Factors We Consider
There are a variety of fitting techniques that have been developed through the years. After attending many conferences and visiting with other Ocularist, through much experience, I have found that the same technique should not be used in every situation. There are several areas we consider when deciding how an individual should be properly fit.
- First time enculeation or evisceration-never wore a prosthesis before.
- What type of implant used -HA-Medpore-PMMA sphere-Dermis fat graph, etc?
- If currently wearing a prosthesis, how accurate is the current prosthesis.
- How long have they been wearing the current prosthesis and is it comfortable?
- Is it a child or an adult?
There are other considerations, but the above are a few general situations I consider when beginning to fit a patient. Generally some type of impression technique should be used, except in sockets which do not have an implant. For the most part, the majority of the recent enucleations do have an implant. There are different impression techniques, such as a full impression or a modified impression. When fitting for a scleral shell, we usually do both types of impressions, and we have been very successful, although it takes a little longer to complete. The full impression basically gives you shape of the fornices, and the curvature of the posterior of the socket or implant, and a modified impression gives us an accurate reading on the thickness needed for the scleral shell. This technique improves fit, comfort, motility of the prosthesis, and in some cases will reduce discharge.