The Seattle Times -- "Seattle ocularist Greg Sankey is the eye guy" -- May 18, 2007

By Caleb Breakey
Special to The Seattle Times

When Greg Sankey was a boy, his father nudged him into building model cars. Greg remembers working alongside Orville Sankey, painting "Goodyear" on the tiny tires, lining the engines with thin gas lines and circling them with small copper wires — all with pinpoint precision.

"I don't know if he was giving me his hobby or training me for his business," Sankey says.

Today Sankey wears a lab coat and shiny shoes and works in a doctor-like office with a window that overlooks a parking lot near Northgate Mall. Next to the window is a wooden desk spotted with pencil-thin brushes.

This is where Sankey paints artificial eyes. Fourteen bottles of paint about the size of a child's drinking cup line the top of his desk, enough to create "six billion colors" — one for each person on the planet. Sankey is one of only about 150 ocularists in the United States. It's a profession that combines artistry, engineering and what every ocularist eventually learns, psychology.


Painstaking painting


By the time Sankey sits down for an hour or three to paint an eye, the patient has already been worked on by a surgeon, who cuts out the cornea and removes the iris and lens, a process best left unmentioned to patients.

"It's pretty gory," Sankey says. "You might not show up for the surgery."

The eyes have it

The first artificial eyes were made by Roman and Egyptian priests in the fifth century, B.C. They were painted clay orbs attached to cloth and worn outside the socket.
In-socket eyes came centuries later, made of gold with colored enamel.
The Germans, with expert glass-blowing skills, perfected glass eyes in the mid-19th century.
In World War II, U.S. companies couldn't get German glass, so they began making artificial eyes from acrylic plastic. Source: American Society of Ocularists

The surgeon drains the jelly and fluids in the eye socket and fits a round silicone or coral ball — these are the newest types of materials — into the open space, a sphere about three-fourths of a circle that stays embedded in the eye permanently. After the surgeon's work is done, Sankey fashions an outer shell that fits into the leftover fourth of this sphere, then matches it with the patient's good eye in patterns that look like colored wagon wheels and star flares. He then inlays the shell on top of the implanted ball.

"It just drops right in. It's like a big contact lens," Sankey says. "Insert it and remove it at will."

It's teamwork, Sankey says: A surgeon decides which implant works best, including its size, style and material; then the ocularist forms an artificial eye that could fool the patient's family. Ocularists even match the red veins that run through eyes.

Greg's father, Orville, remembers trying to duplicate the veins of a drinking man. The patient's good eye was so bloodshot that Orville said he couldn't match it. But the man grabbed a mirror and said, "Ah, hell, that's the way it is most of the time."

"So I loaded it up with veins, and it came out great," says Orville, who started the family business, Custom Ocular Prosthetics, in 1978.

Like dentures, artificial eyes need to be cleaned, re-fit and maybe even replaced. The outer shell needs to be popped off and scrubbed free of bacteria, salt and protein. The yearly maintenance means Sankey often has patients for life.


A positive outlook


One of those is Sam Ramos, a 38-year-old forklift driver from Tacoma. An outgoing, friendly man, Ramos was shot at random during a Christmas Eve party in 1993. The blast from a .357 Magnum blew off half his face, and now part of his jaw is fashioned from one of his ribs.

"I spent six years in the Army and did a lot of 'hoo-rah' stuff, not a scratch," Ramos says. "But I get out and become a civilian and freak stuff happens like that."

During his recovery, Ramos had to relearn tasks such as walking in a straight line, stepping off curbs and driving — anything requiring depth perception. He couldn't even hold his newborn for six months because of his poor coordination.

"He's a great example of how a human being can rise against all odds and recover," says Sankey, who first fitted Ramos' eye after the shooting and again last month. "Some patients have memories that they don't want brought up. But it doesn't affect him. He's a very positive person, and he's accepted [what happened]."


Hardships and hazards


Today Ramos does basically everything he did before he lost his eye. One exception is that he can't work in dirty environments, and he won't drive with his windows down. Dust and dirt, if they get on or around his artificial eye, scratch away at the inside of his eyelids.

"It feels like you've got sand in your eye," he says. "It just kind of sits on the eyeball and turns into a hard substance."

Ramos gets infections at least once a month, and about twice a year it gets so bad he needs medication to ease the pain. During those times he can't put his artificial eye back in the socket for two or three days. In those cases, Ramos has to wear a patch on his eye.

Even eating and sleeping pose hazards, ranging from the annoying to the comical. Sometimes Ramos' eye falls out of its socket while he sleeps. Ramos has a shallow socket because of the bullet wound to his eye, which can contribute to his piece popping out. "I have to look in the bed and stuff like that."

Then there was the time he ate fried chicken doused with hot sauce. After taking a bite, he rubbed his eye and it started burning. His wife panicked and rushed for the nearest faucet and cup.

"We're talking my wife pouring water on my face," he says. "I get a kick out of that one."

Ramos is relieved to take the eye out when he gets home, but sometimes he forgets where he put it. He'll look for two hours, saying to himself, "What am I going to do now?" Ramos doesn't have insurance that covers the eye, which is cracked and outdated, and he can't afford to buy a new one. An artificial eye can cost between $3,000 to $3,200.

For those with good insurance coverage, or those who can afford it, living with an artificial eye is less of a hardship than in years past. This is especially true for patients whose tear ducts were damaged along with their eye. Like Ramos, they can suffer from dry-eye.

Now there's a technology called the "self-lubricating prosthesis," which has a chamber in the back filled with liquid. A valve built into the artificial eye, which has to be refilled daily, releases half of a tear onto the surface of the eye every time its wearer blinks. The technology isn't much of a hassle, either. The chamber can be filled without taking the artificial eye out.


A family practice


The nature of the artificial eye-making field allows Greg Sankey to connect with patients over several years, a part of the job he's fond of. After he fixes an eye onto a patient for the first time, he says, "We're going to be friends for a long time. Don't worry; I'm here. Welcome to the club."

Now, a third generation of eye makers in Seattle seems certain. Greg Sankey's son and daughter, Dimitri, 22, and Angela, 24, are working as apprentices to him. Orville, who sculpted and painted artificial eyes for half a century, though being semi-retired since 1993 — the year he turned the business over to Greg — praises his son for the improvements to the business, which now has offices in Greece, Cyprus and Alaska.

Dimitri, who is in the second year of his apprenticeship, says his father's international advances — traveling to Alaska once a year, and to Athens and Cyprus about every other month — would be tough to match. Appointments at those offices are always booked because there are few ocularists in those parts of the world.

Dimitri says he and his sister plan to work together to keep the business in the family, one of his two passions about the job. The other is interacting with patients, a characteristic he shares with his father.

Before he puts away the equipment, replaces his white coat and exits through the single door out of Custom Ocular Prosthetics, Dimitri takes one last look at his father's patient.

"The face at the end of the day," Dimitri says, "it's the most incredible feeling of the whole thing."


Caleb Breakey is an associate reporter with MLB.com. He grew up in Washington.