Dr. Dan Roach (2:29)

Sure. My name's Dan Roach. I live in Syracuse, New York in the US And I'm an English professor and have Been teaching at Lemoyne College for a couple decades. I decided to write the book because I got a prosthetic eye myself. I had a sort of what I call a bad eye for my whole life because I was born with a cataract on it. And we can go into that history if it's interesting. But in 2009, I eventually had that eye removed and got a prosthetic eye. And I didn't know anything about the world of prosthetic eyes before that, but I immediately, besides, besides sort of benefiting from the eye itself, I immediately saw this as a subject that I would like to write about. My background is kind of a mix between technical and artistic. I studied mechanical engineering when I was in college, worked as an engineer for a few years and then became a writer and sort of switched gears in that direction. And I'm always on the lookout for topics that kind of bridge that gap or divide between the technical and the artistic and prosthetic eyes. Did that beautifully. It was kind of a subject that I was waiting for for a long time. So I started, I did a first, I did an article on it or an essay on it in the year or two after I first got the eye. And then I always knew that there was another, there was more there to investigate and to write about because actually there were no books out there. There was nothing out there in what I was imagining telling the story of this world of eye makers and eyewearers too. So after a few years of other projects, I got back to it just before COVID started. Took some time off during the pandemic and wrote other things and then came back to it and dove into it deeply.

Dr. Miranda Melcher (4:39)

Always interesting to hear how a book comes together. Thank you very much for that introduction. Let's start then with as far back as we can go, I suppose, in talking about prosthetic eyes or at least as far back as we can go when we start to talk about this being kind of realistically possible. You do have some examples in the book that go back a really long time, but for probably obvious reasons, it doesn't sound like they necessarily were worked that well or were kind of that viable of an option. So sort of when do we get to the point and how do we get to the point where prosthetic eyes seem to be maybe more viable than kind of a one off thing that a particular king might do once.

Dr. Dan Roach (5:17)

Yeah, so I do mention the ancient Greeks and Egyptians and some very crude attempts at sort of of creating at least the illusion of an eye. But obviously it was very crude. And it wasn't until the 16th century actually that some progress got made. And there was some experimentation with some eyes made out of gold or other kinds of metal that could fit into the socket. And before that they just would be held on like in front of the bad eye or the missing eye with a piece of cloth or a spring of some sort. So it wasn't until the 1600s, 1500s, that that really began to happen. And then through the, say, 1700s, there were glass eyes made mostly by glassblowers in Venice, Murano glassblowers, and those were pretty crude as well. They were thin shells of glass that you could wear over a shrunken eye because nobody was removing eyes surgically at the time because it was extremely dangerous to do so up until maybe the mid-1800s. So the best they could do was make a very thin shell that had the visual markings of an eye with the iris and the pupil and make that thin enough that it could fit over an eye that had sort of shrunk in on itself some too. But they were not custom fitted, they were not shaped to any particular eye socket or, or terrain that they would go into. And then in the early 19th century, eyes were much more commonly made in sort of the center of eye making. Switched to Paris in the early 1800s. And they were made of porcelain primarily at that time, but they were also still not very custom fitted. They were kind of what they called stock eyes a lot of times. And one size fits all or doesn't fit all. And so in the. In fact, there's a interesting article published in around 1850 about the world's Fair, the exhibition held in Paris. And they had competitions for eye making, prosthetic eyes. And the write up about the entrance into that year's competition noted that eyes had come a long ways, that they were suddenly being made to fit eyes sockets individually rather than the one size fits all. And they talked about how previously eyes were shaped. They used the phrase like half a bird's egg and just kind of a shell that the same for the left eye, the right eye, you just put it in. They were uncomfortable. And because they didn't fit very well, they didn't have much movement either, if any movement too. So it became somewhat common, I think, in that time to, to see people who had fixed eyes, as they call them, and that, you know, they would wear an eye but it didn't move at all. And so it just stared straight ahead, which is a little freaky and for people and confusing. So in the. I'd say around the mid-1800s, mid 19th century, when was when ocularist eye makers started to get better at fitting things for individual sockets and then got more movement or motility to the eye. And then they became more realistic. And there's still a lot more development to go on after that. But that was probably the start of. In what we think of as a modern kind of prosthetic eye that does look as real as it possibly can.

