ocularist india: ocularist india: "RAJU KUMAR BSC in optometry from kolkata fellow LV prasad eye institute hyderabad optometrist/ocularist lvpei hyderabad email- rkumaropto@g..."
Wednesday, December 15, 2010
ocularist india: ocularist india
ocularist india: ocularist india: "RAJU KUMAR BSC in optometry from kolkata fellow LV prasad eye institute hyderabad optometrist/ocularist lvpei hyderabad email- rkumaropto@g..."
Monday, December 13, 2010
Notable people with glass eye
* Baz Bastien – ice hockey player, coach (right eye)
* Sammy Davis, Jr. – singer (left eye)
* Frank Elstner – TV Host (left eye)
* Peter Falk – actor (right eye)
* Nick Griffin – BNP Member of European Parliament and leader (left eye)
* Leo McKern – actor (left eye)
* Claus Schenk Graf von Stauffenberg – German career Army officer and resistance leader (left eye)
* Robert Thurman – writer (left eye)
* Mo Udall – politician
* Carl Ouellet – Canadian Professional Wrestler
* New Jack – American Professional Wrestler (right eye)
[edit]
* Sammy Davis, Jr. – singer (left eye)
* Frank Elstner – TV Host (left eye)
* Peter Falk – actor (right eye)
* Nick Griffin – BNP Member of European Parliament and leader (left eye)
* Leo McKern – actor (left eye)
* Claus Schenk Graf von Stauffenberg – German career Army officer and resistance leader (left eye)
* Robert Thurman – writer (left eye)
* Mo Udall – politician
* Carl Ouellet – Canadian Professional Wrestler
* New Jack – American Professional Wrestler (right eye)
[edit]
Implant movement
Implant and prosthesis movement are important aspects of the overall cosmetic appearance after enucleation and are essential to the ideal objective of crafting a lifelike eye similar in all aspects to the normal fellow eye.[4][18] There are several theories of improved eye movement, such as using integrating prosthetic material, pegging the implant, covering the implant (e.g. with scleral tissue), or suturing the eye muscles directly to the prosthetic implant. The efficiency of transmitting movement from the implant to the prosthesis determines the degree of prosthetic motility. Movement is transmitted from traditional nonporous spherical implants through the surface tension at the conjunctival–prosthetic interface and movement of the fornices. Quasi-integrated implants have irregularly shaped surfaces that create an indirect coupling mechanism between the implant and prosthesis that imparts greater movement to the prosthesis. Directly integrating the implant to the prosthesis through an externalized coupling mechanism would be expected to improve motility further.[7]
Despite the reasoning stating that hydroxyapatite orbital implants without a motility peg would yield a superior artificial eye motility,[19] when similar surgical techniques are used unpegged porous (hydroxyapatite) enucleation implants and donor sclera-covered nonporous (acrylic) spherical enucleation implants yield comparable artificial eye motility.[5][7] In two studies[5][20] there were no differences in maximum amplitude between hydroxyapatite and acrylic or silicone spherical enucleation implants,[5] thus indicating that the implant material itself may not have a bearing on implant movement as long as the muscles are attached directly or indirectly to the implant and the implant is not pegged.[4] The motility of a nonintegrated artificial eye may be caused by at least two forces. (1) The rubbing force between the posterior surface of the artificial eye and the conjunctiva that covers the implant may cause the artificial eye to move. Because this force is likely to be approximately equal in all directions, it would cause comparable horizontal and vertical artificial eye amplitudes. (2) An artificial eye usually fits snugly in the conjunctival space (possibly not in the superior fornix). Therefore, any movement of the conjunctival fornices will cause a similar movement of the artificial eye, whereas lack of movement of the fornices will restrict its motility.[5] Imbrication of the rectus muscles over a nonintegrated implant traditionally was thought to impart movement to the implant and prosthesis. Like a ball-and-socket joint, when the implant moves, the prosthesis moves. However, because the so-called ball and socket are separated by layers of Tenon’s capsule, imbricated muscles, and conjunctiva, the mechanical efficiency of transmission of movement from the implant to the prosthesis is suboptimal. Moreover, the concern is that imbrication of the recti over nonintegrated implants actually can result in implant migration.[21] The recent myoconjuctival technique of enucleation is an alternative to muscle imbrication.[4][22][20]
Although it is generally accepted that integrating the prosthesis to a porous implant with peg insertion enhances prosthetic movement, there is little available evidence in the literature that documents the degree of improvement.[7] And although the porous implants have been reported to offer improved implant movement,[23] these clearly are more expensive and intrusive, requiring wrapping, and subsequent imaging to determine vascularization and pegging to provide for better transmission of implant movement to the prosthesis, and also are prone to implant exposure.[4]
Age and size of the implant may also effect the motility, since in a study comparing patients with hydroxyapatite implants and patients with nonporous implants, the implant movement appeared to decrease with age in both groups. This study also demonstrated improved movement of larger implants irrespective of material.[7]
Despite the reasoning stating that hydroxyapatite orbital implants without a motility peg would yield a superior artificial eye motility,[19] when similar surgical techniques are used unpegged porous (hydroxyapatite) enucleation implants and donor sclera-covered nonporous (acrylic) spherical enucleation implants yield comparable artificial eye motility.[5][7] In two studies[5][20] there were no differences in maximum amplitude between hydroxyapatite and acrylic or silicone spherical enucleation implants,[5] thus indicating that the implant material itself may not have a bearing on implant movement as long as the muscles are attached directly or indirectly to the implant and the implant is not pegged.[4] The motility of a nonintegrated artificial eye may be caused by at least two forces. (1) The rubbing force between the posterior surface of the artificial eye and the conjunctiva that covers the implant may cause the artificial eye to move. Because this force is likely to be approximately equal in all directions, it would cause comparable horizontal and vertical artificial eye amplitudes. (2) An artificial eye usually fits snugly in the conjunctival space (possibly not in the superior fornix). Therefore, any movement of the conjunctival fornices will cause a similar movement of the artificial eye, whereas lack of movement of the fornices will restrict its motility.[5] Imbrication of the rectus muscles over a nonintegrated implant traditionally was thought to impart movement to the implant and prosthesis. Like a ball-and-socket joint, when the implant moves, the prosthesis moves. However, because the so-called ball and socket are separated by layers of Tenon’s capsule, imbricated muscles, and conjunctiva, the mechanical efficiency of transmission of movement from the implant to the prosthesis is suboptimal. Moreover, the concern is that imbrication of the recti over nonintegrated implants actually can result in implant migration.[21] The recent myoconjuctival technique of enucleation is an alternative to muscle imbrication.[4][22][20]
Although it is generally accepted that integrating the prosthesis to a porous implant with peg insertion enhances prosthetic movement, there is little available evidence in the literature that documents the degree of improvement.[7] And although the porous implants have been reported to offer improved implant movement,[23] these clearly are more expensive and intrusive, requiring wrapping, and subsequent imaging to determine vascularization and pegging to provide for better transmission of implant movement to the prosthesis, and also are prone to implant exposure.[4]
Age and size of the implant may also effect the motility, since in a study comparing patients with hydroxyapatite implants and patients with nonporous implants, the implant movement appeared to decrease with age in both groups. This study also demonstrated improved movement of larger implants irrespective of material.[7]
Surgical procedure
Essentially the surgery follows these steps:[7]
* Anesthesia
* Conjunctival peritomy
* Separation of the anterior Tenon’s fascia from the sclera
* Pass sutures through rectus muscles
* Rectus muscles disinserted from the globe
* Rotate and elevate the globe
* Open Tenon’s capsule to visualize optic nerve
* Cauterize necessary blood vessels
* Divide the nerve
* Remove the eye
* Hemostasis is achieved with either cautery or digital pressure.
