EYE FOR AN EYE
Friday May 08, 2009
Raymond Peters, Master Maker of Artificial Peepers, and His Star Pupils
When someone who has lost an eye is being fitted for a cosmetic replacement, the maker of the artificial eye - a craftsman known as an ocularist - undertakes a delicate task. Whereas with an artificial leg, for instance, function is more important than appearance, the same is not true with an ocular prosthesis. The finished product must be virtually indistinguishable from the wearer's good eye, down to the subtlest gradations in color, depth and transparency - or else why bother?
"I want a blue eye," Carol Williams says.
She is kidding. She is black, 50 years old, and her good eye, the right one, is a color like mahogany.
She is sitting in examination room No. 2 in the Prince George's County offices of Raymond E. Peters, master ocularist.
"Well, you ain't getting' a blue eye," Peters says pretending to be annoyed. He has been an ocularist for nearly 50 years and thinks it is best to take a casual approach. His work requires not only a steady hand and an artist's keen sense of color, plus a firm grasp of ocular anatomy and the chemistry of thermoplastics, but also a good bedside manner, especially with new patients. Almost always, the new ones are mired in despair.
Williams, who has been mired in despair since losing her left eye in an assault in April, smiles wanly.
"Hazel then," she says.
"You ain't getting' that, either."
Peters grouses at her playfully, without looking up. He has on white pants, white shoes and a white smock, and is seated opposite Williams at a narrow, white table in the examination room. He is busy arranging the paints and the brushes he will use to paint the artificial eye he has made for her in his laboratory down the hall. People tend to think of an artificial eye as a sphere, like a child's toy marble, but in fact it is nothing like that. It is shaped more like the half shell of a small clam and it is made of plastic, not glass. In William's earlier visits to the ocularist (pronounced ocu-LAR-ist), an artificial eye was painstakingly molded to fit her left socket. Now, in her third visit, the prosthesis - still only a dull white shell - is resting on a two-inch pedestal on the table in front of Peters.
He leans forward, staring into William's right eye.
"You have a chocolate eye," he says
"What?"
"A chocolate eye. You have an eye that has real deep, rich browns in it, and you have a little bit of red that bleeds through those browns. If you put a plain brown eye in next to that, it'll look flat." He eases back in his chair. "We have to give it color. Let me show you. Pay attention."
He is 66, has a bald pate and graying hair on the sides, and wears wire-rim glasses. He is one of 150 or so ocularists in the country. He is gregarious and animated. From the moment you set foot in his office, near Forestville, he acts as if he has known you for years. His craft is not governed by any licensing body, and it is not taught in any schools; it is handed down, master to apprentice. His patients are from the world over.
"Are you going to paint this today, the whole thing?" Williams asks. For a moment there is more wonder than sadness in her voice.
"The whole thing, hon."
It will take 40 minutes.
To Peters's right on the table are a dozen artist's brushes. The brushes are sable. To his left is a slab of glass on which he has squirted tiny lumps of oil paint in the colors he will use to paint the artificial eye: ivory black, magnesium blue, cobalt blue, cerulean blue, cadmium yellow, raw sienna, raw umber, burnt umber, alizarin crimson and titanium white.
He dips a brush into a small white jar on the table. He begins to coat the prosthesis with the substance from the jar. "I'm going to make it real pretty, too," he tells her. "You watch."
The jar contains a transparent liquid plastic that he uses as a primer. Next he studies Williams's right eye again, paying special attention to the iris. The iris is what a person looks at to see what color another person's eyes are - any may think, "Oh, his eyes are blue," or "Her eyes are green". That is because people tend to generalize about eye color. Peters does not generalize. He looks into Williams's iris and sees a multitude of hues, one of which is a dark shade of brown. He tries to match this shade first. He dips his brush into one lump of paint, then another, and he blends the colors in a swirl on the concave bottom surface of an overturned shot glass.
"Yeah, well .what are you going to do about my eyelid?" Williams asks. She has turned sullen again.
"What about it?"
"Well, look at it!"
Peters says, "I know, I know - but you can't worry about that."
Artist and Healer
Her hair, disheveled, is pushed straight back above her face and pressed flat beneath a wide headband. The socket which once held her left eye is covered by a gauze-and-aluminum patch. Wide strips of clear surgical tape hold the patch in place. Williams thinks the patch makes her look awful but thinks what is under it maker her look worse - not just the eyeless socket, but the lid. The lid is lifeless and drooping, the muscles that control it having lost all strength. She and a psychologist talk every Friday about the emotions that have been troubling her - fear, anger, grief - and Williams will say things like," I've never been very pretty. But, my God, I'm 50, I'm divorced, I'm by myself. I don't need to look like this."
