Ophthalmologist Dr Kathleeya Stang-Veldhouse with mentor Dr Keith Pine, who's taken her on as an apprentice in the complex art of making prosthetic eyes. Photo / Dean Purcell
She’s sung for the King of Thailand but Auckland ophthalmologist Kathleeya Stang-Veldhouse has found her creative calling in the meticulous process required to make prosthetic eyes. Joanna Wane pays a visit to the Greenlane Clinical Centre, where hundreds of eye patients are treated every day.
Last year, a young Auckland lawyer developed a serious bacterial eye infection and almost went blind. During the first five days she spent in hospital, two types of eye drops had to be administered by a nurse every 30 minutes for 24 hours a day.
Now fully recovered, she says the eye ward at Auckland’s Greenlane Clinical Centre was an “oddly fascinating place” with its extraordinarily varied clientele.
A construction worker had cement splashes in his eyes from a burst pipe; a teenager’s contact lenses had been left in so long they’d fused to her corneas.
In the next bed was a woman in her early 90s who needed corrective surgery because the droop in her eyelids was obscuring her vision. And on the Saturday night, a gang member was brought in under police escort after being stabbed in the eye.
Auckland ophthalmologist Kathleeya Stang-Veldhouse has pretty much seen it all since joining the acute eye service at Greenlane as an oculoplastic surgeon 13 years ago.
Chemical burns from cooking oil, burst dishwasher pods and even something as seemingly benign as a swan plant can cause permanent scarring to the eye (the milky sap is toxic).
After a woman went blind in 2017 as a result of complications from a “liquid nose job” involving cosmetic injectables – the first case of its kind in New Zealand – Stang-Veldhouse created a safety protocol around the use of hyaluronic acid fillers.
Most of the blunt trauma injuries she treats are more prosaic than a gangland stabbing, though. Branch versus eye. Fingernail versus eye. Cork versus eye. Pencil versus eye. Shuttlecock versus eye. Fish hook versus eye. Car accidents. Rugby elbow.
The youngest patient she’s operated on was a three-month-old baby with retinoblastoma, a tumour that develops in the retina and is most common among very young children. “Those are our paediatric cancer patients,” she says. “They’re a special cohort.”
A gifted surgeon with a special interest in prosthetics and appearance medicine, Stang-Veldhouse is also the only ophthalmologist in the country with the meticulous skills required to make artificial eyes. Three and a half years ago, she began an apprenticeship with internationally renowned ocular prosthetist Dr Keith Pine, who continues to oversee her work.
The former dental technician “cut his teeth” at the plastic surgery unit at Auckland’s Middlemore Hospital in the 1980s. That’s not such a leap as it sounds – dentures are made of the same material as artificial eyes and require similar craftsmanship.
Pine, who set up the NZ Prosthetic Eye Service, now runs pop-up clinics throughout the North Island. He describes the loss of an eye as a very personal invasion of privacy because it’s on such public display.
“If you have a tattoo or a scar on your chest, you can cover that up and nobody needs to know,” he says. “The eye is front and centre when it comes to the architectural structure of the face, so the psychological value of restoring that symmetry is huge.”
A team of 52 ophthalmologists, 89 nurses and 32 allied health staff work across Greenlane’s Te Toka Tumai Ophthalmology Service – and one goldendoodle.
A golden retriever/poodle mix, Bodhi joined the Stang-Veldhouse family as a lockdown puppy and has been trained as a therapy dog to support patients during the long and often emotional process of being fitted for a prosthetic.
At 30kg, Bodhi (who is named after the Sanskrit word for enlightenment) is almost the size of a miniature horse. A regular visitor to the clinic, he’s been a hit with the kids. One pre-teen patient who needed a minor eyelid procedure refused to have a local anaesthetic injection without him nearby.
“I had to write ‘Bodhi is requested’ on the booking form,” Stang-Veldbouse says. “My surgical scheduler was really confused. ‘What is Bodhi? Is this a special surgical instrument?’ I’m like, ‘No, it’s my dog.’”
Bodhi’s calm, gentle nature makes him a great comfort and a useful distraction for patients during the complex five-hour process involved in creating a custom-made prosthetic eye. Typically completed in a single day, it demands a high level of both artistic flair and technical skill. Among the required equipment is a dental lathe to trim and polish the prosthetic and an electric kettle to cure it in boiling water.