* Insert orbital implant.
* If necessary (hydroxyapatite) cover the implant with wrapping material before
* Attach the muscle (if possible) either directly (PP) or indirectly (HA) to implant.
* Create fenerations in wrapping material if necessary
* For HA implants drill 1 mm holes as muscle insertion site
* Draw Tenon’s fascia over implant
* Close Tenon’s facia in one or two layers
* Suture conjunctiva
* Insert temporary ocular conformer until prosthesis is received (4–8 weeks later)
* After implant vascularization an optional secondary procedure can be done to place a couple peg or post.
Also under anesthesia
* Create conjunctival incision at the peg insertion site
* Create hole into implant to insert peg or post
* Modify prosthesis to receive peg/post.
The surgery is done under general anesthesia with the addition of extra subconjunctival and/or retrobulbar anesthetics injected locally in some cases. The following is a description of the surgical procedure performed by Custer et al.:[7]
The conjunctival peritomy is performed at the corneal limbus, preserving as much healthy tissue as possible. Anterior Tenon’s fascia is separated from the sclera. Blunt dissection in the four quadrants between the rectus muscles separates deep Tenon’s fascia.
Sutures may be passed through the rectus muscles before their disinsertion from the globe. Some surgeons also suture one or both oblique muscles. Traction sutures or clamps may be applied to the horizontal rectus muscle insertions to assist in rotating and elevating the globe during the ensuing dissection. Tenon’s capsule may be opened posteriorly to allow visualization of the optic nerve. The vortex veins and posterior ciliary vessels may be cauterized before dividing the nerve and removing the eye. Alternatively, the optic nerve may be localized with a clamp before transection. Hemostasis is achieved with either cautery or digital pressure.
The orbital implant is inserted at the time of enucleation. An appropriately sized implant should replace the volume of the globe and leave sufficient room for the ocular prosthesis. Enucleation implants are available in a variety of sizes that may be determined by using sizing implants or calculated by measuring globe volume or axial length of the contralateral eye.
In the past, spherical nonporous implants were placed in the intraconal space and the extraocular muscles were either left unattached or were tied over the implant. Wrapping these implants allows attachment of the muscles to the covering material, a technique that seems to improve implant movement and reduce the incidence of implant migration. Porous implants may be saturated with antibiotic solution before insertion. Because the brittle nature of hydroxyapatite prevents direct suturing of the muscles to the implant, these implants are usually covered with some form of wrapping material. The muscles are attached to the implant in a technique similar to that used for spherical non-porous implants. The muscles may be directly sutured to porous polyethylene implants either by passing the suture through the implant material or by using an implant with fabricated suture tunnels. Some surgeons also wrap porous polyethylene implants either to facilitate muscle attachment or to reduce the risk of implant exposure. A variety of wrapping materials have been used to cover porous implants, including polyglactin or polyglycolic acid mesh, heterologous tissue (bovine pericardium), homologous donor tissue (sclera, dermis), and autogenous tissue (fascia lata, temporalis fascia, posterior auricular muscle, rectus abdominis sheath). Fenestrations in the wrapping material are created at the insertion sites of the extraocular muscles, allowing the attached muscles to be in contact with the implant and improving implant vascularization. Drilling 1-mm holes into the implant at the muscle insertion sites is performed to facilitate vascularization of hydroxyapatite implants. Tenon’s fascia is drawn over the implant and closed in one or two layers. The conjunctiva is then sutured. A temporary ocular conformer is inserted at the completion of the pro- cedure and is worn until the patient receives a prosthesis 4 to 8 weeks after surgery. An elective secondary procedure is required to place the coupling peg or post in those patients who desire improved prosthetic motility. That procedure is usually delayed for at least 6 months after enucleation to allow time for implant vascularization. Technetium bone or gadolinium-enhanced magnetic resonance imaging scans are not now universally used, but they have been used to confirm vascularization before peg insertion. Under local anesthesia, a conjunctival incision is created at the peg insertion site. A hole is created into the porous implant to allow insertion of the peg or post. The prosthesis is then modified to receive the peg or post. Some surgeons have preplaced coupling posts in porous polyethylene implants at the time of enucleation. The post may spontaneously expose or is externalized in a later procedure via a conjunctival incision.
* Anesthesia
* Conjunctival peritomy
* Separation of the anterior Tenon’s fascia from the sclera
* Pass sutures through rectus muscles
* Rectus muscles disinserted from the globe
* Rotate and elevate the globe
* Open Tenon’s capsule to visualize optic nerve
* Cauterize necessary blood vessels
* Divide the nerve
* Remove the eye
* Hemostasis is achieved with either cautery or digital pressure.
* Insert orbital implant.
* If necessary (hydroxyapatite) cover the implant with wrapping material before
* Attach the muscle (if possible) either directly (PP) or indirectly (HA) to implant.
* Create fenerations in wrapping material if necessary
* For HA implants drill 1 mm holes as muscle insertion site
* Draw Tenon’s fascia over implant
* Close Tenon’s facia in one or two layers
* Suture conjunctiva
* Insert temporary ocular conformer until prosthesis is received (4–8 weeks later)
* After implant vascularization an optional secondary procedure can be done to place a couple peg or post.
Also under anesthesia
* Create conjunctival incision at the peg insertion site
* Create hole into implant to insert peg or post
* Modify prosthesis to receive peg/post.
The surgery is done under general anesthesia with the addition of extra subconjunctival and/or retrobulbar anesthetics injected locally in some cases. The following is a description of the surgical procedure performed by Custer et al.:[7]
The conjunctival peritomy is performed at the corneal limbus, preserving as much healthy tissue as possible. Anterior Tenon’s fascia is separated from the sclera. Blunt dissection in the four quadrants between the rectus muscles separates deep Tenon’s fascia.
Sutures may be passed through the rectus muscles before their disinsertion from the globe. Some surgeons also suture one or both oblique muscles. Traction sutures or clamps may be applied to the horizontal rectus muscle insertions to assist in rotating and elevating the globe during the ensuing dissection. Tenon’s capsule may be opened posteriorly to allow visualization of the optic nerve. The vortex veins and posterior ciliary vessels may be cauterized before dividing the nerve and removing the eye. Alternatively, the optic nerve may be localized with a clamp before transection. Hemostasis is achieved with either cautery or digital pressure.
The orbital implant is inserted at the time of enucleation. An appropriately sized implant should replace the volume of the globe and leave sufficient room for the ocular prosthesis. Enucleation implants are available in a variety of sizes that may be determined by using sizing implants or calculated by measuring globe volume or axial length of the contralateral eye.