She used to work as an assistant at a psychiatric treatment center in Montgomery County, not far from her Gaithesburg town house. On the night of April 19, an enraged patient, a 12-year-old boy, began pummeling her. The boy punched Williams so hard, her left eye split open. Five hours of emergency surgery could not fix it. In another operation two weeks later at Georgetown University Medical Center the eye was taken out.
The oculo-plastic surgeon who removed the eye, Geva E. Mannor, says the lid problem is called blepharoptosis. It can be corrected with surgery. But that will come later. In the May 3 operation, after removing the eye, Mannor replaced it with a small sphere called an ocular implant. The implant made from ocean coral, fills most of the 7.5 cubic centimeters of space left vacant by Williams's missing eye and prevents the facial structure around it from gradually caving in. This is a routine procedure. Mannor grafted tissue over implant and attached all six of William's left eye muscles to the tissue. With the muscles attached, the implanted sphere begins to move - side to side - up and down - in unison with Williams's good eye.
Before Williams left the hospital, Mannor gave her the business card of Raymond E. Peters. He told her that Peters would fashion an artificial eye - a shell really - to precisely fit over the contours of the tissue on the front part of her implant. The shell would fit so snugly against the implant, the doctor said, that when the implant moved, the shell would tend to move with it. And when Peters was finished painting the shell, the doctor promised her, it would look amazingly lifelike.
Now Peters is busy painting the hues of the iris on the white shell.
"So, you know all about 'tosis, right?" he asks her.
"Uh-huh."
"It's a relaxation of that eyelid muscle," he says. "It's very common."
"That's what the doctor said, yeah."
"You're with Dr. Mannor?"
"Uh-huh."
"Well, you're with the best," Peters tell her. "This is his specialty, lid surgery. When you get that done .well, you wait."
On top of the transparent primer already on the shell, he has painted a circle in the centre of the shell and has filled it in, using that dark shade or brown. This is Peters calls "the base color," or the dominant hue, of William's iris. Williams watches as Peters finishes coating the shell, including the dark brown circle, with a second layer of transparent primer. Next he will superimpose lighter shades of paint on top of the base color - first a reddish brown, then a golden brown- after each new shade, he will add another layer of primer. In the end the transparent layers between the shades give the iris a reflective quality and will make the dominant base color more visible through the weaker shades on top of it, creating the illusion of depth.
Later, when the prosthesis is finished and Williams has it in, Mannor will be able to judge how much work needs to be done on her drooping eyelid and perform the surgery to correct the blepharoptosis.
Yet none of this makes Williams any less despondent. "Nine out of ten cases are like this," Peters will say later, when she is out of earshot. "They think they're going to be freaks or whatever, when in fact they're not." He considers it part of his job to try to cheer them up. At the table, he tells Williams: "You know, with Dr. Mannor, you better watch out...When you go to clean this eye, you better make sure you don't take out the wrong one. You won't know what socket it is in, you'll take the wrong one out to clean it. I mean, that's how good he is."
She smiles. "Well I heard he's the best."
"He is."
"And I heard you're the best too."
"Well." Peters shrugs, as if to say "Of course," and continues to paint. She watches him for a moment not saying anything, and when she speaks again, her voice trails off. "This is just not."
"This is not what?"
"You know, it's not .I didn't expect to be 50 and have to get an eye."
"What do you mean?"
"This is just .it's not right." The unfairness of it is something she has talked and cried about for hours with her 74-year-old sister, Vivian Savoy. Savoy is Williams's psychological anchor, accompanying her to every eye appointment. In the examination room, Savoy is seated on a couch, watching her younger sister a few feet away.
She says, "Now, Carol."
"How'd you lose it?" Peters asks. "You were struck in it, right?"
"Boy beat me, attacked me."
"Uh-huh. Well let me tell you something. I've probably seen every kind of injury you could think of in 49 years. I mean, gunshot wounds, sticks, knives. I had a guy from the railroad, he was a brakeman - you know how these guys hang on the back of trains? Bird flew in his eye, knocked it right out."
He glances up, sees her cringe.
