DWAYNE COLLINS used YouTube to teach himself to make an ocular prosthetic for his daughter.
Realising he could impact the lives of many more with damaged or removed eyes, he now runs an
ocularist clinic on the Gold Coast built on compassion and technical know-how.
A parent will do anything for their child. For Mr Dwayne Collins, when his daughter was born with microphthalmia with her affected eye 40% smaller than her other one, he didn’t flinch in the face of endless medical appointments, constant uncertainty, and the search for an ocular prosthetic. He considered them all essential steps to give his first-born child the life he envisaged during his wife’s pregnancy.
But along the way, two regrettable experiences with ocularists – who fit, paint and fabricate custom ocular prostheses – left the family reeling.
The first instance saw his daughter, Liberty, who is now 11, fitted with a prosthetic that was gazing in the wrong direction and was clearly too big for her. He questioned how someone could allow a client, let alone a child, leave in this condition.
And then the second incident occurred.
“An impression was taken of her socket that was the wrong material, in my opinion, and it got stuck to her eye – I’d already tried pulling it out myself, but it wouldn’t budge. I’m a relaxed person, and I said to the professional, ‘Look, let’s just take her to emergency’, but he wanted to be spared the embarrassment,” he says.
“My wife was hugging her and, bearing in mind it was stuck to her eye, he then pulled it out, which pretty much caused my daughter to pass out. We walked out of that appointment, my wife was bawling, and I just got angry. That was my motivator. I started buying everything that I could think of to make an eye and that’s how it all started.”
Today, Collins has turned a desire to help his daughter into a fully-fledged business, Oculus Prosthetics, working as an ocularist on the Gold Coast. He’s been doing it for almost 10 years now and – disappointed by the lack of education and standards in Australia – has trained under the world’s best overseas.
While a deep sense of dissatisfaction spurred Collins into the world of ocular prosthetics, it all began in 2013 when Liberty entered the world. The midwife told them the abnormality with her eye may be trauma from the birth. They were sent home, but in the following days when laying her on the change table and sunlight hit her face, she didn’t squint or look away.
“From there, we got thrown into a whole new world that we knew nothing about. We were passed around multiple specialists, everyone wanted to meet her because there wasn’t much documented on it at the time. She ended up in a few medical journals. It was something we had to adapt to and it became our new norm.”
As a baby, it was stressful for Liberty to endure. In addition to having bilateral microphthalmia in her right eye, she was also diagnosed with chorioretinal coloboma. This impacts her good eye, and while she’s legally blind, Collins says she is doing well with what vision she has.
In those early days, obtaining an ocular prosthetic for his Liberty started well, despite the circumstances. She was blessed to come into the care of Mr Trevor Dorahy in Brisbane, who is an expert for eye prosthetics for children during crucial growing stages.
But soon, the family needed to move and came into the care of other ocularists. It became clear to Collins that, with training, experience, and perseverance, he could do it better himself.
He initially took to YouTube and encountered a video by leading UK ocularist Mr John Pacey-Lowrie, dissecting each step and piecing together what he could to produce an artificial eye for Liberty. Creating a prosthetic that satisfied the family took over 12 months and involved much frustration, but with each iteration, he knew he was getting closer.
“I had a moment where I went out to the shed and cried, knowing she was walking around with a prosthetic I had made for her – because I had done something for the family,” he says.
After producing several prosthetics for Liberty over the years, a family of a girl who lost her eye to cancer contacted Collins and asked if he could create an artificial eye for her. He was apprehensive at first given his inexperience, but slowly came around to the idea. The girl was autistic and didn’t like males, so he got to know the family over the course of two months.
“Then one day, she finally put her arm around me, and that’s when we knew we could get started with her eye,” he says.
Impacting more lives
Becoming an ocularist was an itch Collins could no longer resist scratching. Keen to turn his interest into a career, he was surprised and disappointed to find no official qualification or training in Australasia for the design and manufacturing of bespoke artificial eyes and cosmetic/scleral shells. Especially given what can go wrong with a poorly made prosthesis.
“You are placing a foreign object into the eye socket. So, I’ve had to put all the clinical procedures and practices in place myself because – unlike other countries – there is none for Australia,” he says.
“Post-operatively, you have to know what you’re looking at in the socket, and the scary thing is, anyone can begin making prosthetic eyes. My clients are blessed because of the background I have with my daughter, and I’ve got one of the best ocularists in the world as my mentor.”
He’s referring to Pacey-Lowrie, who has almost 50 years of experience in the field with people flying in to see him from around the world. His career also includes extensive experience at the prestigious Moorfields Eye Hospital in London.
After learning from Pacey-Lowrie’s videos, Collins completed professional development courses in 2017 through the Nottingham Trent University in the UK, tutored by the expert ocularist.
Left wanting more, he contacted Pacey-Lowrie who agreed to help Collins with one month of intense training at his UK clinic. It was a formative experience, and he remembers being blown away by his skill and the effortless way in which he painted the prosthetic.
After returning to Australia, Collins made it a full-time career alongside his window and door glazing business that he still runs today. Collins has opened a state-of-the-art clinic where he openly shares the prosthetic manufacturing process with the client – bucking a trend of secrecy common in the industry.
For his clients, the process takes place over three sessions. It usually begins eight weeks after the enucleation, evisceration, or other surgery the patient might have had, to ensure the swelling has dissipated.
First, he takes an impression of the socket and then creates a wax model. It’s intentionally made too big so it can be tooled down to match the other eye symmetrically.
“A big issue we encounter is that a surgeon will tell the patient, ‘Go see Dwayne, he’ll make you look normal’, but quite often we’ve got complications in the socket, so it’s important to remain realistic,” he says.
Next, he creates the iris component, which involves intricate painting. A corneal unit – that he sells to ocularists worldwide – with a pupil are then added to the painted iris disc. Once in acrylic, the veins and staining are added to the sclera, and the final part is enhanced for maximum realism. The final step is ensuring the implant sits correctly, and the gaze is in the right direction.
“We want the client to look as natural as possible and have the gaze for conversation etc,” he explains. “Being realistic, if we achieve 80% movement, that’s fantastic. If the surgeon’s done a good job and attached all the muscles correctly, that transposes onto what I make so that the prosthesis will move as much as possible. That’s why an impression is so important and the foundation for getting it right.”
While there’s a lot of technical skill involved, Collins says there’s a significant emotional factor to his work. It can be traumatic losing an eye, so he never books appointments back-to-back.
“Eighty percent of what I do is psychological and having that understanding of what the client’s going through. So many people come to me from other states that have been treated poorly because there’s no understanding or sympathy,” he says.
“It’s something I’m passionate about. Unfortunately, it’s perceived by many as ‘aesthetics’, even though there’s a functional side to it in terms of socket health keeping the face symmetrical and preventing it from collapsing in on itself.
“The NDIS will fund as many psychology appointments as you want and spend all that money, but why not come sit with me, talk it through, go through the process and leave feeling confident you’ve got an eye in place?
“The psychological impact of not having an eye, walking around in public, is huge – so the system is a bit upside down when it comes to that.”
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