Lindsay Pronk has been told her work makes people feel whole again.

An ocularist with University of Iowa Hospitals & Clinics, Pronk spends her days creating and fitting prosthetic eyes.

“Eye loss is so difficult for everyone, no matter if they lose their eye to trauma, from a disease…or if it’s something that’s more immediate. It’s hard,” Pronk says. “It’s not just the loss of depth perception; it’s a loss of self-esteem and self-confidence. The best part of my job is helping people get back to life, so that it’s not something that they think about.” 

Pronk launched the Ocular Prosthetics Service at UI Hospitals & Clinics in the summer of 2016. Patients who come to the Ocular Prosthetics Service need a prosthetic eye for various reasons: cancer, accidents, development issues (in children), glaucoma, or serious infections.

Deb Floyd, one of Pronk’s patients, sustained retinal detachment in her right eye caused by a traumatic assault while she was shopping in Michigan some 30 years ago. While she could initially see with both eyes after the incident, the intraocular pressure started to increase. Over the next five years, Floyd had a series of procedures to keep the pressure down, but by 1994, she had lost all sight in her right eye. 

Twenty years passed before she decided to have that eye removed and get a prosthetic eye. By that time, Floyd was living in Iowa City, where she met Pronk, who was working at a different clinic at the time. Floyd received her initial prosthetic there, and followed Pronk to UI Hospitals & Clinics when the time came to be fitted with a new prosthetic.

“I can’t even imagine not doing it,” Floyd says. “I am surprised I didn’t choose to have this done a number of years ago.”

The shape of the prosthetic eye is not actually spherical, as one may expect. When a patient’s eyeball is surgically removed, a spherical implant is permanently attached to the back of the eye socket. The back of the prosthetic eye is made to fit perfectly over the implant already in the eye socket.

“I don’t often remove the prosthetic eye. It is kind of just like my own,” Floyd says.

When she does remove it—every couple of months to clean it—she describes it similar to inserting a contact lens: “It’s larger and thicker, but it involves just moving the eyelid so you can slip it up under your upper lid, and then kind of pull the lower lid around it.”

Making of an eye: The process

1. Taking an impression

First, Pronk makes an impression of the eye socket by injecting alginate into the space—the same material used to make dental impressions. It takes less than a minute to set.

2. Creating the mold

Next, Pronk makes a mold around the impression. Liquid wax is poured into the empty mold to make a wax replica of the eye. A plastic iris is attached to the replica and is placed in the eye socket to ensure correct direction of gaze and the proper fit, symmetry, and comfort. The wax is adjusted as necessary, and when the fitting is complete, a second mold is made around the wax replica.

3. Creating the acrylic eye

A white polymer mixture is placed into this mold, compressed, and cooked for 35 minutes to create the acrylic eye, which is then trimmed and polished.

4. Decorating the prosthetic

Pronk creates the appearance of veins on the surface using red cotton thread covered by a layer of clear plastic, and the prosthetic eye is cooked again. Pronk then spends three to four hours painting the prosthesis using multiple layers and colors of paint to give the iris depth and to match the patient’s other eye.

5. Fine-tuning

Throughout the process, Pronk makes tiny adjustments to get just the right look and feel for the patient. She ensures proper curvature, a natural-looking gaze, and precise symmetry to the other eye, both in shape and coloring.

6. Polishing

When both Pronk and the patient are happy with the prosthesis, it is placed in a water bath for 90 minutes then given a final trim and polish.