Rethinking access, fit and function in ocular prosthetics

December 1, 2025 Dr Kathleeya Stang-Veldhouse

The field of ocular prosthetics represents a unique intersection of surgical rehabilitation, prosthetic bioengineering and facial restoration. Historically, the loss of vision or an eye may have been viewed as the ‘end of the road’ from an ophthalmology and optometry perspective. However, this is certainly not the case for patients and their families. There is increasing need for evidence-based approaches that integrate rehabilitation, surgical planning, socket dynamics, prosthetic fabrication and longitudinal care for this complex patient group. This article reviews three recent works that collectively examine national service delivery in New Zealand, the biomechanical interplay between prosthesis and orbit and the under-utilisation of scleral shell prostheses. These studies highlight opportunities for clinical refinement, interdisciplinary collaboration and improved equity of access in prosthetic eyecare.

 

Ocular prosthetics in Aotearoa New Zealand: systems, gaps and opportunities

Jacobs R, Yeoman J, Pine K, et al

NZ Dent J. 2024;120(4):167–171

Review: This 2024 publication in the New Zealand Dental Journal offers an overview of the ocular prosthetics landscape across Aotearoa, based on interviews and systemic review. The authors outline several barriers to equitable and timely care, particularly in the public sector. These include significant wait times (often exceeding six months post-enucleation), geographic disparities in service availability and inconsistent referral patterns from ophthalmology and optometry providers. Survey data showed that 50% of prosthetic eye wearers had lost their eye due to trauma, 43% due to medical conditions and 7% were congenital cases. Notably, many patients and referring providers lacked awareness of available prosthetic options or the value of early socket rehabilitation. The authors argue for integrating prosthetic care into a broader rehabilitative framework that includes psychosocial support, surgical planning and follow-up.

Comment: The article underscores a critical need for enhanced interprofessional collaboration and a standardised care pathway. It shines a light on gaps in care delivery and challenges prevailing assumptions that anophthalmic rehabilitation is secondary to surgical outcomes. By positioning prosthetic care as an essential rehabilitative service, the paper advocates for policies and protocols that reflect patient needs across the continuum of care.

 

 

Ocular prosthesis dynamics and influences: a multimodal investigation using cine-MRI and eye tracking

Stang-Veldhouse K (master’s thesis)

University of Auckland; 2024

 

Review: This mixed-methods thesis evaluates prosthetic motility using a multimodal toolkit: cine-mode MRI, infrared eye tracking (EyeLink) and digital video. The study included patients with a blind eye, microphthalmia, evisceration and enucleation, each with corresponding prosthetic types. The cine-MRI enabled a high-resolution, real-time view of socket activity during eye movements, while EyeLink offered rapid quantification of horizontal and vertical excursion in both prosthetic and contralateral eyes. Together, these tools enabled analysis of muscle coupling, prosthetic slippage, edge interference and lag time in gaze response.

 

A key innovation in the project was correlating subjective prosthesis appearance with objective motility data. The thesis also discussed barriers to wider MRI adoption, such as cost, accessibility and the need for tailored imaging protocols for prosthetic eyes.

 

Comment: This work offers a valuable framework for understanding ocular prosthesis-socket dynamics beyond static fit. By incorporating data-driven evaluation, it challenges the status quo of subjective socket assessments. The EyeLink tracker stands out as a feasible clinical adjunct and cine-MRI offers exciting research potential. This data-driven lens may inform future prosthetic design, improve surgical outcomes and help personalise socket management.

 

 

The under-utilisation of scleral shell prostheses in New Zealand: a clinician survey 

Yeoman J, Pine K, Sloan D

NZ Med J. 2024;137(1602):27–36

 

Review: This nationwide dual-survey study investigated the use of a non-surgical rehabilitative option for patients with blind but structurally intact eyes in New Zealand. Surveys were conducted with both eye health professionals and patients across Aotearoa. Only 18% of patients who may have benefited from a scleral shell recalled being offered one. Many patients were not informed of the option at all, even in cases where it could have delayed or avoided surgical eye removal. Among professionals, over 40% admitted uncertainty around indications for scleral shells and more than 60% acknowledged inconsistency in how the option was presented to patients.

 

Perceived barriers included concerns about cost, discomfort and maintenance, often based on anecdote rather than evidence. Furthermore, the lack of defined referral pathways between ophthalmology and prosthetic services was noted to contribute to delays or oversight. Clinicians also cited limited exposure to scleral shells during training as a major contributor to the knowledge gap.

 

Comment: This study highlights the need for improved education and referral protocols around scleral shells, particularly for clinicians managing microphthalmia, trauma or phthisis. It urges the field to reconsider these prostheses not merely as cosmetic solutions, but as rehabilitative tools. Patient-centred care demands that all viable options be clearly explained. Addressing these practice gaps may reduce unnecessary eye removal and give patients access to more conservative, life-enhancing interventions, especially in rural or underserved regions.

 

 

Dr Kathleeya Stang-Veldhouse is a consultant ophthalmologist, oculoplastic surgeon and ocularist for Te Whatu Ora Auckland. She holds additional qualifications in public health, cosmetic medicine and medical education, serves as a clinical lead for the Acute Eye Service and supervises ophthalmology fellows, registrars and junior doctors within the Greenlane Clinical Centre. Dr Stang-Veldhouse has a special interest in anophthalmic care and works closely with the New Zealand Prosthetic Eye Service.