"I mean, I have priests, nuns, all kinds of people. The thing is, you have to go on with your life. Your have to live your life, enjoy it."
"Yeah, I know," she says. "I know."
Taking Shape
Peters began learning the ocularist's craft in the years right after World War II, when he was a teenager in the Navy, assigned to the dental corps. These days, many of his 1,200 or so patients come from countries where the craft is not nearly as refined.
His laboratory is the size of an average kitchen, with counters on three walls. On one counter are stacks of brass molds in small sizes, a built-in electric range, a steel sink, a drill like a dentist's drill, and a lathe motor with muslin buffing wheels attached to the spindles. On the wall above the lathe motor are racks of 3-by-5-inch manila envelopes, each bearing a patient's name and an artificial eye - either a work-in-progress or a worn prosthesis in for a buffing. On the other two counters are a portable drying oven, a propane torch, a heavy-compression vise, bottles and jars of powders and plastics and two dozen more brass molds, all in use.
When he at work in his laboratory, Peters is almost constantly in motion, mixing powders, heating wax, forming molds, boiling water, sculpting, sanding, polishing, buffing. On a typical morning, he will have 25 to 30 custom-fitted shells in various stages of production, and, in an average month, he will deliver about the same number of finished artificial eyes to patients, at $1,800 to $2,200 apiece. Many of the artificial eyes are for people who have been patients of his for decades. Because of natural changes in eye-socket structure, the wearer of an artificial eye normally has to be fitted for a new prosthesis every four or five years.
In his first appointment with Williams, Peters packed her left socket with an ophthalmic alginate, a substance that is slightly more congealed than gelatin at the time it goes in. He allowed it to harden, then pulled it out and looked at it. The lump of alginate bore an impression - a precise inverse image of the inside of the socket, including the contours of the tissue on the front part of Williams' spherical implant. Before and after their next appointment, he mixed powders, formed molds, heated wax, boiled water - and he sculpted, sanded, polished and buffed. When he was done he had produced a small white shell - an artificial eye - made of a hard plastic called methyl methacrylate. The concave inner surface of the shell, the part that would rest against William's implant bore the tissue impression he had taken with the alginate. This meant the shell would rest snugly against the implant and would tend to move when the implant moved. Just as important, when the implant was still, the shell would stay fixed in place.
Now here you have an example of better living through chemistry. You couldn't do this with a glass eye - which is why, after World War II, glass eyes were pretty much rendered obsolete by advances in plastics. For one thing, there was no way you could include that tissue impression on the surface of a hand-blown piece of glass, and so the glass shell, when placed in the socket, could just stare in the same direction all day - or worse would drift. Also, glass eyes wouldn't hold paint. The iris was created with tiny rods of stained glass. And even in the hands of the most artful glass blower, it almost always would come out looking artificial, its colors unblended and empty of warmth, its surface lacking a lifelike reflective value and giving no illusion of depth.
Plastic, though - plastic you can paint.
"These are your veins," Peters says to Williams, in the examination room. He snips a six-inch length of red silk thread from a spool on the wall beside the table. With tweezers, he unravels the strand of thread, and a few dozen faint red fibers fall onto a white paper towel in front of him.
He is done painting the iris, and he is done painting the white area that surrounds the iris. The white of an eye is called the sclera. But of course it is not just white. "All scleras have a bluish influence to them," Peters told Williams earlier. "You almost can't see it." Now he coats the sclera with the primer and lays the veins across the sclera before the primer dries.
"I'm laying these in a pattern," he says, pausing to study her good eye. When he is done with the veins, he says to Williams: "Now, look at me, honey. Look over here." He summons Vivian Savoy to the table and points to Williams's right eye. "Now look at that eye. You see those little splotches in there? You see them? Look at them."
"Oh, yes, yes," says Savoy, leaning close. The splotches are minute brown flecks barely visible in the bluish white of the sclera.
"That's normal," Peters says. He paints the flecks on the prosthesis, humming as he does so. "Now here's another thing a lot of people miss," he says a moment later. He is pointing to William's right eye again, telling Savoy: "See that gray band just inside the edge of the iris? You know that they call that? They call that an arcus synillus. It's a little band of fatty tissue." And he adds an arcus synillus to the artificial eye.
"It's so faint," says Savoy, in a whisper.