Dr. Miranda Melcher (10:00)

Okay, that's helpful to know for the starting point, but I am intrigued to hear more about the developments from that point onwards. You talk in the book about a whole bunch of things that were trialled over the 19th and 20th centuries. Can you tell us more about what these different options were and sort of how they were debated and discussed?

Dr. Dan Roach (10:16)

Sure. I would say up until about the 1880s, it was, well, maybe a little bit earlier, maybe a decade or two earlier. Like I said, eye surgery was still not performed by choice. And a lot of people had maybe tumors on their eyes or very prolapsed eyes that would be enlarged. And no matter how bad it got, surgeons would often not. Would choose to let them suffer or even die from whatever was happening there, rather than taking the eye out. Because it was almost a death sentence to remove an eye with the. With the hemorrhaging. And so it was one of the most, you know, gory, I think, and unpleasant surgeries that people could imagine. And so very few people undertook it until the mid-1800s when they discovered some more finer anatomy of the eye, especially the little shell. Little, really sort of almost invisible, I guess you would call it, a little shell of the eye called a tenon's capsule, that allowed for a little bit easier and successful, more successful removal of the eye and without the danger of imminent death, I suppose. So then in, I would say, about the 1880s, because of those advances in surgery, there was a British surgeon named Philip Mules who started to do eviscerations of the eye, taking out the contents of the eyeball, but leaving the sclera and leaving that attached to the muscles that move the eye. And then to fill that void, that emptiness that was left behind, and to give a prosthetic eye a resting place, I guess, to sit upon and to be solidified in the socket. He inserted a glass ball, initially called a mule's implant, and that took up some of the space and that was sewed in behind the tissue of the eye socket, behind the conjunctiva, and. And then was supposed to theoretically stay in there forever. And then a prosthetic eye, the part that people see is not round. And it doesn't look like a ping pong ball or anything like that. It looks more like a thick contact lens. It's concave on the back, convex on the front. And so you can put that over the implant, the sort of little mound that the implant would create in the eye socket. And it would fit much better and could also give a lot more movement because muscles are still there. And there's some kind of friction between the prosthetic and the shaped inner part of the eye socket too. So that was the start of a really sort of different phase in eye making. And over the next century actually took. There was a lot of experimentation on what kind of design or kind of material could best be put into that emptied out eyeball to stay there, to not break. Because a lot of the glass balls that were there broke while they were in there and had to be picked out meticulously and replaced. So a lot of the sort of the design and technology for the succeeding decades was like, what can we put in there that will fill that space, will give us some geography within the socket on which to lay a prosthetic eye and have it sort of connect either physically or just through the friction of the shapes, the back of the eye and the front of the conjunctiva. So there were experiments with aluminum balls, more glass balls, silver balls, which worked, but also tended to turn people's skin blue from the reaction to the silver. So that didn't work out well. There were experiments with some different kinds of waxes. Paraffins in the early 1900s were the first experiments with fat grafts, taking fat from a patient's buttocks or thigh and using that hollow rubber balls, polished bone, number of other kinds of materials, most of which didn't work as well. And they either shrunk in the socket or they didn't stay in place, or they extruded and came out or they broke or something else. So it wasn't until mid. Well, yeah, probably the 30s, 40s and 50s, where some other kinds of designs of ocular implants came about that were usually at least round on the back. And they could be attached to the muscles or they could have blood vessels kind of grow into them. So they get rooted into the eye, into the eye socket. And sometimes they would have the front of them would be, say, some nubs, little pips or nubs that would stick out of it. And those would put little mounds, they would stick, you know, push out the conjunctiva within the socket. And then the prosthetic eye could have little places for those nubs to fit in. And that would be kind of locked into place that way too. Then there were other ones that experimented with what they called exposed implants, where it would have a little, maybe a little peg coming out of it, and that would come through the conjunctiva, so it would be sticking out into the eye socket. And then the prosthetic would have a little female receptacle on it, and it would just snap in. And that was the most direct connection that you could get. And that created a good amount of motility, a good amount of eye movement. But it also brought up problems of infection because there was an exposure through the skin, through the tissue there. So that was something to be dealt with as well. And then eventually, actually in the, I think it was the late 80s, an ophthalmologist out in California tried a actual sea coral. And he made a little ball out of this coral that was harvested from off an island in the South Pacific. And it worked really well because it's light, it has all these little tunnels going through it. And if it's in there, once you put it in, the blood vessels can migrate through and grow into that and it becomes sort of part of the body and will very reliably stay in place. And so the most common kind of implant these days is a synthetic version of that, which looks the same, does the same kind of thing with the tunnels and being sort of grown into the body in that way. And most of the time stays in place. There are obviously exceptions to that based on the specific injury that somebody might have or the reasons that they lost their eye or what, what the topography or the geography of their particular anatomy is there as well.

