Ocularist John Pacey-Lowrie Talks Making Artificial Eyes in Nottingham

Interview: Georgianna Scurfield
Tuesday 25 April 2017
reading time: min, words

John Pacey-Lowrie is the only ocularist in the whole of the Midlands. He’s spent forty years perfecting his craft, and people travel from all over the world to be fitted with one of his handmade, acrylic prosthetic eyes. He is constantly striving to make his prosthetics as realistic as possible and is currently at the forefront of the development of an artificial dilating pupil which reacts to light...

What exactly is an ocularist?
It’s someone who designs, handpaints, manufactures and fits artificial eyes or ocular prosthetic devices. That can either be an artificial eye which fits a socket where an eye has been removed, or a device called a scleral, or cosmetic shell, to fit over an ugly blind eye – as is mine. There are also different devices for lifting eyelids and dealing with eyelid malpositions.

How much does your job vary?
Every day. Every case is different. No two people have got the same coloured eyes. No matter where you live, your race, creed, colour doesn’t come into it. People always say “Ah it must be harder doing blue eyes than brown eyes.” It’s not the case – brown eyes are just as difficult to do because of the depth of the colour. So every job’s a challenge, every job’s individual. We get a lot of people coming in who have very high expectations, which of course, you would. If you’re involved in a horrendous accident you just want to be you, be how people remembered you. It’s very difficult, therefore, for you to perceive what we can do and we always make sure that’s the first line we take with the patient.

What sort of customers do you deal with?
Unfortunately, eye disease and trauma doesn’t favour or miss any part of the community, age group or anything else. We do have children who are born with anophthalmia, which is where the eye or eyes are missing. Microphthalmia is where the eye is underdeveloped, blind and useless, or they have cancer of the retina which is called retinoblastoma. Nine times out of ten, retinoblastoma children will lose that eye or both eyes. It’s very sad. We also get people who have been involved in road traffic accidents or accidents at work and other traumatic injuries.

You get people coming in that might be sixty or seventy, and you ask them how they lost an eye. A lot of it is “my brother accidentally shot me in the eye with an arrow,” or “a pellet from an air gun.” Some pretty horrendous accidents. One that always makes me feel pretty sick is a child who, like we’ve all done, was jumpin’ on the bed, came off it and smacked her eye on the valve on the radiator. Kaboom. Gone. I think that people generally don’t realise just how precious their eyes and their eyesight is, which is something I really understand because I’ve been blind in my right eye since I was a baby. But, getting back to your question, it’s all age groups and all sorts of people.

How much work goes into making one prosthetic?
The way we do it is in a bespoke fashion, so it’s made to measure for the patient. It doesn’t come out of a plastic tub and get cut to shape, which happens in some places. We make each eye individually. You have to bear in mind that you’re talking to a private practitioner, so that means if you come in on Monday, you’ll have your new prosthesis on Wednesday. I’d say it takes us three days to make an eye, but we might see five patients a day, so we can make more than one eye in one day.

Which part of this process is your favourite?
The artwork is my favourite practical part. My favourite part of the whole process is to see that patient with a smile on their face at the end, cos that’s all it is about. It’s not me getting a kick out of thinking I’m fantastic with a paint brush, cos I couldn’t paint a barn door. I can paint your eye but I couldn’t do anything else.

This doesn’t seem to be a profession that you fall into. How did you start making prosthetic eyes?
I was born with a condition in my right eye where my pupil didn’t form properly, called a coloboma. In my eye, it’s a full thickness coloboma, so it goes straight through all the layers of my eye and I have no vision in that eye at all. It’s smaller and it looks a bit disfigured. It always bothered me as a child. I was bullied and useless at school. I left when I was not quite sixteen, which you could do in those days. I started the very next day as an apprentice dental technician and hated every single minute for five years, but I qualified very well.

I went on to do orthodontics, but then a job came up for somebody to be an artificial eye fitter, which is the most disgusting title you can imagine. You’re thinking there’s some guy in a white coat, a monkey wrench and big tub of grease... It was basically designing a prosthetic eye, but not making it or painting it. I did that for quite a long time and then I was fortunate enough to get a job at Moorfields eye hospital in London. They do everything bespoke, so I was taught to do the artwork and the manufacturing and all the rest of it. That’s how I’ve gone on from then.

Do you do all the work here?
Nothing goes anywhere – it’s all done in-house. The patient comes here, and when they leave, the prosthesis has been made by me and my colleague Sean. Nothing goes out of house. It’s very much a cottage industry, it’s an art and it’s something that I’m determined will remain a craft. In these days of 3D printing and super-duper photography techniques, I see those deskilling my craft.

How much has the prosthetic eye industry changed since you got into it?
The industry hasn’t changed much at all. The materials have got better, they’ve got lighter in weight, shinier and they last a bit longer. We’re more aware of clinical quality materials so that's what we use. The biggest thing is in the surgical techniques. Surgery has improved a lot, so perhaps there are less people losing their eyes. That said, it’s still 0.1% of people in all developed nations that have one eye missing. If you get yourself down to somewhere like Guatemala, South America, it can be up to 25% of people that have only got one eye. That’s huge, and it’s because of lack of adequate medical care.

Is it just people in Nottingham that you treat?
Nope, we treat people as far away as Australia. We have three or four people that come from Australia, a couple from New Zealand, Nigeria, Africa, Scotland, Ireland, Wales, Europe. It’s a worldwide thing. They come here. A guy comes from New Delhi, India, just to have his eye serviced. So every three to four months this particular chap who does lots of flying around the world needs to have his eye removed, polished, resurfaced and reinserted. It takes about twenty minutes, but he has been known to fly from New Delhi just to have that done.

So you’ve been working on developing an artificial pupil. How’s that going?
When we started I offered a bursary to a student at NTU. He did a terrific job and he came up with a system called dielectrics. That was the first idea and we got that to work really well. It was the miniaturisation that was so difficult because the electronic parts were very much encased in big cases. Getting them out of that and miniaturised was a problem. The student moved on and we decided it was too cumbersome. Since that's happened, there are things that have emerged like colour-changing paint. We’re looking into whether we can use that, but I can’t tell you too much or I’ll have to shoot you.

John Pacey-Lowrie is the only ocularist in the whole of the Midlands. He’s spent forty years perfecting his craft, and people travel from all over the world to be fitted with one of his handmade, acrylic prosthetic eyes.

John Pacey-Lowrie website

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