Human Eye Conditions

• Anatomy of the eye
• 3 types of eye removal
• Orbital eye implants
• Possible conditions leading to an artificial eye
• Possible conditions leading to a scleral shell
• Eye care specialists
• Leading causes of eye loss in children

Whats is artificial eye ?

In the present scenario, where over millions of citizens are affected by visual anomalies, it was with a challenge that this project came into being.

•Introduction
•What is artificial eye?
•The History of Artificial Eyes
•How eyes work?
•Visual System
•The Manufacturing Process
•The eye
•Human Eye Conditions
•Three Types of Eye Removal
•Possible Conditions Leading to an Artificial Eye
•Conclusion and Future Scope
•References

Artificial Eye Lens

The artificial lens, which is usually made from state-of-the-art acrylic, silicone or polymethylmethacrylate, is placed inside the lens capsule

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Ocular Prosthesis and Artificial Eye

Ocular Prosthesis from Fahmida Hoque

Ocular Prosthesis Ophthalmic horizon Published on September 2016

   1.OCULAR PROSTHESIS: 

AN ESSENTIAL COSMETIC MANAGEMENT Prof. Munirujzaman Osmani

    2. BACKGROUND 

The ocular prosthetic device is very important to provide the best possible functional & cosmetic results. • It is important to have a firm understanding of management of the anophthalmic socket, and when to make appropriate referrals to the ophthalmic surgeon.

    3. SURGICAL PROCEDURES 

To understand & manage the complications associated with prosthetic eye wear, eye care professionals first must understand anophthalmic procedures. There are three main surgical techniques used in the partial or complete removal of the eye: • Enucleation, • Evisceration, & • Exenteration.

    4. ENUCLEATION 

It is the complete removal of the globe, along with a portion of the optic nerve, while maintaining the surrounding orbital tissue. INDICATION:  Intraocular malignancy include – • Retinoblastomas & • Uveal melanomas  Phthisical eyes of unknown etiology.  Severely ruptured globe.

    5. EVISCERATION

 It involves the surgical removal of the contents of globe, while preserving the sclera, extraocular muscles & optic nerve. INDICATION:  Painful blind eyes found in end stage of – • Chronic uveitis or • Neovascular glaucoma, and • Corneal perforation.  Endophthalmitis

    6. EXENTERATION 

It is a procedure involving removal all of the tissues within the entire orbit, typically including the conjunctiva, globe, orbital fat, part or all of the lids & sometimes a portion of the bony orbit. INDICATION: • Large, highly invasive orbital tumors • Malignant tumors involving the orbit from –  Eyelids,  Conjunctiva,  Intraocular structures

    7. GOALS 

The short term goals after both enucleation & evisceration are • deep fornices • healthy conjucntiva, • a normal appearance of the lid.

    8. THE CONFORMER 

 Made of either acrylic or silicone • It is left in the conjunctival fornices for 4-6 weeks • Helps to fit the prosthesis • Helps to stabilize the implant during the healing process • Reduces the risk of tissue contracture of an anophthalmic socket.

    9. ORBITAL IMPLANTS

 Orbital implants are typically made of either non- porous or porous materials.

    10. NONPOROUS ALLOPLASTIC IMPLANTS 

 Silicone & polymethyl methacrylate (PMMA) .  Solid, spherical implant that are well tolerated, POROUS MATERIAL  More commonly used  Material: porous polyethylene, hydroxyapatite & aluminum oxide.  Due to the porous nature of these materials, fibrovascular ingrowth occurs, allowing for improved implant stability & decreases rejection risk.

    11. TYPES OF OCULAR PROSTHESIS 

• BASED ON THICKNESS: • BASED ON FABRICATION:

 Prosthetic eye Prosthetic shell Thickness more than 1.5 mm Thickness less than 1.5mm Ready made Custom made Advantage:  Inexpensive  Time limitation exists Disadvantage:  Ill fitting  Improper shade matching • Increases the adapting with movement of the eyeball as well as fitting • Exactly matches the iris position as that of the adjacent natural eye

    12. FABRICATION OF OCULAR PROSTHESIS

 • Six to eight weeks after surgery, an ocular prosthesis can be fitted. • A prosthetic device can be fabricated in two forms, • A scleral shell -- fit over a phthisical eye • A full thickness prosthesis -- fit over the anophthalmic socket.
    13. • Prosthetic devices can be fit either from a stock set of pre- fabricated eyes or can be custom made. • Custom made prosthetic eye is preferred to increase stability & aid in movement. • The fitting method chosen is upon the ocularist. • One of the most common fitting techniques is the impression fitting.