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Dr. Dan Roach (19:19)

We do a routine call after surgery and I could tell in her voice that she was struggling.

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Dr. Dan Roach (19:25)

I knew that this is very serious.

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Dr. Dan Roach (19:31)

And I called the hospital and said, she's coming in. Here are her labs and got her.

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Dr. Dan Roach (19:36)

I see my role at UnitedHealthcare as a life saving role.

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Dr. Miranda Melcher (20:47)

So that's a whole bunch of things being trialed with a range of outcomes too. How did we get to the point of the glass eye becoming dominant? And was it because they were more realistic or comfortable than some of these options?

Dr. Dan Roach (21:01)

Well, the glass eye is, I mean, eyes were made of glass up through the 1940s. So you know, in Venice in the 1700s, early 1800s, they were made by the glassblowers. In Paris, when that became sort of the center of eye making is glass and porcelain. And then the center of eye making kind of shifted to Germany. And Germany dominated the glass eye industry and market for maybe 80 years or so. And they were of the highest quality. The Germans had glassblowers, which is kind of a long standing industry and craft in different parts of Germany had just made sort of an art of it too. And the glass itself had the proper lead content. I guess that it, that the colors were good, it was easier to work with. And in the, I think the maybe 1840s, ish, a German glass maker also discovered or made a certain type of glass that when it's white, if it's not colored, it's very much the same color as the white of a person's eye, the sclera too. So that became easier to work with as well. So through the second half of the 19th century, and certainly up through the first decade or two of the 20th century, Germany was the place that supplied most of the eyes around the world. Probably, certainly throughout most of Europe and in the United States there were small sort of pockets of manufacturing of eyes and custom making of eyes here and there. Philadelphia, some of the glass factories made eyes, but that change, it was a very small amount relative to what was being imported from Germany or distributed from Germany to other countries. And then the glass factory is, for instance, in the United States, started to specialize in other things like jars and windows and whatnot. And the making of eyes kind of fell away because it just took a lot of training and time to do that particular kind of work. And it wasn't, it turned out, not to be, you know, efficient for that, you know, the changing nature of those particular businesses, too. But Germany long supported the craft of eye making. Glassblowing is, I think, a valued heritage within German culture. And so When World War I began, obviously, a lot of the supply of glass eyes to the rest of the world got cut off. I remember seeing a headline in the New York times in, like, 1916, from 1916 or so that talked about a glass eye famine in Britain and the United States because the supply had gotten cut off. After World War I, that export came back, and Germany again dominated that. But then in the 30s, coming up to World War II, those supplies and other supplies coming out of Germany, other glass products got cut off again for export. And so both there were efforts. During World War II, for instance, the United States had a pretty hefty stock of glass eyes on hand that they had accumulated. And they needed a lot for soldiers who were losing eyes or had damaged eyes or people who were being drafted into the services and needed an eye.

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So.

Dr. Dan Roach (25:43)