In the past, spherical nonporous implants were placed in the intraconal space and the extraocular muscles were either left unattached or were tied over the implant. Wrapping these implants allows attachment of the muscles to the covering material, a technique that seems to improve implant movement and reduce the incidence of implant migration. Porous implants may be saturated with antibiotic solution before insertion. Because the brittle nature of hydroxyapatite prevents direct suturing of the muscles to the implant, these implants are usually covered with some form of wrapping material. The muscles are attached to the implant in a technique similar to that used for spherical non-porous implants. The muscles may be directly sutured to porous polyethylene implants either by passing the suture through the implant material or by using an implant with fabricated suture tunnels. Some surgeons also wrap porous polyethylene implants either to facilitate muscle attachment or to reduce the risk of implant exposure. A variety of wrapping materials have been used to cover porous implants, including polyglactin or polyglycolic acid mesh, heterologous tissue (bovine pericardium), homologous donor tissue (sclera, dermis), and autogenous tissue (fascia lata, temporalis fascia, posterior auricular muscle, rectus abdominis sheath). Fenestrations in the wrapping material are created at the insertion sites of the extraocular muscles, allowing the attached muscles to be in contact with the implant and improving implant vascularization. Drilling 1-mm holes into the implant at the muscle insertion sites is performed to facilitate vascularization of hydroxyapatite implants. Tenon’s fascia is drawn over the implant and closed in one or two layers. The conjunctiva is then sutured. A temporary ocular conformer is inserted at the completion of the pro- cedure and is worn until the patient receives a prosthesis 4 to 8 weeks after surgery. An elective secondary procedure is required to place the coupling peg or post in those patients who desire improved prosthetic motility. That procedure is usually delayed for at least 6 months after enucleation to allow time for implant vascularization. Technetium bone or gadolinium-enhanced magnetic resonance imaging scans are not now universally used, but they have been used to confirm vascularization before peg insertion. Under local anesthesia, a conjunctival incision is created at the peg insertion site. A hole is created into the porous implant to allow insertion of the peg or post. The prosthesis is then modified to receive the peg or post. Some surgeons have preplaced coupling posts in porous polyethylene implants at the time of enucleation. The post may spontaneously expose or is externalized in a later procedure via a conjunctival incision.
Implant types and chemical construction
Implant types and chemical construction
There are many different types of implants, classification ranging from shape (Spherical vs egg (oval) shaped), stock vs custom,[3] porous vs non porous, specific chemical make-up, and the presence of a peg or motility post. The most basic simplification can be to divide implant types into two main groups: nonintegrated (non-porous) and integrated (porous).[4]
[edit] Nonintegrated implants
Though there is evidence that ocular implants have been around for thousands of years (already cited reference 2) modern nonintegrated spherical intraconal implants came into existence around 1976 (not just glass eyes[3]).[5] Nonintegrated implants contain no unique apparatus for attachments to the extraocular muscles and do not allow in-growth of organic tissue into their inorganic substance. Such implants have no direct attachment to the ocular prosthesis.[4] Usually, these implants are covered with a material that permits fixation of the extraocular recti muscles, such as donor sclera or polyester gauze which improves implant motility, but does not allow for direct mechanical coupling between the implant and the artificial eye.[5] Non-integrated implants include the acrylic (PMMA[4]), glass, and silicone spheres.[6]
Polymethyl methacrylate (PMMA) (acrylic)
PMMA[4] is a transparent thermoplastic available for use as ocular prosthesis, replacement intraocular lenses when the original lens has been removed in the treatment of cataracts and has historically been used as hard contact lenses (see poly(methyl methacrylate)).
PMMA has a good degree of compatibility with human tissue, much more so than glass. Although various materials have been used to make nonintegrated implants in the past, polymethyl methacrylate (PMMA) is one of the implants of choice.[4]
[edit] Integrated implants (porous)
The porous nature of integrated implants allows fibrovascular ingrowth throughout the implant and thus also insertion of pegs or posts.[7] Because direct mechanical coupling is thought to improve artificial eye motility, attempts have been made to develop so-called ‘integrated implants’ that are directly connected to the artificial eye.[5] Historically, implants that directly attached to the prosthesis were unsuccessful because of chronic inflammation or infection arising from the exposed nonporous implant material.[7] This led to the development of quasi-integrated implants with a specially designed anterior surface that allegedly better transferred implant motility to the artificial eye through the closed conjunctiva and Tenon’s capsule.[5] In 1985, the problems associated with integrated implants were thought to be largely solved with the introduction of spherical implants made of porous calcium hydroxyapatite. This material allows for fibrovascular ingrowth within several months.[5] Porous enucleation implants currently are fabricated from a variety of materials including natural and synthetic hydroxyapatite, aluminum oxide, and polyethylene.
The surgeon can alter the contour of porous implants before insertion, and it is also possible to modify the contour in situ, although this is sometimes difficult.[7]
Hydroxyapetite (HA)
Hydroxyapatite implants are spherical and made in a variety of sizes and different materials (Coralline/ Synthetic/ Chinese).[6][7]
Since their introduction in 1989 when an implant made from hydroxyapatite received Food and Drug Administration approval, spherical hydroxyapatite implants have gained widespread popularity as an enucleation implant[5][7] and was at one point was the most commonly used orbital implant in the United States.[8][9] The porous nature of this material allows fibrovascular ingrowth throughout the implant and permits insertion of a coupling device (PEG) with reduced risk of inflammation or infection associated with earlier types of exposed integrated implants.[7]
hydroxyapatite is limited to preformed (stock[3]) spheres (for enucleation) or granules (for building up defects).[10]
One main disadvantage of HA is that it needs to be covered with exogenous material, such as sclera, polyethylene terephthalate, or vicryl mesh (which has the disadvantage of creating a rough implant tissue interface that can lead to technical difficulties in implantation and subsequent erosion of overlying tissue with the end stage being extrusion), as direct suturing is not possible for muscle attachment. Scleral covering carries with it the risk of transmission of infection, inflammation, and rejection.[8]
A recent study has shown that HA has a more rapid rate of fibrovascularization than Medpor.[8]
Porous polyethylene (PP)
MEDPOR is a high-density porous polyethylene (Medpor) [7] Implant manufactured from linear high-density polyethylene.[11][12] Development in polymer chemistry has allowed introduction of newer biocompatible material such as porous polyethylene (PP) to be introduced into the field of orbital implant surgery.[8] Porous polyethylene enucleation implants have been used since at least 1989.[7] It is available in dozens of prefabricated spherical and non-spherical shapes and in different sizes or plain blocks for individualized intraoperative customizing.[7] The material is firm but malleable and allows direct suturing of muscles to implant without wrapping or extra steps. Additionally, the smooth surface is less abrasive and irritating than other materials used for similar purposes.[10] Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.[7]
PP has been shown to have a good outcome, and in 2004, it was the most commonly used orbital implant in the United States.[8][13] Porous polyethylene fulfills several criteria for a successful implant, including little propensity to migrate and restoration of defect in an anatomic fashion; it is readily available, cost-effective, and can be easily modified or custom-fit for each defect.[10] The PP implant does not require to be covered and therefore avoids some of the problems associated with hydroxyapatite implants.[8]
Bioceramic
Bioceramic prosthetics are made of aluminum oxide (Al2O3). Aluminum oxide is a synthetic ceramic biomaterial that has been used for more than 35 years in the orthopedic and dental fields for a variety of prosthetic applications because of its low friction, durability, stability, and inertness.[14] Aluminum oxide ocular implants can be obtained in spherical and non-spherical (egg-shaped) shapes and in different sizes [7] for use in the anophthalmic socket The bioceramic implant is available in spherical and egg-shaped models for use in the anophthalmic socket. It received US Food and Drug Administration approval in April 2000 and was approved by Health and Welfare, Canada, in February 2001.[14]