    14. IMPRESSION FITTING 

Injecting alginate material directly into the patient’s orbit using an impression tray. • The substance hardens & removed from the orbit, • Adjusted to form the front surface of the device using wax.

    15. • The mold is filled with methyl- methacrylate resin that is liquid acrylic. • The mold is heat treated to harden the liquid. • After this stage, the device is hand painted to reflect the unaffected eye. • The iris & pupil positioned taking into account the appearance of the fellow eye. • It is recommended that the patient should see the ocularist every six months for polishing & adjustments to the device at least annually. • Removal of prosthetic device is similar in fashion to the removal of a hard contact lens. polishing contouring

    16. Ocular prosthesis in CEITC, Bangladesh

    17. In 45 study patients, commonly performed surgical procedures listed in a table (n = 45)

    18. COMPLICATION 

The common complications include • discharge, • dry eye, • discomfort, • implant exposure, • pain, • ptosis, • lid laxity, • expulsion, • Adhesions , & • problem associated with the peg.
    19. According to the study held in 2015, CEITC; The major complications of prosthetic eye wearer who followed up in the hospital are given below in a bar diagram

    20. CONCLUSION 

To provide the patient with the most comprehensive eye care, the most important procedure – • Is removal of the device for inspection of the tissue & prosthesis, • Treat the underlying tissue disorders • Refer to the appropriate specialist.
    21. LITERATURE REVIEW

    22. ANOPHTHALMIA 

Anophthalmia is absence of globe • It may be congenital or acquired.

    23. CONGENITAL ANOPHTHALMIA 

Very rare condition • Optic vesicle fails to develop • Causes: • Idiopathic/ sporadic • Inherited as dominant, recessive or sex- linked • Maternal exposure or teratogenic infection

    24. OCULAR FINDING 

Orbital findings: Small orbital rim & entrance Reduced size of bony orbital cavity Extra ocular muscles usually absent Lacrimal gland may be absent Small & maldeveloped optic foramen • Eyelid findings: Foreshortening of the lids in all directions Absent or decreased levator function with decreased lid folds Contraction of orbicularis oculi muscle Shallow conjunctival fornix, especially inferiorly

    25. ACQUIRED ANOPHTHALMIA 

 After enucleation, evisceration or exenteration.

    26. IDEAL ANOPHTHALMIC SOCKET

 1. Centrally placed, well- covered, buried implant of adequate volume. 2. Fabricated from a bio- inert material. 3. Socket lined with healthy conjunctiva. 4. Fornices deep enough to retain a prosthesis 5. Eyelids with normal position & appearance, & adequate tone to support a prosthesis 6. Normal position of the eyelashes & eyelid margin 7. A comfortable ocular prosthesis that looks similar to the sighted, contralateral globe & in the same horizontal plane.

    27. ADVANTAGES OF EVISCERATION OVER ENUCLEATION: 

 Less disruption of orbital anatomy • Good motility of prosthesis • Lower rate of migration, extrusion & reoperation.

    28. Changes associated with anophthalmia

    29. POST ENUCLEATION SOCKET SYNDROME 

Introduced by Tyler's & Collin • Sequelae of an enucleation are orbital volume deficiency & changes in the orbital soft tissue architecture leading to the clinical picture of “POST- ENUCLEATION SOCKET SYNDROME (PESS)”. • CLINICAL FEATURES:  Enophthalmos  An upper eyelid sulcus deformity  Ptosis or eyelid retraction  Laxity of the lower eyelid  A backward tilt of the ocular prosthesis.

    30. MANAGEMENT 

1. Orbital volume replacement a) Secondary implant (intraconal) if no implant was placed at the time of primary surgery b) Orbital floor implant c) Dermis fat graft to upper sulcus (option in patients with associated surface contracture) 2. Lower lid tightening a) Lateral canthal sling b) Medial canthal reconstruction c) Fascial sling 3. Correction of shallow lower fornix Fornix deepening sutures 4. Ptosis correction

    31. IDEAL ORBITAL IMPLANT 

Maintain natural Lid shape • Light weight • Porosity • Natural biocompatibility • Non toxic & non allergic. COMPLICATION OF IMPLANT: Exposure & Extrusion of implant: • Implant exposure may occur with any type of implant or at any time may lead to implant extrusion or explantation. • Porous orbital implants have a lower incidence of implant exposure than traditional non porous implants.