So that supply that they had, they thought initially it would last through the war, but it didn't. It kind of ran out in about 1943. So both the American military and the British military separately started to look at ways to replace that supply. And interestingly enough, they look to dentists to do it, because dentists had been working with acrylic to make crowns and artificial teeth. So this happened sort of simultaneously in a couple different places. But one sort of reliable story is that the US army got three dentists who were part of the army and sent them to Valley Forge actually to come up with a replacement of glass eyes. And they experimented with the kind of acrylic that they had been using for their dental prosthesis and made the first or some of the first acrylic or plastic eyes. And they were not artists. Dentists were not used to the requirements of making an eye look realistic, because they don't have to worry about doing that with teeth so much. It's certainly not as intricate, but that was the start of it. And from then on, the acrylic eye sort of took over and over the next, say, 10 years after the end of World War II, the acrylic eye kind of pushed out glass eyes in most of the world. Eye makers in the United States and throughout much of Europe switched over to that material because it was more durable. You could fit it in different ways. But there are some places. Germany, even today continues to make more glass eyes than it does acrylic ones. But it's certainly in the minority now. So acrylic is the material of choice throughout most of the world. But I talked to some ocularists in Germany, and I asked them why they stuck with glass rather than transitioning over, as so many other eye makers had. And they're. The response was just, glass is better that they had a very deep belief in the quality of it. Glass does have a better ability to sort of hold moisture, so it can look a little bit more moist in the way that a real eye does. And it doesn't last as long. Obviously, if you're wearing a glass eye prosthetic, you usually get a new one every year, maybe every two years. An acrylic eye prosthetic can last, oh, you know, decades without breaking.

Dr. Miranda Melcher (29:12)

And, yeah, that's a pretty big difference.

Dr. Dan Roach (29:14)

Yeah, it's a huge difference in that. And there are difference of ways that they fit them as well that.

Dr. Miranda Melcher (29:21)

Can you tell us more about that?

Dr. Dan Roach (29:23)

So with a glass eye, and I should say also that one of the eye makers I talked to in Germany, she said, okay, you don't say glass eye because that's an insult. Almost like, oh, what are you, a glass eye? Can you not see what's right in front of you? So you say eye prosthesis made in glass. So I'll try to be careful about that. And so with an eye prosthesis made in glass, you start with a ball of glass that's blown from a glass rod in the way that you would make any other blown glass object, like an ornament or maybe even a glass, a chalice or something like that. And then you. You paint it with different colored glass rods. These are all in the flame and the Bunsen burner as you're shaping it and coloring it. And then at the end, when you get to the end of the process, you kind of suck in the back of the eye so that it's no longer a round ball, but. But it kind of collapses in on itself so that it then becomes that sort of thick contact lens shape. But you can't put that in the patient's socket to test it because that's Just the nature of producing a glass eye. And so it's called empirical fitting. And it's a little bit like, you know, to use eyeballing what the person's socket looks like. Oh, I see that it's got a little ridge here, it's got a little notch there. And you kind of make the eye shape it, the edges of it, according to what you're looking at in that socket, or according to another previously made eye from glass that fits pretty well and you could just make adjustments, but it's empirically done. And so there's a little bit, I guess you could call it, of guesswork in it, but they're pretty. They're obviously very good at doing so as well. With an acrylic eye, it's done much like you would get a crown made for your tooth. There's usually insert some alginate solution into the socket, this kind of whipped cream consistency with a little syringe, and let that set for 30 seconds or so and take it out. And that gives you a shape of what the socket is. And it has on its surface all of, you know, all of the ridges and bumps and other, you know, quirks of that particular socket. And from there, so it's a very exact model of what the eye needs to fit. So from there that is made into a wax model. And that wax model maintains all those ridges and everything on the back of the eye, on the back of the future prosthetic. And then the ocularist will can put that in, take it out, it's not hot or anything like that. You can put it in, take it out, and you can shape it, you can add more wax to the front, you can sort of whittle it down, you can keep putting it in and taking it out, mostly to. There's usually a temporary little iris and pupil on the front of it. So mostly to make sure that it is pointing in line with your other eye, that the gaze is in the right direction, and also that the eyelids fall in symmetry with the eyelids of the natural eye. So that takes usually, I mean, when I had mine done, it took a good three or four hours for that sort of whittling and shaping to be done with the wax model. But the back of it was never changed. It was only the front. So the back is going to be an exact mirror copy of the geography of the inside of the person's eye socket. Then once the wax model is very close to what the ocularis wants it to be, then they take that and make an acrylic version of it, and then that's what's going to be the prosthetic. And then I came back a week later and when that acrylic version was made, and then there's the painting of it. So that was another, say, four hours of work by Iocularis to take that white shape. But again, the back of it fits perfectly into what your particular eye socket is. And that's important because that's where your motility comes from. That's where your movement comes from. So if it's, like, really snug against the tissue of your socket, for one, there's no room for excess mucus or anything to build up behind it, which was a problem with early eyes that didn't fit very well. If they were that half of a bird's egg and they just kind of plopped into the socket, you would get a lot of accumulation of mucus and secretions behind it, and that would cause its own problems for wearing the eye, and irritation and infection maybe. But if it's really snug against there, it doesn't have room. There's no room for that to happen. And you then have that if you're. If the implant is rooted in to behind the tissue of the eye, and it's basically connected to the eye muscles. And then when that moves, you know, in line with how the muscles move, then it's going to basically move the prosthetic, too, because it's such a tight fit between those two surfaces, the front surface of the conjunctiva and the back surface of the prosthetic itself, too.