Aluminum oxide has previously been shown to be more biocompatible than HA in cell culture studies and has been suggested as the standard reference material when biocompatibility studies are required to investigate new products. The rate of exposure previously associated with the bioceramic implant (2%) was less than most reports on the HA or porous polyethylene implant (0% to 50%).[14]
Conical orbital implant (COI) and multipurpose conical orbital implant (MCOI)
The safe and effective sphere (still popular and easy to use) was supplemented with the pyramid or COI implant.[10] The COI has unique design elements that have been incorporated into an overall conical shape, including a flat anterior surface, superior projection and preformed channels for the rectus muscles.[15] 5-0 Vicryl suture needles can be passed with slight difficulty straight through the implant to be tied on the anterior surface. In addition, this implant features a slightly recessed slot for the superior rectus and a protrusion to fill the superior fornix.[10]
The newest model is the multipurpose conical orbital implant, which was designed to address the issues of the postoperative anophthalmic orbit being at risk for the development of socket abnormalities including enophthalmos, retraction of the upper eyelid, deepening of the superior sulcus, backward tilt of the prothesis, and stretching of the lower eyelid.1 after evisceration or enucleation, These problems are generally thought to be secondary to orbital volume deficiencies which is also addressed by MCOIs. The conical shape of the multipurpose conical porous polyethylene orbital implant (MCOI) (Porex Medical) more closely matches the anatomic shape of the orbit than a spherical implant. The wider anterior portion, combined with the narrower and longer posterior portion, allows for a more complete and natural replacement of the lost orbital volume. This shape reduces the risk of superior sulcus deformity and puts more volume within the muscle cone.[16][17] Muscles can be placed at any location the surgeon desires with these implants. This is advantageous for cases of damaged or lost muscles after trauma, and the remaining muscles are transposed to improve postoperative motility. And in anticipation of future peg placement there is a 6-mm diameter flattened surface, which eliminates the need to shave a flat anterior surface prior to peg placement.[10]
Both implants (COI and MCOI) are composed of interconnecting channels that allow ingrowth of host connective tissue. Complete implant vascularization reduces the risk of infection, extrusion, and other complications associated with nonintegrated implants. And both implants produce superior motility and postoperative cosmesis.[10]
Pegged (motility post) implants
In hydroxyapatite implants a secondary procedure can insert an externalized, round-headed peg or screw into the implant. The prosthesis is modified to accommodate the peg, creating a ball-and-socket joint:[7] after fibrovascular ingrowth is completed, a small hole can be drilled into the anterior surface of the implant. After conjunctivalization of this hole, it can be fitted with a peg with a rounded top that fits into a corresponding dimple at the posterior surface of the artificial eye. This peg thus directly transfers implant motility to the artificial eye.[5] However, the motility peg is mounted in only a minority of patients. This may partially be the result of problems associated with peg placement, whereas hydroxyapatite implants are assumed to yield superior artificial eye motility even without the peg.[5]
Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.[7]
There are many different types of implants, classification ranging from shape (Spherical vs egg (oval) shaped), stock vs custom,[3] porous vs non porous, specific chemical make-up, and the presence of a peg or motility post. The most basic simplification can be to divide implant types into two main groups: nonintegrated (non-porous) and integrated (porous).[4]
[edit] Nonintegrated implants
Though there is evidence that ocular implants have been around for thousands of years (already cited reference 2) modern nonintegrated spherical intraconal implants came into existence around 1976 (not just glass eyes[3]).[5] Nonintegrated implants contain no unique apparatus for attachments to the extraocular muscles and do not allow in-growth of organic tissue into their inorganic substance. Such implants have no direct attachment to the ocular prosthesis.[4] Usually, these implants are covered with a material that permits fixation of the extraocular recti muscles, such as donor sclera or polyester gauze which improves implant motility, but does not allow for direct mechanical coupling between the implant and the artificial eye.[5] Non-integrated implants include the acrylic (PMMA[4]), glass, and silicone spheres.[6]
Polymethyl methacrylate (PMMA) (acrylic)
PMMA[4] is a transparent thermoplastic available for use as ocular prosthesis, replacement intraocular lenses when the original lens has been removed in the treatment of cataracts and has historically been used as hard contact lenses (see poly(methyl methacrylate)).
PMMA has a good degree of compatibility with human tissue, much more so than glass. Although various materials have been used to make nonintegrated implants in the past, polymethyl methacrylate (PMMA) is one of the implants of choice.[4]
[edit] Integrated implants (porous)
The porous nature of integrated implants allows fibrovascular ingrowth throughout the implant and thus also insertion of pegs or posts.[7] Because direct mechanical coupling is thought to improve artificial eye motility, attempts have been made to develop so-called ‘integrated implants’ that are directly connected to the artificial eye.[5] Historically, implants that directly attached to the prosthesis were unsuccessful because of chronic inflammation or infection arising from the exposed nonporous implant material.[7] This led to the development of quasi-integrated implants with a specially designed anterior surface that allegedly better transferred implant motility to the artificial eye through the closed conjunctiva and Tenon’s capsule.[5] In 1985, the problems associated with integrated implants were thought to be largely solved with the introduction of spherical implants made of porous calcium hydroxyapatite. This material allows for fibrovascular ingrowth within several months.[5] Porous enucleation implants currently are fabricated from a variety of materials including natural and synthetic hydroxyapatite, aluminum oxide, and polyethylene.
The surgeon can alter the contour of porous implants before insertion, and it is also possible to modify the contour in situ, although this is sometimes difficult.[7]
Hydroxyapetite (HA)
Hydroxyapatite implants are spherical and made in a variety of sizes and different materials (Coralline/ Synthetic/ Chinese).[6][7]
Since their introduction in 1989 when an implant made from hydroxyapatite received Food and Drug Administration approval, spherical hydroxyapatite implants have gained widespread popularity as an enucleation implant[5][7] and was at one point was the most commonly used orbital implant in the United States.[8][9] The porous nature of this material allows fibrovascular ingrowth throughout the implant and permits insertion of a coupling device (PEG) with reduced risk of inflammation or infection associated with earlier types of exposed integrated implants.[7]
hydroxyapatite is limited to preformed (stock[3]) spheres (for enucleation) or granules (for building up defects).[10]
One main disadvantage of HA is that it needs to be covered with exogenous material, such as sclera, polyethylene terephthalate, or vicryl mesh (which has the disadvantage of creating a rough implant tissue interface that can lead to technical difficulties in implantation and subsequent erosion of overlying tissue with the end stage being extrusion), as direct suturing is not possible for muscle attachment. Scleral covering carries with it the risk of transmission of infection, inflammation, and rejection.[8]
A recent study has shown that HA has a more rapid rate of fibrovascularization than Medpor.[8]
Porous polyethylene (PP)
MEDPOR is a high-density porous polyethylene (Medpor) [7] Implant manufactured from linear high-density polyethylene.[11][12] Development in polymer chemistry has allowed introduction of newer biocompatible material such as porous polyethylene (PP) to be introduced into the field of orbital implant surgery.[8] Porous polyethylene enucleation implants have been used since at least 1989.[7] It is available in dozens of prefabricated spherical and non-spherical shapes and in different sizes or plain blocks for individualized intraoperative customizing.[7] The material is firm but malleable and allows direct suturing of muscles to implant without wrapping or extra steps. Additionally, the smooth surface is less abrasive and irritating than other materials used for similar purposes.[10] Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.[7]
PP has been shown to have a good outcome, and in 2004, it was the most commonly used orbital implant in the United States.[8][13] Porous polyethylene fulfills several criteria for a successful implant, including little propensity to migrate and restoration of defect in an anatomic fashion; it is readily available, cost-effective, and can be easily modified or custom-fit for each defect.[10] The PP implant does not require to be covered and therefore avoids some of the problems associated with hydroxyapatite implants.[8]
Bioceramic