Next the reaches for a leather-puncher on a cart behind him, and puts it on the table. Then he finds a thin sheet of black rubber on a shelf to his right. He studies the pupil in William's good eye, measuring it visually, gauging its fluctuation by shining a light, and decides: "It's a three." He punches out a black rubber dot, three millimeters in diameter - the average width of her pupil - and attaches it to the prosthesis with liquid plastic. He coats the shell again with the primer - a thick layer; it's the final one, the cornea - then straightens in his chair, looking at Williams.
'There you are," he says. "That's you."
Vivian Savoy is shaking her head slowly. "That is a-mazing." She gazes at the prosthesis, and turns to her sister and says, "Isn't that amazing?"
Williams already is up from her chair. "All right," she says, "when do I come in for you to put it in, a week or two?"
"I should have it ready by the end of the week," Peters says.
Williams falls silent, staring back at the table, and after a moment, in a dull vice, she says, "Once you put it in me, and it's there, then how often do I have to, you know, do I have to."
"Take it out?"
"Yeah - because I'm not hardly every going to take this out."
"Why not?" her sister says. "It's yours."
"It grosses me out."
Peters tells her she will learn to pop out the artificial eye with a small suction cup. In time, he says, it will become second nature. He says she should clean the prosthesis daily and should bring it to the office for a high-speed buffing about every six months.
"So you want me back in Friday?" Williams says. She is at the door of the examination room, and the prosthesis is still on the table.
"You come back Friday," Peters says.
"And you're going to put it in then?"
"Uh-huh."
"All right," she says, turning away, her voice still flat. "I guess I'll come back Friday."
Rediscovering "Normal"
She did come back, on Friday, Aug. 11. Peters wedged the finished shell into her left socket and held up a mirror, and Williams could see that what Peters and Mannor had told her was true: The prosthesis was practically indistinguishable from her good eye. And with the shell in place, she noticed, her left lid wasn't as droopy. Soon she began to venture outdoors without her patch, and, in time, she realized something: People on the street were paying her no mind. She felt.normal.
Lately, emotionally, she has had more good days than bad. Tuesday this week was a good day. She met with Mannor in his office to discuss her blepharoptosis. When they were finished, Mannor mentioned that he hoped to organize a support group for people in despair over the loss of an eye. And he wanted to know: Would Williams lead the group? He told her she could think about it. But Williams said, "I don't have to. I can tell you right now. I'll do it."
<< Back
When someone who has lost an eye is being fitted for a cosmetic replacement, the maker of the artificial eye - a craftsman known as an ocularist - undertakes a delicate task. Whereas with an artificial leg, for instance, function is more important than appearance, the same is not true with an ocular prosthesis. The finished product must be virtually indistinguishable from the wearer's good eye, down to the subtlest gradations in color, depth and transparency - or else why bother?
"I want a blue eye," Carol Williams says.
She is kidding. She is black, 50 years old, and her good eye, the right one, is a color like mahogany.
She is sitting in examination room No. 2 in the Prince George's County offices of Raymond E. Peters, master ocularist.
"Well, you ain't getting' a blue eye," Peters says pretending to be annoyed. He has been an ocularist for nearly 50 years and thinks it is best to take a casual approach. His work requires not only a steady hand and an artist's keen sense of color, plus a firm grasp of ocular anatomy and the chemistry of thermoplastics, but also a good bedside manner, especially with new patients. Almost always, the new ones are mired in despair.
Williams, who has been mired in despair since losing her left eye in an assault in April, smiles wanly.
"Hazel then," she says.
"You ain't getting' that, either."
Peters grouses at her playfully, without looking up. He has on white pants, white shoes and a white smock, and is seated opposite Williams at a narrow, white table in the examination room. He is busy arranging the paints and the brushes he will use to paint the artificial eye he has made for her in his laboratory down the hall. People tend to think of an artificial eye as a sphere, like a child's toy marble, but in fact it is nothing like that. It is shaped more like the half shell of a small clam and it is made of plastic, not glass. In William's earlier visits to the ocularist (pronounced ocu-LAR-ist), an artificial eye was painstakingly molded to fit her left socket. Now, in her third visit, the prosthesis - still only a dull white shell - is resting on a two-inch pedestal on the table in front of Peters.
He leans forward, staring into William's right eye.
"You have a chocolate eye," he says
"What?"
"A chocolate eye. You have an eye that has real deep, rich browns in it, and you have a little bit of red that bleeds through those browns. If you put a plain brown eye in next to that, it'll look flat." He eases back in his chair. "We have to give it color. Let me show you. Pay attention."