Dr. Miranda Melcher (36:04)

And this is obviously a really intricate and involved process. Is there anything further you want to tell us about kind of how the process of fitting goes from, for example, your perspective or any of the people you spoke to? What is it like to have all this happen? And then once it's all done, what are the first few days like?

Dr. Dan Roach (36:22)

Well, you know, everybody's experience is different, obviously, and it depends on why you ended up in that place where you need a prosthetic eye. And obviously, there are all kinds of ways to lose an eye. And for everything from cancer to a car accident to a gunshot to just a freak accident. And, you know, the list of ways to lose an eye is horrifyingly long and imaginative to, too. So it depends on how you got there, what your shape is. And obviously, if there's some kind of real trauma, then the eye socket and the orbit may be damaged much more extensively than it was for, say, me, because I never had that kind of trauma I had, you know, the eye was removed surgically and there was nothing else affected. So in the best case scenario, the most realistic looking eyes obviously are going to be ones that the whole anatomy of the orbit is intact and the eyelids are not say, stretched out or damaged in some other way. And in that case, if the eye is fitted and shaped so that it has that motility and it has, you know, so that the, the eyelids fall in symmetry with the other eye, then it can look absolutely realistic. And, and, and you know, people would never know that, that it was a, that it was an illusion, that it was fake. I will say that for me, I didn't get my eye till I was almost 50 and I had lived with my whole life with this eye that I thought it was very ugly, it was covered with a cataract, it was kind of pointed off to the side. It just cost me so much self consciousness throughout my life and I just wanted to be done with it. And I didn't have any vision in it to speak of anyway, so it didn't do me any good in that regard. And so I dreamed over and over and over and over again throughout those years of having two eyes that would be symmetrical and that I didn't have to think about it all the time or have people look at me and not know exactly where I was looking. And so I avoided eye contact a lot too, which was not, know, always great for relationships or whatever. But sitting in the Ocularis office for all those hours, 10, 12, 14 hours, whatever it took, and having them look at me so intensely and so extensively was for me an incredibly moving experience. I never let myself be looked at like that before and they were looking at, you know, it as, as professionals making this eye for me. But I also felt like I was being looked at in a way that I hadn't been very often before of somebody seeing sort of the whole, the whole me and, and seeing things that, that I, I could let them look at anyway. It's, you know, it was, I found it incredibly healing to have that as part of the process and to have it be that long and that intense and that intimate really. And then once I got the eye and left with was euphoric, you know, it was, I looked in the mirror and this, it's a little cliched. It's very cliched. But you know, this, this dream that I'd had for years had, had come true. I could look in the mirror and I had two symmetrical eyes pointing the same direction. One of the Most common things, you know, we see every day. But I had never seen it with myself. And so for me it was, yeah, euphoric. I, you know, I don't know if I would say the word life changing, but I guess it really was on some levels because it did change the way that I thought about myself and the way I interacted with people. When you live with, you know, some kind of self consciousness about a physical flaw or whatever for a long time, that doesn't disappear, you know, automatically. So there's still some awareness of that. But I would say, you know, over the years since I've had the eye, I would say about 90% of that has disappeared and I don't think about it nearly as much. And I can look in the mirror and I've done this many times, look in the mirror and forget which eye is real and which one is not. And so I know it fools me sometimes. And I've had many people say, oh, I never would have known. People I've known for years didn't know.

Dr. Miranda Melcher (41:41)

But it makes a difference.