Bioceramic prosthetics are made of aluminum oxide (Al2O3). Aluminum oxide is a synthetic ceramic biomaterial that has been used for more than 35 years in the orthopedic and dental fields for a variety of prosthetic applications because of its low friction, durability, stability, and inertness.[14] Aluminum oxide ocular implants can be obtained in spherical and non-spherical (egg-shaped) shapes and in different sizes [7] for use in the anophthalmic socket The bioceramic implant is available in spherical and egg-shaped models for use in the anophthalmic socket. It received US Food and Drug Administration approval in April 2000 and was approved by Health and Welfare, Canada, in February 2001.[14]
Aluminum oxide has previously been shown to be more biocompatible than HA in cell culture studies and has been suggested as the standard reference material when biocompatibility studies are required to investigate new products. The rate of exposure previously associated with the bioceramic implant (2%) was less than most reports on the HA or porous polyethylene implant (0% to 50%).[14]
Conical orbital implant (COI) and multipurpose conical orbital implant (MCOI)
The safe and effective sphere (still popular and easy to use) was supplemented with the pyramid or COI implant.[10] The COI has unique design elements that have been incorporated into an overall conical shape, including a flat anterior surface, superior projection and preformed channels for the rectus muscles.[15] 5-0 Vicryl suture needles can be passed with slight difficulty straight through the implant to be tied on the anterior surface. In addition, this implant features a slightly recessed slot for the superior rectus and a protrusion to fill the superior fornix.[10]
The newest model is the multipurpose conical orbital implant, which was designed to address the issues of the postoperative anophthalmic orbit being at risk for the development of socket abnormalities including enophthalmos, retraction of the upper eyelid, deepening of the superior sulcus, backward tilt of the prothesis, and stretching of the lower eyelid.1 after evisceration or enucleation, These problems are generally thought to be secondary to orbital volume deficiencies which is also addressed by MCOIs. The conical shape of the multipurpose conical porous polyethylene orbital implant (MCOI) (Porex Medical) more closely matches the anatomic shape of the orbit than a spherical implant. The wider anterior portion, combined with the narrower and longer posterior portion, allows for a more complete and natural replacement of the lost orbital volume. This shape reduces the risk of superior sulcus deformity and puts more volume within the muscle cone.[16][17] Muscles can be placed at any location the surgeon desires with these implants. This is advantageous for cases of damaged or lost muscles after trauma, and the remaining muscles are transposed to improve postoperative motility. And in anticipation of future peg placement there is a 6-mm diameter flattened surface, which eliminates the need to shave a flat anterior surface prior to peg placement.[10]
Both implants (COI and MCOI) are composed of interconnecting channels that allow ingrowth of host connective tissue. Complete implant vascularization reduces the risk of infection, extrusion, and other complications associated with nonintegrated implants. And both implants produce superior motility and postoperative cosmesis.[10]
Pegged (motility post) implants
In hydroxyapatite implants a secondary procedure can insert an externalized, round-headed peg or screw into the implant. The prosthesis is modified to accommodate the peg, creating a ball-and-socket joint:[7] after fibrovascular ingrowth is completed, a small hole can be drilled into the anterior surface of the implant. After conjunctivalization of this hole, it can be fitted with a peg with a rounded top that fits into a corresponding dimple at the posterior surface of the artificial eye. This peg thus directly transfers implant motility to the artificial eye.[5] However, the motility peg is mounted in only a minority of patients. This may partially be the result of problems associated with peg placement, whereas hydroxyapatite implants are assumed to yield superior artificial eye motility even without the peg.[5]
Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.[7]
History-ocular prosthesis or artificial eye
The earliest known evidence of the use of ocular prosthesis is that of a woman found in Shahr-I Sokhta, Iran [1] dating back to 2900–2800 BCE.[2] It has a hemispherical form and a diameter of just over 2.5 cm (1 inch). It consists of very light material, probably bitumen paste. The surface of the artificial eye is covered with a thin layer of gold, engraved with a central circle (representing the iris) and gold lines patterned like sun rays. On both sides of the eye are drilled tiny holes, through which a golden thread could hold the eyeball in place. Since microscopic research has shown that the eye socket showed clear imprints of the golden thread, the eyeball must have been worn during her lifetime. In addition to this, an early Hebrew text references a woman who wore an artificial eye made of gold (Yer. Ned. 41c; comp. Yer. Sanh. 13c). Roman and Egyptian priests are known to have produced artificial eyes as early as the fifth century BCE constructed from painted clay attached to cloth and worn outside the socket.[3]
The first in-socket artificial eyes were made of gold with colored enamel, later evolving into the use of glass (thus the name "glass eye") by the Venetians in the later part of the sixteenth century. These were crude, uncomfortable, and fragile and the production methodology remained known only to Venetians until the end of the 18th century, when Parisians took over as the center for artificial eye-making. But the center shifted again, this time to Germany because of their superior glass blowing techniques. Shortly following the introduction of the art of glass eye-making to the United States, German goods became unavailable because of WWII. As a result, the US instead made artificial eyes from acrylic plastic.[3]
Modern ocular prosthetics has expanded from simply using glass into many different types of materials
Limits of realism
Ocularists and eye surgeons have always worked together to make the most realistic artificial eye. For decades, all efforts and investments to improve the appearance of artificial eye are neutralized by the immobility of the pupil. A solution to this problem has been demonstrated recently.[4] The device is based on a LCD which simulates the pupil size as a function of the ambiant light.
for more information
http://www.chnpress.com/news/?Section=2&id=6857
2 .
A 5,000-year-old golden artificial eye that once stared out mesmerisingly from the face of a female soothsayer or priestess in ancient Persia has been unearthed by Iranian and Italian archaeologists.
The eyeball — the earliest artificial eye found — would have transfixed those who saw it, convincing them that the woman — thought to have been strikingly tall — had occult powers and could see into the future, archaeologists said.
It was found by Mansour Sajjadi, leader of the Iranian team, which has been excavating an ancient necropolis at Shahr-i-Sokhta in the Sistan desert on the Iranian-Afghan border for nine years.
Italian archaeologists said yesterday that the prophetess had also been buried with an ornate bronze hand mirror, which she presumably used to check her “startling appearance”.
They said the eyeball consisted of a half-sphere with a diameter of just over an inch. It was made of a lightweight material thought to be derived from bitumen paste. Its surface was meticulously engraved with a pattern consisting of a central circle for the iris and gold lines “like rays of light”.
Lorenzo Costantini, leader of the Italian group, said the eyeball still had traces of the gold that had been applied in a thin layer over the surface. On either side of it two tiny holes had been drilled, through which a fine thread, perhaps also gold, had held the eyeball in place.
Costantini said the woman had been as tall as 6 feet, putting her head and shoulders above most other women of the time. Aged between 25 and 30, she had a high sloping forehead, a “determined” jutting chin and dark skin, suggesting that she was from Arabia. Farad Foruzanfar, an Iranian anthropologist, agreed that the woman’s height and her “Afri-canoid cranial structure” suggested that she came from the Arabian Peninsula.
“She must have been a very striking and exotic figure,” Costantini told Corriere della Sera. He said the team had initially thought the eyeball might have been placed in the woman’s eye at burial. But microscopic examination had found an imprint left on her eye socket by prolonged contact with the golden eye. The socket also bore the marks of the thread, further proving that she had worn the eyeball in life.
Sajjadi said the skeleton had been dated to between 2900 and 2800 BC, when Shahr-i-Sokhta was a bustling, wealthy city and trading post at the crossroads of East and West. He said the woman might have arrived with a caravan from Arabia. Shahr-i-Sokhta means “Burnt City”, a local name referring to the fact that it burnt down and was rebuilt three times during Persia’s turbulent history before being finally destroyed in 2000 BC — about the time that Stonehenge was erected. The archaeologists said it was not clear what caused the woman’s death.
Costantini said the articial eye was clearly not intended to mimic a real eye but had “a special purpose... It must have glittered spectacularly, conferring on the woman a mysterious and supernatural gaze”. This would have been effective for someone who claimed to see into the future, such as a soothsayer or oracle.
Analaysis suggested that the woman may have suffered from an abscess on her eyelid because of long-term contact with the golden eyeball.