    32. PREDISPOSING FACTORS OF EXPOSURE OF IMPLANT 

Closing the wound under tension 2. Poor wound closure techniques 3. Infection 4. Mechanical or inflammatory irritation from the speculated surface of the porous implant 5. Delayed ingrowth of fibrovascular tissue with subsequent tissue breakdown

    33. PREVENTIVE MEASURE FOR IMPLANT EXPOSURE 

Proper placement of the implant within the orbit followed by a two- layered closure of anterior Tenon’s capsule & conjunctiva • The rectus muscles are then attached to the wrapped implant. TREATMENT: if few weeks, • No infection, simple reclosure or with a patch graft (e.g. sclera, temporalis fascia) is required. • If infection is suspected & treated vigorously with topical & systemic antibiotics, an extrusion & removal of the implant may be avoided.

    34. Beyond 4-6 months, 

If non porous implant, the defect should not be closed, & secondary orbital implant surgery should be arranged. • If porous, exposure < 3 mm >3 mm Treat conservatively Wait 8 weeks for spontaneous closure no Closure with scleral patch graft • Surgical repair is indicated • Using scleral patch graft or temporalis fascia patch graft
    35. THANK YOU Next case presentation by DR. BURHAN UDDIN Topic: THYROID ORBITOPATHY

Artificial Eye

Artificial eye from Rakesh Mairembam

    How eye work?
    Disease related to eye Artificial Eye
   What is Artificial Eye?
   Component
   Working
   Working Diagram
    Image Identification
    Normal and artificial vision Limitations
    Future

    How eyes work?

 The light coming from an object enters the eye through cornea and pupil. The eye lens converges these light rays to form a real, inverted and diminished image on the retina. The light sensitive cells of the retina gets activated with the incidence of light and generate electric signals. These electric signals are sent to the brain by the optic nerves and the brain interprets the electrical signals in such away that we see an image which is erect and of the same size as the object. ECE Dept. M.I.T. Manipur 3

    DISEASE RELATED TO EYE 

Age-related macular degeneration (AMD) ECE Dept. M.I.T. Manipur 4


        IT WOULD BE BETTER TO TELL - “WE SEE WITH OUR BRAINS THAN WITH OUR EYES” THE SOLE PRINCIPLE USED TO VISIONISE A BLIND IS “DECEIVING OUR BRAINS”

    7. • Form of neural prosthesis to restore vision. • An externally worn camera and a retinal implanted chip makes it possible. • It is often usable for those who suffers from age-related macular degeneration (AMD) or retinal pigmentosa. What is artificial eye? ECE Dept. M.I.T. Manipur 7
    8. Component Digital camera Video- processing unit Radio transmitter Radio receiver Retinal implant ECE Dept. M.I.T. Manipur 8
    9. Digital Camera • The camera used for this is the CMOS image sensor. • The camera captures the image and converts it into pixels of black and white. • This camera is placed on the goggles. • The battery required for this is provided from the video processing unit. ECE Dept. M.I.T. Manipur 9
    10. Video Processing Unit • Video Processing Unit acts as a optogenic transducer unit which simplifies the image as spots of light and then reduces the image to the number of photodiodes. • This is connected to goggles through router. • This unit majorly consists of • Video decoder • Video scaler • DSP processor • Video processor ECE Dept. M.I.T. Manipur 10
    11. Retinal implant • Electrode implantation is one of the most critical jobs in this artificial vision system • The first step done in this electrode implantation is perforating a platinum foil with each hole having a diameter of 3mm • 68 flat platinum electrodes of 1mm diameter are pierced through the holes into the nucleus of neurons of the occipital lobe ECE Dept. M.I.T. Manipur
    12. Continued……. • Each electrode is connected by separate Teflon insulated wire to a connector contained in the pedestal • The group of wires pass the electrical impulses which are generated by the processor • When the electrode is stimulated by the processor by sending an electrical impulse, the electrode produces closely spaced phosphene (light spots seen by visual field) • By sending the electrical impulses in different combinations and permutations the phosphene can be created in a regular fashion describing the image ECE Dept. M.I.T. Manipur 12
    13. Camera on glasses views image Signals are sent to video processing microchip Processed information is sent back to receiver Receiver sends information to electrodes in retinal implant Electrodes stimulate retina to send information to brain ECE Dept. M.I.T. Manipur 13
    14. Video Camera Video processing unit Receiver Retinal ImplantNeuronsBrains ECE Dept. M.I.T. Manipur 14
    15. By using this technology the person can read large letters or identify the objects before him. ECE Dept. M.I.T. Manipur 15
    16. Normal vision- Begins when light enters and strike on photoreceptor cells. These cells convert light to electric impulses that are sent to brain via optic nerves. Artificial vision- The camera captures images and sends to retina implant. It stimulates neurons. The stimulated neurons send information to brain via optic nerves. ECE Dept. M.I.T. Manipur 16
    17. Surgery is required to implant the electrode array. Repairing is difficult if any of the devices got damaged. Those who lost their visions due to other reasons could not use this device. The approximated cost of the device is $70,000 ECE Dept. M.I.T. Manipur 17
    18. ECE Dept. M.I.T. Manipur 18
    19. Revolutionary piece of technology. Good news for AMD and retinal pigmentosa patients ECE Dept. M.I.T. Manipur 19
    20. • www.howstuffworks.com • Chandu Gude,"Bionic Eye", Scribd, 2009. • www.wikipedia.org • www.sciencedaily.com • www.electrooptic.com ECE Dept. M.I.T. Manipur 20
    21. ECE Dept. M.I.T. Manipur 22