He is 66, has a bald pate and graying hair on the sides, and wears wire-rim glasses. He is one of 150 or so ocularists in the country. He is gregarious and animated. From the moment you set foot in his office, near Forestville, he acts as if he has known you for years. His craft is not governed by any licensing body, and it is not taught in any schools; it is handed down, master to apprentice. His patients are from the world over.
"Are you going to paint this today, the whole thing?" Williams asks. For a moment there is more wonder than sadness in her voice.
"The whole thing, hon."
It will take 40 minutes.
To Peters's right on the table are a dozen artist's brushes. The brushes are sable. To his left is a slab of glass on which he has squirted tiny lumps of oil paint in the colors he will use to paint the artificial eye: ivory black, magnesium blue, cobalt blue, cerulean blue, cadmium yellow, raw sienna, raw umber, burnt umber, alizarin crimson and titanium white.
He dips a brush into a small white jar on the table. He begins to coat the prosthesis with the substance from the jar. "I'm going to make it real pretty, too," he tells her. "You watch."
The jar contains a transparent liquid plastic that he uses as a primer. Next he studies Williams's right eye again, paying special attention to the iris. The iris is what a person looks at to see what color another person's eyes are - any may think, "Oh, his eyes are blue," or "Her eyes are green". That is because people tend to generalize about eye color. Peters does not generalize. He looks into Williams's iris and sees a multitude of hues, one of which is a dark shade of brown. He tries to match this shade first. He dips his brush into one lump of paint, then another, and he blends the colors in a swirl on the concave bottom surface of an overturned shot glass.
"Yeah, well .what are you going to do about my eyelid?" Williams asks. She has turned sullen again.
"What about it?"
"Well, look at it!"
Peters says, "I know, I know - but you can't worry about that."
Artist and Healer
Her hair, disheveled, is pushed straight back above her face and pressed flat beneath a wide headband. The socket which once held her left eye is covered by a gauze-and-aluminum patch. Wide strips of clear surgical tape hold the patch in place. Williams thinks the patch makes her look awful but thinks what is under it maker her look worse - not just the eyeless socket, but the lid. The lid is lifeless and drooping, the muscles that control it having lost all strength. She and a psychologist talk every Friday about the emotions that have been troubling her - fear, anger, grief - and Williams will say things like," I've never been very pretty. But, my God, I'm 50, I'm divorced, I'm by myself. I don't need to look like this."
She used to work as an assistant at a psychiatric treatment center in Montgomery County, not far from her Gaithesburg town house. On the night of April 19, an enraged patient, a 12-year-old boy, began pummeling her. The boy punched Williams so hard, her left eye split open. Five hours of emergency surgery could not fix it. In another operation two weeks later at Georgetown University Medical Center the eye was taken out.
The oculo-plastic surgeon who removed the eye, Geva E. Mannor, says the lid problem is called blepharoptosis. It can be corrected with surgery. But that will come later. In the May 3 operation, after removing the eye, Mannor replaced it with a small sphere called an ocular implant. The implant made from ocean coral, fills most of the 7.5 cubic centimeters of space left vacant by Williams's missing eye and prevents the facial structure around it from gradually caving in. This is a routine procedure. Mannor grafted tissue over implant and attached all six of William's left eye muscles to the tissue. With the muscles attached, the implanted sphere begins to move - side to side - up and down - in unison with Williams's good eye.
Before Williams left the hospital, Mannor gave her the business card of Raymond E. Peters. He told her that Peters would fashion an artificial eye - a shell really - to precisely fit over the contours of the tissue on the front part of her implant. The shell would fit so snugly against the implant, the doctor said, that when the implant moved, the shell would tend to move with it. And when Peters was finished painting the shell, the doctor promised her, it would look amazingly lifelike.
Now Peters is busy painting the hues of the iris on the white shell.
"So, you know all about 'tosis, right?" he asks her.
"Uh-huh."
"It's a relaxation of that eyelid muscle," he says. "It's very common."
"That's what the doctor said, yeah."
"You're with Dr. Mannor?"
"Uh-huh."
"Well, you're with the best," Peters tell her. "This is his specialty, lid surgery. When you get that done .well, you wait."