The archaeologists earlier unearthed what is believed to be the oldest backgammon set in the world, with 60 pieces made of turquoise and agate and a rectangular ebony board, probably imported from India.
The first in-socket artificial eyes were made of gold with colored enamel, later evolving into the use of glass (thus the name "glass eye") by the Venetians in the later part of the sixteenth century. These were crude, uncomfortable, and fragile and the production methodology remained known only to Venetians until the end of the 18th century, when Parisians took over as the center for artificial eye-making. But the center shifted again, this time to Germany because of their superior glass blowing techniques. Shortly following the introduction of the art of glass eye-making to the United States, German goods became unavailable because of WWII. As a result, the US instead made artificial eyes from acrylic plastic.[3]
Modern ocular prosthetics has expanded from simply using glass into many different types of materials
Limits of realism
Ocularists and eye surgeons have always worked together to make the most realistic artificial eye. For decades, all efforts and investments to improve the appearance of artificial eye are neutralized by the immobility of the pupil. A solution to this problem has been demonstrated recently.[4] The device is based on a LCD which simulates the pupil size as a function of the ambiant light.
| 3rd Millennium BC Artificial Eyeball Discovered in Burnt City | |
 Skeleton of a woman having an artificial eye unearthed in Burnt City, southeast Iran | Discovery of an artificial eyeball belonging to 4800 years ago in the historic site of Burnt City has astounded archeologists. |
| Tehran, 10 December 2006 (CHN Foreign Desk) -- Archeologists in Burnt City announced unprecedented discovery of an artificial eyeball, dated to 4800 years ago, in this historic site. Announcing this news, director of Burnt City archeology excavation team, Mansour Sajadi, said that this eyeball belongs to a sturdy woman who was between 25 to 30 years of age at the time of death. Skeletal remains of the woman were found in grave number 6705 of Burnt City’s cemetery. Regarding the material used to make this artificial eyeball, Sajadi said: “The material this artificial eyeball is made of has not yet been determined and will be assessed through later testing. However, at first glance it seems natural tar mixed with animal fat has been used in making it.” Initial studies on the eyeball also suggest formation of an abscess in the eyelid due to long-term contact with the eyeball. Moreover, remaining eyelid tissues are still evident on this artificial eyeball. According to Sajadi, even the most delicate eye capillaries were drawn on this eyeball using golden wires with a thickness measuring less than half a millimeter. There are also some parallel lines around the pupil forming a diamond shape. Two holes are also seen on the sides of this eyeball to hold it in the eye socket. Initial anthropological studies on the remaining skeleton of the woman to which this artificial eyeball belong revealed that she was of mixed race and died 4800 years ago between the ages of 25 to 30. A number of clay vessels, ornamental beads, a leather sack, and a bronze mirror have also been found in the grave of this woman. Located 57 kilometers from the city of Zabol in Sistan va Baluchistan province, southeast Iran, Burnt City is one of the most important prehistoric sites of the country which was well developed during the third millennium BC. Spreading over a 300,000 hectare area, Burnt City was recently recognized as mainland-Iran’s largest prehistoric site. The city experienced four stages of civilization and was burnt down three times, which is why it was named ‘Burnt City.’ Discovery of hundreds of historical sites including 166 satellite villages together with large numbers of archeological relics, skeletons, and ancient structures in the archeological site of Burnt City makes it holder of an unparalleled record in the history of archeological activities in Iran. Maryam Tabeshian foreigndesk@chn.ir | |
http://www.chnpress.com/news/?Section=2&id=6857
2 .
5,000-Year-Old Artificial Eye Found on Iran-Afghan Border
Published February 20, 2007
London Times
The eyeball — the earliest artificial eye found — would have transfixed those who saw it, convincing them that the woman — thought to have been strikingly tall — had occult powers and could see into the future, archaeologists said.
It was found by Mansour Sajjadi, leader of the Iranian team, which has been excavating an ancient necropolis at Shahr-i-Sokhta in the Sistan desert on the Iranian-Afghan border for nine years.
Italian archaeologists said yesterday that the prophetess had also been buried with an ornate bronze hand mirror, which she presumably used to check her “startling appearance”.
They said the eyeball consisted of a half-sphere with a diameter of just over an inch. It was made of a lightweight material thought to be derived from bitumen paste. Its surface was meticulously engraved with a pattern consisting of a central circle for the iris and gold lines “like rays of light”.
Lorenzo Costantini, leader of the Italian group, said the eyeball still had traces of the gold that had been applied in a thin layer over the surface. On either side of it two tiny holes had been drilled, through which a fine thread, perhaps also gold, had held the eyeball in place.
Costantini said the woman had been as tall as 6 feet, putting her head and shoulders above most other women of the time. Aged between 25 and 30, she had a high sloping forehead, a “determined” jutting chin and dark skin, suggesting that she was from Arabia. Farad Foruzanfar, an Iranian anthropologist, agreed that the woman’s height and her “Afri-canoid cranial structure” suggested that she came from the Arabian Peninsula.
“She must have been a very striking and exotic figure,” Costantini told Corriere della Sera. He said the team had initially thought the eyeball might have been placed in the woman’s eye at burial. But microscopic examination had found an imprint left on her eye socket by prolonged contact with the golden eye. The socket also bore the marks of the thread, further proving that she had worn the eyeball in life.
Sajjadi said the skeleton had been dated to between 2900 and 2800 BC, when Shahr-i-Sokhta was a bustling, wealthy city and trading post at the crossroads of East and West. He said the woman might have arrived with a caravan from Arabia. Shahr-i-Sokhta means “Burnt City”, a local name referring to the fact that it burnt down and was rebuilt three times during Persia’s turbulent history before being finally destroyed in 2000 BC — about the time that Stonehenge was erected. The archaeologists said it was not clear what caused the woman’s death.
Costantini said the articial eye was clearly not intended to mimic a real eye but had “a special purpose... It must have glittered spectacularly, conferring on the woman a mysterious and supernatural gaze”. This would have been effective for someone who claimed to see into the future, such as a soothsayer or oracle.
Analaysis suggested that the woman may have suffered from an abscess on her eyelid because of long-term contact with the golden eyeball.
The archaeologists earlier unearthed what is believed to be the oldest backgammon set in the world, with 60 pieces made of turquoise and agate and a rectangular ebony board, probably imported from India.
ocular prosthesis or artificial eye
An ocular prosthesis or artificial eye (a type of Craniofacial prosthesis) replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. The prosthetic fits over an orbital implant and under the eyelids. Often referred to as a glass eye, the ocular prosthesis roughly takes the shape of a convex shell and is made of medical grade plastic acrylic. A few ocular prosthetics today are made of cryolite glass. A variant of the ocular prosthesis is a very thin hard shell known as a scleral shell which can be worn over a damaged eye. Makers of ocular prosthetics are known as ocularists. An ocular prosthetic does not provide vision; this would be a visual prosthetic. Someone with an ocular prosthetic is totally blind on the affected side and has monocular (one sided) vision which affects depth perception
Glossary of OCULAR PROSTHETICS
Anophthalmia
Absence of the eyeball
Adnexa (Ocular adnexa)
Tissues surrounding (the eye i.e. the eyelids, canthi, and lacrimal apparatus)
Alginate
Powdery product that solidifies within a minute after mixing with water to make a paste.
Bio integrated orbital implant
Orbital Implant that is allows body tissues to grow inside due to its porous nature
Canthus (Plural: Canthi)
Angle where upper and lower eyelids meet
Conformer
A concave plastic piece that is inserted following enucleation or evisceration or socket reconstruction surgery to retain the fornices. It has draining holes that do not allow pooling of secretion behind
Custom
Designed for the individual
Congenital
Present since birth
Cornea
The clear convex portion of the eyeball
Dermis Fat Graft
Tissue containing Dermis (a layer of skin) and Fat (adipose tissue) that is removed from one part of the body (usually buttock) to augment volume and add surface to the contracted socket.