Made from a medical grade of perspex, modern artificial eyes are intricately hand-painted to match the patient’s natural colouring, using high-grade oil paints and sable hair brushes for the iris, and cotton thread to tease out fine, spidery veins.
They can also swivel to provide a degree of natural movement, unlike the glass marbles that were once used. In fact, these days they’re not ball-shaped at all.
Instead, a spherical acrylic mould wrapped in donor sclera (the white of the eye) is implanted into the cavity and tethered to working muscles at the back of the socket. The prosthetic shell, which looks more like a fancy contact lens, simply slides into place over that.
Ocular prosthesis orbital dynamics and influences – artificial eye movement – was the subject of Stang-Veldhouse’s recent master’s thesis for her fourth university degree (first-class honours).
Born in the United States to parents who had migrated from Thailand, she must have felt predestined for a career in medicine. Her father, an obstetrician and gynaecologist, turned 80 last year and is still working fulltime alongside her brother in their practice outside Chicago. Her mother was a nurse.
A shy child, she discovered a love of the arts and used to tell people she wanted to be a singing, dancing doctor when she grew up. To some degree, that played out. As part of the celebrations for the late King of Thailand’s 84th birthday, she sang on a compilation album, A Tout Jamais, which featured a selection of the monarch’s own compositions performed in French.
“In another life, I’d be in musical theatre – the summer before I went to med school, I did a course at NYU [New York University] and that was fun. But I think there’s nothing more rewarding to me than what I can offer as a physician,” says Stang-Veldhouse, who knew from the get-go she was a hands-on person suited to surgery.
“The eyes are such an amazing organ system that provides us with so much in terms of quality of life and it’s a special part of medicine where we, as clinicians, can see the impact we make rather quickly. In some cases, you can take a patient with hand-motions vision to 6/6 in one day.
“One of the first things we do to communicate with one another and to connect is having eye contact. So when you lose that, it’s a change in your identity, and you have to reimagine or re-evaluate your sense of self. That’s hard for the patient and it’s hard for their family, too.”
Stang-Veldhouse began her oculoplastic fellowship at Greenlane in 2011 after becoming pregnant unexpectedly in the US. When she and her husband TJ, who’s an emergency medicine specialist, arrived in Auckland with their five-week-old baby, all she knew about New Zealand was that it had something to do with Flight of the Conchords and The Lord of the Rings.
The couple now have two daughters, Talia, 12, and Miki, 9. Their third child was stillborn at 38 weeks due to a placental abruption, a rare pregnancy complication. That was a “tough, tough time”, says Stang-Veldhouse, and it must have been hard to be so far from home, but the family has firmly bedded into life here.
“It’s a really lovely work-life balance,” she says. “I felt that I could fully commit to being a physician and a mother, and not compromise either.”
When Kerikeri business owner Andre Kunz first noticed his eyes were flickering, he thought it was nerves. His wife thought he needed a new pair of glasses. A routine eye test picked up that something was wrong and he was diagnosed with ocular melanoma, a rare type of eye cancer.
At his first appointment with Stang-Veldhouse to be fitted for a prosthetic, she discovered a post-surgical infection that had developed after his eye was removed and an implant inserted into the empty socket. A long delay also meant he’d lost muscle mass and needed plastic surgery on his bottom eyelid to hold the implant in place.
Kunz has now been operated on four times by Stang-Veldhouse, who replaced his implant and fitted a new prosthetic for him last year, under Pine’s supervision.
Back at the clinic for a clean and polish as part of his annual check-up, he’s one of some 3500 New Zealanders who wear an eye prosthesis. He’s remained cancer-free but will be monitored for secondary tumours over the next 10 years.
“When I was diagnosed with cancer, the prospects were pretty dark and dismal, not only the loss of an eye and that grieving process, but the actual possibility of death,” he says. “Keith and Kat are just lovely people and they’ve been amazing to deal with. Even though it’s a doctor-patient relationship, it feels like so much more. It feels like I’m a friend.”
Kunz remembers Stang-Veldhouse getting Bodhi as a puppy, and his wife and two children have met both her daughters. He says having his eye restored to normality has changed his outlook on life in more ways than one.
After two months of wearing a patch in public, the constant pirate jokes quickly wore thin. Now, when he asks people to pick the prosthetic eye, most can’t easily tell the difference. “I can look at myself in the mirror and feel complete.”
Joanna Wane is an award-winning senior feature writer in the NZ Herald’s Lifestyle Premium team, with a special focus on social issues and the arts.