Dr. Dan Roach (41:43)

It does make a huge difference psychologically. And because you can't, you can't really hide a damaged eye or missing eye. It's not like, you know, losing a finger or some other body part, which, not to diminish any of that, they have their own, you know, repercussions. But an eye is there. It's right. It's what, you know, is front and center. It's what you look at. You could wear a patch, but that calls attention to it in a different way too. So it's not really possible to hide it very well. And.

Dr. Miranda Melcher (42:22)

So well, making things like being able to have such a good prosthetic really makes such a difference then it.

Dr. Dan Roach (42:27)

Makes a huge difference. Yeah. And yeah, many of the people I talked to for the book about their experience of getting the I is was similar, just kind of, you know, changing in their self perception mostly. And you know, for instance, my Oculus told me a story of one of his other patients who got an eye, a prosthetic eye, when he was 40s or 50s. And he'd always been super self conscious of it and he, he thought his divorce was due to the eye. He was embarrassed to go out and like, you know, to be seen with a woman he was dating after his divorce because he was thinking, oh, she could do better than that because what's she doing with somebody with a damaged eye like that. And then he got a new eye and it, you know, he, it changed him in the same way it changed me. His daughter was getting married and he said, now I can be in the picture, I can be in the wedding pictures and not be embarrassed and not feel like I'm embarrassing my daughter too. Which his daughter probably never thought about it. That's the other thing that it's much more important to you than it is to mostly other people in the world. They don't see what you see a lot of times, but.

Dr. Miranda Melcher (44:01)

And make an impact.

Dr. Dan Roach (44:01)

Yeah, yeah, it made a huge impact for how he sort of was in the world himself too.

Dr. Miranda Melcher (44:08)

What about the other person that's in the room, the ocularist who's making all of this literally possible? What sorts of reasons did they give when you spoke to them for why they became an ocularist? Is there sort of a particular pathway or how does one end up sort of in that room with you?

Dr. Dan Roach (44:27)

Great question. So there aren't very many ocularists in the world. In the United States and Canada, there are about 170 certified professional ocularists. And throughout Europe, different countries, there are similarly small numbers. And it's not something generally you can go study in school. You have to do an apprenticeship for it. And typically that's five years, 10,000 hours of apprenticeship with a experienced professional ocularist. And then you can take some exams to get certified through different organizations. In the United States, it's the American Academy or American Society of Ocularists. And there are different ones in other countries. It is a. It's interesting. It's kind of like a little guild, I always think of it. And a lot of the people in it come from families of ocularists. So it's very common to have multi generational families who practice this profession. And usually most of them don't work in hospitals. They'll have their own small business in a little medical park someplace or downtown or ever. But it's usually not always, but many, many times it'll be a parent training their child to take over the business and to do that apprenticeship too. So I talked to people who were fourth generation ocularis or fifth generation. I talked to one person who was training his son to be the sixth generation in his family to be in the business. And the reason that that happens is there are so few ocularis and probably enough to fulfill the need in most places. But because it's an apprenticeship and because it's such a small kind of world that when you take on an apprentice and you commit to training that person for five years, you don't want them if they're not family to go set up shop across town from you and suddenly be a competitor too. So if they are family, then you can, you can know that they're going to be probably stay in the business, probably take over that particular business when you are done or retire. And I saw that happen a lot too. If you want to be an ocularist and you don't grow up in the business, you don't grow up in an ocularistry family, then you have to find somebody who will take you on. And that happens. I talked to people who came from other backgrounds who just discovered it and saw that it looked like a really interesting way to make a living. And just, you know, this, it's. It is interesting because it's a. It's a mixture of art and, you know, science or engineering and psychology and business, and it kind of rolls a lot of different facets into the work. So if for those people who sort of discover it either by knowing somebody who got a prosthetic eye or getting one themselves more rarely, or just discovering it in some other way, then they have to find somebody who will take them on as an apprentice. And those people that I talked to, they came from different backgrounds. Some of them came from art backgrounds. They might have been sculptors or painters. A fair number of people have a background in medical illustration, but other people got into it much more, less directly, I guess. So. One person I interviewed, she's been an Ocularis for 20 years or so. She got trained as a pastry chef and then it ended up that that career didn't quite work out where she wanted to live. And so she was able to get on as an apprentice because she had some connections in the field. But she kind of transferred her skills of cake making and decorating over to eye making and just different materials as she thought of it, but kind of the same creative design methodology, too. A couple other people that I, that I talked to, they got into it because they saw a documentary about a. And I can't remember the person's name offhand of the film, but it was a documentary film about a person who had been making prosthetics for people in various parts of the world. And they were so inspired by it that they, you know, searched out and. And looked around and around to find somebody who would take them on as an apprentice and found somebody in the UK who did that. And now they're working in Africa as certified ocularist, too. So the paths are varied. Most commonly it comes from sort of being in the family and already being in that world, but not necessarily.

