Ocular Prosthetics

Details

Title

Ocular Prosthetics

Type

Stage Two

Module code

HPE410

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge of appropriate information relevant to clinical management and custom-made manufacture in the specialist area of ocular prosthetics. This will include interpretation of information gathered after discussion with the patient, patient examination, review of the medical history and surgical interventions, and liaison with surgical colleagues and the MDT to achieve the optimal prosthetic outcome for the patient. They should also consistently demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist, placing the patient at the centre of care, treating them with courtesy, kindness and compassion, and maintaining the dignity of the patient at all times. The Consultant Clinical Scientist in Reconstructive Science will be expected to be able to contribute to national guidelines on the treatment of patients with ocular deformities and enucleations.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the altered orbit, including:

• the anatomy and physiology of the orbit, eyelids, lacrimal system, nose, sinuses, and head and neck as it relates to the orbits and associated structures;
• ocular microbiology and device-associated infections of the ocular socket;
• disorders affecting the orbital structures in both the adult and paediatric patient;
• the principles of surgery of the orbit, e.g. evisceration, enucleation, exenteration, secondary implantation and the impact on the associated structures;
• the altered anatomy of the orbit following pathological changes, ablative surgery, or congenital anophthalmia;
• the principles of pre-prosthetic surgery for improved prosthetic outcomes, e.g. dermal fat grafting, orbital implants, ;
• the use of deep-buried alloplastic materials for improved prosthetic outcomes, e.g. ‘sled’ orbital floor implant to raise the floor and increase the volume;
• the post-surgical management of the socket, e.g. surgical conformers;
• expansion techniques to promote the growth of the bony orbit in paediatric congenital cases, e.g. implanted tissue expanders;
• expansion techniques to address soft tissue deficiencies;
• materials appropriate for a range of custom medical devices for immediate (conformers), intermediate, or active devices (expanders) and definitive prosthetics;
• surface properties of prosthetic materials and the effect on the tissues of the ocular socket.

Clinical Care

• how the care of the paediatric patient differs significantly to that of the adult monocular vision patient;
• the impact for patients with monocular vision and how to support the patient and carers in adapting to this;
• the importance of a structured programme of aftercare, review and replacement of ocular prosthetics;
• the protection of children and vulnerable adults from maltreatment, abuse, neglect, or exploitation (safeguarding);
• cross-contamination in ocular prosthetic clinical practice and patient education for prosthesis and socket maintenance.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will have a critical understanding of current evidence and its application to the performance and mastery of a range of technical skills and will:

• design, make, supervise and quality assure the manufacture of the complex ocular prostheses that may include attachments to implants;
• carry out/oversee the manufacturing process and quality assurance of the custom made medical devices.
• undertake prosthetic alterations to manipulate soft tissues, e.g. in situations of deficient lid support;
• use modified indwelling prostheses in cases of upper or lower lid absence or insufficiency;
• construct custom-made implants to improve lid function in specialist care scenarios, e.g. gold eyelid weights to improve lid closure.

By the end of this module Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills with respect to ocular prosthetics and pre-prosthetic surgical reconstruction of the socket. They will communicate effectively with patients, carers, relevant clinicians and other healthcare professionals and will be able to perform systematic clinical pre- prosthetic assessment and will:

• examine the patient and their ocular defect for the suitability for ocular prosthetic treatment;
• risk assess the socket prior to any treatment;
• assess the need for, design and prescribe aesthetically and biomechanically sound indwelling and haptic prostheses;
• determine if any further surgery would improve prosthetic outcomes and advise or refer appropriately to oculoplastic consultants;
• discuss various treatment options with the patient and allow them to make an informed choice of treatment;
• assess the function of the definitive prosthesis and recognise prosthetic techniques that may improve the aesthetic and functional outcome, e.g. ptosis shelves;
• administer topical local anaesthetics for impressions of the damaged globe and indications for onlay prostheses, e.g. haptic shells;
• assess the upper lid function/elevation following palsy (surgical or disease acquired) or motor deficiency and prescribe an accurate custom implant for surgical insertion.