acquired, he did not like the “two-tier” system in which the service separated the prostheses designers and painters. “For me, the painting and manufacturing: that’s the skill, that’s the art, that’s fun," he says. “That's the nice thing at the end; you made that, you've created that for the patient and you see the smile on their face.”
Along with Richard Downes, director of Jersey Eye Centre in Jersey, United Kingdom, Dr Pacey-Lowrie developed a technique for enhancing the motility of artificial eyes.
For typical prostheses, the surgeon tries to retain at least three muscles and attach them to a spherical polypropylene implant full of holes. Blood vessels grow through the holes and integrate it, and the implant is attached to the prosthesis.
The two ocularists employ an additional pegging technique in which a surgeon drills a hole in the conjunctiva after the implant is integrated. The ocularist then places a peg, resembling a rivet, into a titanium sleeve in this hole. The prosthesis sits onto this peg. “So you have the muscles moving the implant, the implant moving the peg, and the peg moving the eye,” Dr Pacey-Lowrie explains.
Watching the videos from his home in Taranaki, New Zealand, oilrig worker Dwayne Collins got to work. His own daughter, Liberty Collins was also born with microphthalmia so severe that without a prosthesis her face would have collapsed.
“As a father I didn't know how to deal with it,” Collins says in An Eye Fit for Liberty (https://www.youtube.com/watch?v=3Hj3sFodt7E). “What do you do? You can’t fix it.”
Working with ocularists in New Zealand and Australia proved uncomfortable for Collins. “Some of the appointments were horrendous,” he says. In one, a mold stuck in Liberty’s eye socket and had to be removed with force that left her trembling.
“That was it for me. I wasn’t putting her through any of that again. I wanted to know how to start making prosthetic eyes myself for my daughter.”
“Maybe we should just let the professionals deal with it,” his wife told him.
“Look what a professional just did to our daughter,” he responded. “I can do it better and I can do it without hurting her.”
Watching Dr Pacey-Lowrie's how-to video, Collins began experimenting at home. “I pieced together the process to do it the best I could with the things I had,” he says. “It was really frustrating. I’d get three-fourths of the way to making the perfect eye, and in the last bit of process I'd stuff up.”
But Collins persevered until he had created an eye that he felt comfortable giving to Liberty. “That was a moment [to] walk out to the shed and have a cry with no one looking, because I’d done something for the family finally,” he says.
Passion for prosthetics
Two years and some 20 artificial eyes later, Collins realised he had developed a passion for the work. He travelled to England and apprenticed with Dr Pacey-Lowrie until he gained the skills to open his own shop in Varsity Lakes, Australia. “I’ve got a state-of-the art clinic that’s really growing into my dream,” he says.
Dr Pacey-Lowrie, meanwhile, is trying to bring the work to the next level by designing an eye whose pupil will dilate or contract according to light stimulus. He is collaborating with researchers at nearby Nottingham Trent University and the team have already developed a prototype using a capacitor and two electrodes.
“It does work,” said Dr Pacey-Lowrie. “It needs more research. But given the money and a couple of years I’m pretty we can have this up and running and enhance the patient’s life even further.”
No one in Dr Pacey-Lowrie’s life wants to follow in his profession, which is one reason he was happy to take Collins on as an apprentice. “Although I am 60 very soon, that’s hopefully not the end,” he remarked.
“There is a lot of skill there and a lot of knowledge, and it would be dreadful if I shuffle off the earth and keep it to myself. So I want to pass it along. That certainly is my main goal.”