Dr. Miranda Melcher (50:06)

Yeah, all sorts of options there.

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Dr. Miranda Melcher (52:09)

This is obviously, as you said, a pretty small community, so I imagine there's probably a lot of connections between Ocularis in different Places you mentioned in the book that you got to go to some of their conferences. What sorts of topics come up at an ocularist conference?

Dr. Dan Roach (52:24)

Well, they are usually say three day conferences and they do them twice a year at least. The American Society of Ocularis does other organizations have their conferences at least annually, probably more so. And the ones I went to, two of them and the topics were a wide range of stuff. A lot of it was training topics like sharing techniques for fitting eyes or you know, sort of very specific painting techniques to create certain kinds of illusion or maybe different ways of polishing an eye. Because when you do get an eye, there's very little maintenance involved in most eyes. I never have to think about mine. I go and get it polished once a year, just like I go get my teeth cleaned, you know, so maybe something about different polishing methods. Sometimes there are more sort of, I guess you would call them abstract or theoretical presentations on things like the history of ocularistry. And I saw a couple presentations on, on, on, on like the history of ocular implants, which I wrote about a lot. But you know, somebody might, because a lot of ocularists, you know, this is where they get a lot of that training and that kind of run into that a lot of information and that or something like the dealing with PTSD or the trauma after eye loss. I think at the conference that's coming up soon, the next one, there's somebody on the schedule who has a PhD in maybe something like psychiatry or something and is going to talk about that kind of psychological trauma that you're dealing with, because that's in the room when you're making the eye, you're talking to the person for a long time. And so often it is like they're not trained as psychologists, they're not doctors. But this is a big part of the work to listen, to see, to respond as helpfully as possible. So sometimes there are sessions on that there may be some real sort of very specific things like on dealing with dryness the eye. So what kind of drops are out there? Usually they have a, they invite an ophthalmologist, a oculoplastic ophthalmologist, surgeon to talk about surgical techniques. Because you know, a patient will go to an ocularis to get an eye usually about six weeks or so after surgery. Sometimes the ocularists are in the operating room, if it's say a pediatric patient, a small child, and they can be there and they can take measurements and whatnot while the child is under anesthesia. And it's easier that way, too. But a lot of times they're not in the operating room, so they'll have a surgeon come. And the last one I went to in 2023, there was a very extensive presentation by oculoplastic surgeon on, on methods of removing an eye with a lot of gory slides and everything. But it was just kind of like, here's what happens to your patient before they get to you so that you know what their history is, or some of their history too, so that you can sort of do your work more empathetically and with more information about, you know, what they've, what they've gone through to get to where you are. Because ocularistry is the end of the line, really. You know, some of these people have gone through multiple surgeries and various other, you know, medical procedures. And then once you have the eye removed, you know, the ocularist is the last person to sort of in that healing process or that treatment process, I guess.

Dr. Miranda Melcher (56:56)

I imagine there are conferences, like conferences in any sort of field. One of the things they talk about is also kind of what's next in ocularist work. So I'm wondering what sorts of things are potentially on the horizon in the field.

Dr. Dan Roach (57:09)