Enucleation
Surgical procedure to remove the eyeball as done in cases of cancer of eye or badly damaged eye in trauma.
Evisceration
Surgical procedure to remove the inner contents of the eyeball and cornea leaving the outer coat of sclera.
Extrusion
Exposure of the inner structure/implant due to necrosis of overlying tissue.
Fornix (Plural: Fornices)
The peripheral space in the eye socket behind the eyelids.
Implant
An inert foreign or autogenous body that is put within living tissue.
Impression tray
A concave plastic tray that is place in the fornices and alginate material is instilled behind it to get an impression of the socket.
Integrated
A foreign body that has body tissue growing within.
Microphthalmos
Condition of having a smaller eyeball at the time of birth.
Mold
A replica of any space or cavity.
Mono ocular
Related to one eye.
Ocularist
Person trained in making and fitting custom artificial eye.
Ophthalmologist
Person having expert skills in diagnosis and treatment of eye disorders.
Ophthalmic plastics & reconstructive surgery
Repair work around the eyeball including the eyelids, socket and orbit.
Optician
A person trained in making and dispensing spectacles.
Optometrist
Person trained in examining the eye and related structure and prescribing eyeglasses, contact lenses and other optical aids.
Orbit
The Bony cavity housing the eye and related structures
Phthisis/phthisical
The damaged, shrunken eyeball with no visual potential.
Plastics
Repair work on the body tissue.
Polymethylmethacrylate (PMMA)
A special type of plastic that is very inert biologically and polymer of methacrylate.
Posterior surface
Back surface.
Protein deposits
Accumulation of biological material over the surface of the artificial eye.
Reconstruction Surgery
Repair of the damaged body structure by specialized surgical techniques.
Retinoblastoma
A kind of cancer arising from the inner layers of eye and if not treated in time can be fatal.
Superior sulcus defect
Hollow or depression under the eyebrow due to loss of the fatty tissue in the orbit
Absence of the eyeball
Adnexa (Ocular adnexa)
Tissues surrounding (the eye i.e. the eyelids, canthi, and lacrimal apparatus)
Alginate
Powdery product that solidifies within a minute after mixing with water to make a paste.
Bio integrated orbital implant
Orbital Implant that is allows body tissues to grow inside due to its porous nature
Canthus (Plural: Canthi)
Angle where upper and lower eyelids meet
Conformer
A concave plastic piece that is inserted following enucleation or evisceration or socket reconstruction surgery to retain the fornices. It has draining holes that do not allow pooling of secretion behind
Custom
Designed for the individual
Congenital
Present since birth
Cornea
The clear convex portion of the eyeball
Dermis Fat Graft
Tissue containing Dermis (a layer of skin) and Fat (adipose tissue) that is removed from one part of the body (usually buttock) to augment volume and add surface to the contracted socket.
Enucleation
Surgical procedure to remove the eyeball as done in cases of cancer of eye or badly damaged eye in trauma.
Evisceration
Surgical procedure to remove the inner contents of the eyeball and cornea leaving the outer coat of sclera.
Extrusion
Exposure of the inner structure/implant due to necrosis of overlying tissue.
Fornix (Plural: Fornices)
The peripheral space in the eye socket behind the eyelids.
Implant
An inert foreign or autogenous body that is put within living tissue.
Impression tray
A concave plastic tray that is place in the fornices and alginate material is instilled behind it to get an impression of the socket.
Integrated
A foreign body that has body tissue growing within.
Microphthalmos
Condition of having a smaller eyeball at the time of birth.
Mold
A replica of any space or cavity.
Mono ocular
Related to one eye.
Ocularist
Person trained in making and fitting custom artificial eye.
Ophthalmologist
Person having expert skills in diagnosis and treatment of eye disorders.
Ophthalmic plastics & reconstructive surgery
Repair work around the eyeball including the eyelids, socket and orbit.
Optician
A person trained in making and dispensing spectacles.
Optometrist
Person trained in examining the eye and related structure and prescribing eyeglasses, contact lenses and other optical aids.
Orbit
The Bony cavity housing the eye and related structures
Phthisis/phthisical
The damaged, shrunken eyeball with no visual potential.
Plastics
Repair work on the body tissue.
Polymethylmethacrylate (PMMA)
A special type of plastic that is very inert biologically and polymer of methacrylate.
Posterior surface
Back surface.
Protein deposits
Accumulation of biological material over the surface of the artificial eye.
Reconstruction Surgery
Repair of the damaged body structure by specialized surgical techniques.
Retinoblastoma
A kind of cancer arising from the inner layers of eye and if not treated in time can be fatal.
Superior sulcus defect
Hollow or depression under the eyebrow due to loss of the fatty tissue in the orbit
Thursday, December 2, 2010
Ocular prosthesis (artificial eyes) camp in chennai
Ocular prosthesis (artificial eyes) camp in chennai
Dear friends,
For the first time in INDIA we are going to organize a camp for people with blindness in one eye(lost one eye). You can get free consultation by an experienced ocularist regarding fitting an artificial eye which enhances your cosmesis.
ARTIFICIAL EYE CAMP
Date : January 2, 2011
Venue :DARSHAN ART GALLERY
D 9 , Anand Apartments
Thiruvanmiyur
Chennai
Near by HOTEL BHARANI , opp to Jayanthi theatre
Please make prior registration through email or phone before 28th December, 2010
For details:
Contact email : eyecareandartificialeyes@gmail.com
Mobile :+91- 9003262021
For the first time in INDIA we are going to organize a camp for people with blindness in one eye(lost one eye). You can get free consultation by an experienced ocularist regarding fitting an artificial eye which enhances your cosmesis.
ARTIFICIAL EYE CAMP
Date : January 2, 2011
Venue :DARSHAN ART GALLERY
D 9 , Anand Apartments
Thiruvanmiyur
Chennai
Near by HOTEL BHARANI , opp to Jayanthi theatre
Please make prior registration through email or phone before 28th December, 2010
For details:
Contact email : eyecareandartificialeyes@gmail.com
Mobile :+91- 9003262021
Dear friends,
For the first time in INDIA we are going to organize a camp for people with blindness in one eye(lost one eye). You can get free consultation by an experienced ocularist regarding fitting an artificial eye which enhances your cosmesis.
ARTIFICIAL EYE CAMP
Date : January 2, 2011
Venue :DARSHAN ART GALLERY
D 9 , Anand Apartments
Thiruvanmiyur
Chennai
Near by HOTEL BHARANI , opp to Jayanthi theatre
Please make prior registration through email or phone before 28th December, 2010
For details:
Contact email : eyecareandartificialeyes@gmail.com
Mobile :+91- 9003262021
For the first time in INDIA we are going to organize a camp for people with blindness in one eye(lost one eye). You can get free consultation by an experienced ocularist regarding fitting an artificial eye which enhances your cosmesis.
ARTIFICIAL EYE CAMP
Date : January 2, 2011
Venue :DARSHAN ART GALLERY
D 9 , Anand Apartments
Thiruvanmiyur
Chennai
Near by HOTEL BHARANI , opp to Jayanthi theatre
Please make prior registration through email or phone before 28th December, 2010
For details:
Contact email : eyecareandartificialeyes@gmail.com
Mobile :+91- 9003262021
Monday, August 23, 2010
Ocularist India-- Celia Vinny (L V Prasad Eye Institute)
Celia Vinny- L V Prasad Eye Institute
Celia Vinny-Ocularist
Kerala India –Celia Vinny Ocularist
Ocular Prosthesis Clinic
L V Prasad Eye Institute
Banjara Hills
Hyderabad – 500 034
AP, India
Ph: +91-92934 50467
L V Prasad Eye Institute
Banjara Hills
Hyderabad – 500 034
AP, India
Ph: +91-92934 50467
Email:vinnycelia@gmail.com
Completed Bsc optometry at Arupadai veedu medical college, Pondicherry(Vinayaka Mission University,Salem)
Fellowship in Clinical Optometry at L V Prasad Eye Institute, Hyderabad.