On top of the transparent primer already on the shell, he has painted a circle in the centre of the shell and has filled it in, using that dark shade or brown. This is Peters calls "the base color," or the dominant hue, of William's iris. Williams watches as Peters finishes coating the shell, including the dark brown circle, with a second layer of transparent primer. Next he will superimpose lighter shades of paint on top of the base color - first a reddish brown, then a golden brown- after each new shade, he will add another layer of primer. In the end the transparent layers between the shades give the iris a reflective quality and will make the dominant base color more visible through the weaker shades on top of it, creating the illusion of depth.
Later, when the prosthesis is finished and Williams has it in, Mannor will be able to judge how much work needs to be done on her drooping eyelid and perform the surgery to correct the blepharoptosis.
Yet none of this makes Williams any less despondent. "Nine out of ten cases are like this," Peters will say later, when she is out of earshot. "They think they're going to be freaks or whatever, when in fact they're not." He considers it part of his job to try to cheer them up. At the table, he tells Williams: "You know, with Dr. Mannor, you better watch out...When you go to clean this eye, you better make sure you don't take out the wrong one. You won't know what socket it is in, you'll take the wrong one out to clean it. I mean, that's how good he is."
She smiles. "Well I heard he's the best."
"He is."
"And I heard you're the best too."
"Well." Peters shrugs, as if to say "Of course," and continues to paint. She watches him for a moment not saying anything, and when she speaks again, her voice trails off. "This is just not."
"This is not what?"
"You know, it's not .I didn't expect to be 50 and have to get an eye."
"What do you mean?"
"This is just .it's not right." The unfairness of it is something she has talked and cried about for hours with her 74-year-old sister, Vivian Savoy. Savoy is Williams's psychological anchor, accompanying her to every eye appointment. In the examination room, Savoy is seated on a couch, watching her younger sister a few feet away.
She says, "Now, Carol."
"How'd you lose it?" Peters asks. "You were struck in it, right?"
"Boy beat me, attacked me."
"Uh-huh. Well let me tell you something. I've probably seen every kind of injury you could think of in 49 years. I mean, gunshot wounds, sticks, knives. I had a guy from the railroad, he was a brakeman - you know how these guys hang on the back of trains? Bird flew in his eye, knocked it right out."
He glances up, sees her cringe.
"I mean, I have priests, nuns, all kinds of people. The thing is, you have to go on with your life. Your have to live your life, enjoy it."
"Yeah, I know," she says. "I know."
Taking Shape
Peters began learning the ocularist's craft in the years right after World War II, when he was a teenager in the Navy, assigned to the dental corps. These days, many of his 1,200 or so patients come from countries where the craft is not nearly as refined.
His laboratory is the size of an average kitchen, with counters on three walls. On one counter are stacks of brass molds in small sizes, a built-in electric range, a steel sink, a drill like a dentist's drill, and a lathe motor with muslin buffing wheels attached to the spindles. On the wall above the lathe motor are racks of 3-by-5-inch manila envelopes, each bearing a patient's name and an artificial eye - either a work-in-progress or a worn prosthesis in for a buffing. On the other two counters are a portable drying oven, a propane torch, a heavy-compression vise, bottles and jars of powders and plastics and two dozen more brass molds, all in use.
When he at work in his laboratory, Peters is almost constantly in motion, mixing powders, heating wax, forming molds, boiling water, sculpting, sanding, polishing, buffing. On a typical morning, he will have 25 to 30 custom-fitted shells in various stages of production, and, in an average month, he will deliver about the same number of finished artificial eyes to patients, at $1,800 to $2,200 apiece. Many of the artificial eyes are for people who have been patients of his for decades. Because of natural changes in eye-socket structure, the wearer of an artificial eye normally has to be fitted for a new prosthesis every four or five years.
In his first appointment with Williams, Peters packed her left socket with an ophthalmic alginate, a substance that is slightly more congealed than gelatin at the time it goes in. He allowed it to harden, then pulled it out and looked at it. The lump of alginate bore an impression - a precise inverse image of the inside of the socket, including the contours of the tissue on the front part of Williams' spherical implant. Before and after their next appointment, he mixed powders, formed molds, heated wax, boiled water - and he sculpted, sanded, polished and buffed. When he was done he had produced a small white shell - an artificial eye - made of a hard plastic called methyl methacrylate. The concave inner surface of the shell, the part that would rest against William's implant bore the tissue impression he had taken with the alginate. This meant the shell would rest snugly against the implant and would tend to move when the implant moved. Just as important, when the implant was still, the shell would stay fixed in place.
