Prosthetic eyes, Product or Service?


I would define a “primary artificial eye” as the artificial eye fitted post operatively when someone has had an eye removed.

At the recent Ocularists Association of Australia meeting the issue of item numbers for health insurance companies was debated. To keep things simple we want to define the products and services we provide with the minimum number of item numbers.

Proposed Item Numbers

1) Ocular Prosthesis                

2) Primary Ocular Prosthesis

3) Haptic/Scleral Lens          

4) Modification  / build up to eye prosthesis      

5) Review and Polish                                                       

6) Consultation                                                                   

Item 2: (the primary ocular prosthesis) was the subject of much debate.

When someone loses an eye it is a time of emotional turmoil. It is a period of adjustment and adaption. In Western Australia we encourage clients to visit us prior to having the operation so we can help people understand the journey ahead.

 We have prepared a mind map which illustrates the various aspects of eye loss such as the operation, dealing with the emotional aspects , monocular vision and support groups. By using the mind map while we explain the various aspects of eye loss.  People can take a copy of the mind map with them and use it as a reference to remind them of all the information we share on the first visit. The information is also available on this website.

 On this first visit we will also make up an eye prosthesis which is fitted at the end of the operation. This could be defined as an aesthetic conformer shell. It is fitted as part of the surgery to hold the shape of the eye socket while it heals. Also by having the prosthesis fitted at the time of the surgery the patient and their family are not confronted by the sight of an empty eye socket or transparent conformer shell which has been the practice in the past.

About one week after the operation the pressure bandage comes off and the patient gets to see the eye prosthesis in situ for the first time. We invite clients to visit us after their ophthalmologists’ appointment so we are able to make small adjustments to the shell for the purpose of alignment. We see the client again after one week for adjustments as the socket swelling subsides.

The final prosthesis is not made until eight weeks after the operation once the residual swelling subsides. Once the prosthesis if fitted there is a follow up visit after one week to see how it is settling in.

This process including the Pre-op talk, the manufacturing and supply of the aesthetic conformer, the adjustments to the aesthetic conformer, the five or so visits to custom make and fit eye prosthesis and any adjustments to the artificial eye are all included in the one item number and are covered under the one invoice as a “primary ocular prosthesis.”

Under the current health insurance system an artificial eye is covered as an ancillary benefit. It is my hope that in the future the health insurance companies will recognise that a primary eye prosthesis is an integral part of the operation and it should be covered under the hospital table as part of the operation. This is a vulnerable time for most people who go through enucleation. There is a period of time were the patient is unable to work and it is often a financially difficult period.

People do not choose to have an eye removed for cosmetic reasons. People may lose an eye as a result of trauma or disease and is only done as a last resort.

Under the hospital table it would be covered as a part of the operation and would attract a more reasonable rebate.

I would suggest that a primary prosthesis is so much more than a product and should be recognised as a complete service. If someone has an eye removed through the public health system in Australia, the cost of the artificial eye is covered by the Government as it is recognised as an integral part of the operation and recovery. It is my hope that private health insurance companies follow suit.

1 Comment

  1. Avatar for Bridget Borsare Bridget Borsare on September 20, 2010 at 4:48 am

    I think insurance companies should cover more or all. I have medicare and I still have to pay $2,000 for my eye. I’m going to have yo take out a loan for my first eye prosthetic and will have to save continually for my replacements. This was not cosmetic, as stated in this article, my brother shot me when I was five with a bb gun and after 40 years it finally had to come out. I work in a public relations job and I must see people for my job, having an eye instead of a pink gaping hole is very important for my job. Insurance SHOULD cover more in prosthetic cases.

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