Completed apprenticeship in ocularistry at L V Prasad Eye Institute, Hyderabad.
Mob: 09288708707, Resi: 04842617311, E mail: vinnycelia@gmail.com
Thursday, July 29, 2010
Raju Kumar- Ocularist
Hyderabad, India – Raju Kumar
Raju Kumar
Raju Kumar- Ocularist
Address:
LV Prasad Eye Institute,
Hyderabad, India
BSC in optometry Kolkata
FLVPEI
Optometrist/ocularist
Lv prasad eye institute hyderabad
email-rkumaropto@gmail.com
rkumarocularist@gmail.com
mob-9705931841
Tuesday, June 8, 2010
ocularist
What is an ocularist?
An ocularist is a carefully trained technician skilled in the arts of fitting, shaping, and painting ocular prostheses. In addition to creating it, the ocularist shows the patient how to handle and care for the prosthesis, and provides long-term care through periodic examinations.
How long have artificial eyes been around?
Artificial eye-making has been practiced since ancient times. The first ocular prostheses were made by Roman and Egyptian priests as early as the fifth century B.C. In those days, artificial eyes were made of painted clay attached to cloth and worn outside the socket.
It took many centuries for the first in-socket artificial eyes to be developed. At first, these were made of gold with colored enamel. Then, in the later part of the sixteenth century, the Venetians started making artificial eyes out of glass. These early glass eyes were crude, uncomfortable to wear, and very fragile. Even so, the Venetians continued making them and kept their methods secret until the end of the eighteenth century. After that, the center for artificial eye-making shifted to Paris for a time; but by the mid-nineteenth century, German glass-blowers had developed superior techniques, and the center for glass eye-making moved to Germany.
Shortly thereafter, glass eye-making was introduced in the United States. During World War II, the imported German glass used for glass prostheses became unavailable in this country. As a result of this shortage, the U.S. Government, in conjunction with a number of American firms, popularized the techniques for making artificial eyes out of acrylic plastic.
The popularity of this method has continued to increase over the years, and today the vast majority of patients wear ocular prostheses made of acrylic.
What's the difference between "stock" and "custom" eyes?
"Stock" or "ready-made" ocular prostheses are mass-produced. Since a "stock eye" is not made for any particular person, it doesn’t fit any particular patient. A "custom" ocular prosthesis, on the other hand, is made by your ocularist to fit you and you alone.
How often do you have to see an ocularist?
The ocular prosthesis, like hard contact lenses, needs to be polished regularly in order to restore the acrylic finish and insure the health of the surrounding tissues. It is generally recommended that infants under 3 years of age be seen every 3 months; patients under 9 twice yearly, and all other patients at least once a year.
Does medical insurance pay for artificial eyes?
If insurance coverage is available, most ocularist offices will assist you in every possible way to obtain full benefits of your policy. However, it should be noted that the patient, or in the case of children, a parent or guardian is always responsible for payment...and in the case of HMO'S it is always necessary to obtain a referral before work can begin.
What is the American Society of Ocularists?
The American Society of Ocularists (ASO) is a professional organization which was established by a group of skilled American ocularists in 1957. Their purpose was to promote high standards through research and education in the field of ophthalmic prosthetics. Today the ASO maintains quality ocularistry through its formal education, training and continuing education programs.
How do I find a good ocularist?
In most states, there are no laws governing ocularists. When choosing an artificial eyemaker, you should consult your state regulations and look for the following credentials:
Membership in the American Society of Ocularists
Certification by the National Examining Board of Ocularists
How does a person learn to become an ocularist?
There are no schools that teach ocularistry. A person must learn how to make artificial eyes through an apprenticeship with an approved ocularist (a Board Approved Diplomate Ocularist). The ASO Apprentice Program requires that the apprentice must study all aspects of ocular prosthetics, and spend five years (10,000 hours) in practical training. The apprentice must also successfully complete 750 credits of related study courses offered by the Education Program of the ASO. Upon successful completion of all requirements, the title, Diplomate of the American Society of Ocularists, is awarded.
Does the Society arrange apprenticeships?
Apprenticeships are not arranged by the American Society of Ocularists. A person seeking training must contact ocularists in their area and locate someone who is able to hire and train an apprentice. For people willing and able to relocate, we suggest attending one of the bi-annual conferences to meet ocularists from different parts of the country.
Can I apprentice with any ocularist?
To qualify for the Society’s apprenticeship program, you must train with a Board Approved Diplomate Ocularist (BADO).
I already make artificial eyes. Do I have to become an apprentice?
Persons who are already working as ocularists may apply to the Society’s Associate program.
Aren’t there classes I can take somewhere to learn to become an ocularist?
The American Society of Ocularists is the only organization that offers educational training in ocularistry. Classes are offered at the Society’s bi-annual meetings, and are designed to prepare ocularists to take their certification exams.
I’m in school now. What courses should I take to increase my chances of becoming an apprentice?
The sciences provide a good base, in addition to taking extensive courses in art, sculpting, communicative skills and applied psychology.
Who certifies ocularists?
The National Examining Board of Ocularists (NEBO) is an independent entity whose directors come from the following participating organizations:
American Academy of Ophthalmology
American Board for Certification of Orthotics and Prosthetics
American Society of Ocularists
Canadian Society of Ocularists
Public Member
NEBO awards the title, Board Certified Ocularist (BCO), to those ocularists who successfully complete a comprehensive two-part written and practical examination. All BCOs must complete continuing education requirements and be recertified by NEBO every six years.
Wednesday, June 2, 2010
Chinmaya Ocular prosthetics, New Delhi
Chinmaya Ocular prosthetics, New Delhi
Chinmaya Ocular prosthetics, New Delhi
Postal Address :
Chinmaya Prosthetics Center,
28, Bhera Enclave, Outer Ring Road,
Paschim Vihar,
New Delhi,
India.
PIN : 110087
Phone Number : 91-011-25274842
91-011-25282864
Office Hours: Monday – Saturday
10 am – 6 pm
Diwakar Raj Ocularist
India -Ocularists in India
* Chennai, India -Diwakar Raj Ocularist
Chennai, India -Diwakar Raj Ocularist
Diwakar Raj ( Ocularist)
Address :
Sankara Nethralaya Hospital
2/34, Elephant Tank First Street, Royepettah,
Chennai – 600014 Tamil Nadu, India
Phone : +91-9884056003
E-mail : diwakarrj@gmail.com
Languages : Tamil, English, Hindi, Bengali
Areas of Interest/Specialty:
Anaplastology, Ocularistry, Research in rehabilitation
Ocular prosthesis,
facial prosthesis,
scleral shell,
acrylic shells,
spectacle prosthesis,
stock ocular prosthesis
Education/Credentials/CertificationTraining given for ocular prosthesis in India.
Attended Indo, Israel conference of oculoplasty 2005
Training Ocular Prosthesis from Sankara Nethralaya
Attended West Bengal conference of opthalmology 2007,
Training for facial prosthesis, Diploma in dental technician, Diploma in optometry
Visit to Kuwait for providing ocular prosthesis service at Ministry of Health, Kuwait.
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