Well, like everything else, AI and 3D printing, and it's kind of an obvious match for that because you are sort of just creating this small object that is intricately designed and painted right now. You know, most ocularis are, they hand paint it, you know, the little brushes and little vials of paint. And it's very old school, if we want to use that term. But like every other sort of creative and manufacturing outlet, AI is going to change things. So there have been some places, like some places that have been experimenting with and making 3D printed prosthetic eyes. And you can technically sort of scan a person's socket and get all the measurements and as much as the scanner will take, and then scan the other eye, the natural eye that's still in place for the shape of that eye and the color. And then you can feed all of that information into a software program that can merge them and kind of come up with a design, shape and color of a prosthetic, and then you can print that. And so that's not only on the horizon, but it's kind of here already. I don't know how fast the transition might happen or whether it'll be total too. There are a number of different advantages and disadvantages to that process or to that prospect. One is that it can be very efficient and cheap to do. And the other is that it can become very mechanical and impersonal. So you know, theoretically it would be possible and may very well happen that some company, you know, invests in a really high end printer that can print, you know, layers of resin or polymers at like 0.00063 inch layers and really make a very realistic looking prosthetic and, and then just mail it to you, you know, and you pop it in and kind of, you know, that could be, that can be very helpful in a lot of places where Ocularis are not available. And there are a lot of places in the world where they are not available. Some places, some whole countries have maybe one or two or three Ocularis. So and there are places like that still rely on manufactured eyes rather than custom fit ones. And India and China especially make a lot of eyes like that and sort of ship them around so you can order them online. And again, it's like, you know, buying a pair of shoes or something. You get the color you want and hopefully it'll fit. And, and so that whole AI scenario is probably going to intrude or not, I won't use the word intrude, but kind of make its way into the manufacturer and the craft of imaking. And I think, you know, it may be partially, you use, you could combine it with the handcrafting techniques so you can print a sort of a prototype of an eye and then add material to it and add paint and color and all the other stuff to it by hand. So your work might become more efficient in that way too. But that's kind of what's looming and probably making a lot of people nervous about that prospect of the industry changing pretty drastically that way too. But as I said before, the real loss, if that ever came to pass, would be the loss of that time and that intimacy with somebody who can sort of be there to help you through that transition of losing an eye and getting a replacement too. And you know, I've talked, I've, I've ordered eyeglasses online for cheap and they're fine. They come and I put them on and you know, that was that they work, they're cheap. But I also go down to the, the optical shop down my, down the street and, and work with the woman who owns that, you know, and she has a great selection of frames and she can try them on and she can tell me what works and doesn't and lead me in ways that I wouldn't know myself. And we can we can talk about it and, and they're a lot more expensive, but a lot of times it's, you know, it's a much better experience and I just get a better pair of glasses too. So the same thing is kind of with, with prosthetic eyes, I think. And, but, but especially when you're dealing with people who have gone through a trauma that kind of goes to the core of their self identity and their self image, that it's just really valuable to have that person or those people there who can help you through that part of it.

Dr. Miranda Melcher (63:19)

Well, we shall have to see, if you'll forgive the pun, how this all develops. But what might you be working on now that this book is done? Any projects you want to mention or highlight?

Dr. Dan Roach (63:32)

Yeah, I have a couple. So this book is about replacing eyes with kind of an illusion, something that looks like it but doesn't work in terms of vision. It works for different other things, but it doesn't, it doesn't give you sight. Prosthetic eyes so far are not to that point where they can restore vision. I'm interested, I think, in looking into where the efforts are actually to restore vision. And I did some research on that for this book just to sort of give us a little context for what's coming down the line maybe. So I know there's a lot of efforts out there on the science and, and of, you know, getting a, say, a transplanted eye. And I think it's been like two years now that they did the first full eye transplant with a man who had lost. He had to have a whole face transplant. But they transplanted an eye for him that they fully expected to just shrivel up like a raisin pretty quickly. But it didn't. It, it actually maintained its shape, it had good blood flow. They connected it to his own optic nerve. But there's so much complexity in that transmission of information down the optic nerve into the brain because seeing is much more of a brain function than it is an eye function. But I think there's really interesting work being done in that regard, whether it's transplantation or whether it's, you know, growing artificial retinas or growing retinas in the lab and placing them in. So I'm looking at sort of asking around and investigating where that's at, see if there might be something to write about on that level as well.

Dr. Miranda Melcher (65:37)

All right, well, that definitely sounds interesting. So best of luck with those investigations.

Dr. Dan Roach (65:41)

Thank you.

Dr. Miranda Melcher (65:42)

Well, you are off exploring that area. Of course. Listeners can read the book with been talking about titled Eyes by Hand Prosthetics of Art and healing, published by MIT Press in 2025. Dan, thank you so much for joining me on the podcast.

Dr. Dan Roach (65:56)

Thank you very much, Miranda. It was a real pleasure and I enjoyed talking with.