Now here you have an example of better living through chemistry. You couldn't do this with a glass eye - which is why, after World War II, glass eyes were pretty much rendered obsolete by advances in plastics. For one thing, there was no way you could include that tissue impression on the surface of a hand-blown piece of glass, and so the glass shell, when placed in the socket, could just stare in the same direction all day - or worse would drift. Also, glass eyes wouldn't hold paint. The iris was created with tiny rods of stained glass. And even in the hands of the most artful glass blower, it almost always would come out looking artificial, its colors unblended and empty of warmth, its surface lacking a lifelike reflective value and giving no illusion of depth.
Plastic, though - plastic you can paint.
"These are your veins," Peters says to Williams, in the examination room. He snips a six-inch length of red silk thread from a spool on the wall beside the table. With tweezers, he unravels the strand of thread, and a few dozen faint red fibers fall onto a white paper towel in front of him.
He is done painting the iris, and he is done painting the white area that surrounds the iris. The white of an eye is called the sclera. But of course it is not just white. "All scleras have a bluish influence to them," Peters told Williams earlier. "You almost can't see it." Now he coats the sclera with the primer and lays the veins across the sclera before the primer dries.
"I'm laying these in a pattern," he says, pausing to study her good eye. When he is done with the veins, he says to Williams: "Now, look at me, honey. Look over here." He summons Vivian Savoy to the table and points to Williams's right eye. "Now look at that eye. You see those little splotches in there? You see them? Look at them."
"Oh, yes, yes," says Savoy, leaning close. The splotches are minute brown flecks barely visible in the bluish white of the sclera.
"That's normal," Peters says. He paints the flecks on the prosthesis, humming as he does so. "Now here's another thing a lot of people miss," he says a moment later. He is pointing to William's right eye again, telling Savoy: "See that gray band just inside the edge of the iris? You know that they call that? They call that an arcus synillus. It's a little band of fatty tissue." And he adds an arcus synillus to the artificial eye.
"It's so faint," says Savoy, in a whisper.
Next the reaches for a leather-puncher on a cart behind him, and puts it on the table. Then he finds a thin sheet of black rubber on a shelf to his right. He studies the pupil in William's good eye, measuring it visually, gauging its fluctuation by shining a light, and decides: "It's a three." He punches out a black rubber dot, three millimeters in diameter - the average width of her pupil - and attaches it to the prosthesis with liquid plastic. He coats the shell again with the primer - a thick layer; it's the final one, the cornea - then straightens in his chair, looking at Williams.
'There you are," he says. "That's you."
Vivian Savoy is shaking her head slowly. "That is a-mazing." She gazes at the prosthesis, and turns to her sister and says, "Isn't that amazing?"
Williams already is up from her chair. "All right," she says, "when do I come in for you to put it in, a week or two?"
"I should have it ready by the end of the week," Peters says.
Williams falls silent, staring back at the table, and after a moment, in a dull vice, she says, "Once you put it in me, and it's there, then how often do I have to, you know, do I have to."
"Take it out?"
"Yeah - because I'm not hardly every going to take this out."
"Why not?" her sister says. "It's yours."
"It grosses me out."
Peters tells her she will learn to pop out the artificial eye with a small suction cup. In time, he says, it will become second nature. He says she should clean the prosthesis daily and should bring it to the office for a high-speed buffing about every six months.
"So you want me back in Friday?" Williams says. She is at the door of the examination room, and the prosthesis is still on the table.
"You come back Friday," Peters says.
"And you're going to put it in then?"
"Uh-huh."
"All right," she says, turning away, her voice still flat. "I guess I'll come back Friday."
Rediscovering "Normal"
She did come back, on Friday, Aug. 11. Peters wedged the finished shell into her left socket and held up a mirror, and Williams could see that what Peters and Mannor had told her was true: The prosthesis was practically indistinguishable from her good eye. And with the shell in place, she noticed, her left lid wasn't as droopy. Soon she began to venture outdoors without her patch, and, in time, she realized something: People on the street were paying her no mind. She felt.normal.
Lately, emotionally, she has had more good days than bad. Tuesday this week was a good day. She met with Mannor in his office to discuss her blepharoptosis. When they were finished, Mannor mentioned that he hoped to organize a support group for people in despair over the loss of an eye. And he wanted to know: Would Williams lead the group? He told her she could think about it. But Williams said, "I don't have to. I can tell you right now. I'll do it."