Artificial Eye Cost

The price of a single prosthetic eye in India can be around Rs 15,000 to Rs 30,000 and above. However, the cost of the surgery also gets counted in. 

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ARTIFICIAL EYE

 

 

artificial eye from Rajeshwari Raji

ARTIFICIAL EYE

this is technology developed for who are suffering from blindness
  There are 10 billion people in the US who are blind or facing blindness due to diseases of the retina… and there’s little that can be done for them. • For the vast majority, their best hope is through prosthetic devices. • The U.S. Food and Drug Administration (FDA) has granted market approval to an artificial retina technology, the first bionic eye to be approved for patients in the U.S.

INTRODUCTION

    Scientists claim to have developed a new revolutionary bionic eye that enables blind people to read letters and simple words. • In the mid-20th century, researchers began to explore the idea of creating an artificial eye which could actually see.

    ARTIFICIAL EYE? 

An artificial eye is a prosthesis which is used to replace a missing or damaged eye. • In order to accomplish the goal of creating a visual prosthesis, scientists had to develop a camera which could interact with the brain by stimulating the optic nerve.
  

HOW BRAIN WORKS AFTER SEEING AN IMAGE? 

After seeing an image the brain takes information from the outside world and encodes it in patterns of electrical activity. • After the creating pattern the brain get an visualization of an image. That can we actually seeing the image from our eyes.
   In damaged or dysfunctional retina, the photoreceptors stop working, causing blindness • The absence of effective therapeutic remedies for retinitis pigmentosa (RP) and age-related macular degeneration (AMD)

     ARGUS-II DEVICE 

The Argus II Retinal Prosthesis System (“Argus II”) is the world’s first approved device intended to restore some functional vision for people suffering from blindness. transmits images from a small, eye-glass- mounted camera wirelessly to a microelectrode array implanted on a patient’s damaged retina.
  

PARTS OF ARGUS II DEVICE

 The System has three parts: • a small electronic device implanted in and around the eye, • a tiny video camera attached to a pair of glasses, • and a video processing unit that is worn or carried by the patient.

       HOW ARGUS II DEVICE WORKS?

 The patient wears glasses with an attached video camera that captures images of the surrounding area.
    These images become an electrical signal which is processed by the video processing unit. The signal is then wirelessly delivered to the eye stimulating the retina
    This electrical stimulation of the retina is recognized by the brain as spots of light.

    When is it used? 

The Argus II Retinal Prosthesis System is intended for patients aged 25 years • and older with bare or no light perception vision caused by advanced retinitis pigmentosa

    RESULTS OF THIS SYTEM 

identify the location or movement of objects and people; • recognize large letters, words, or Sentences. • and helped in other activities of daily life, such as detecting street curbs and walking on a sidewalk without stepping off.

 Support for argus ii device

Three government organizations provided support for the development of the Argus II. The Department of Energy, National Eye Institute at the National Institutes of Health and the National Science Foundation collaborated to provide grant funding totaling more than $100 million, support for material design and other basic research for the project.

  Advantages 

ability to perform visual tasks demonstrated in many patients • Upgradable external hardware and software to benefit from future innovations • the brain has an amazing ability to adapt to new input and to improve his or her understanding of what is being “seen” via an artificial vision system.

   Disadvantages 

The cost of device is too high( $1500)
It is difficult to acquire this technology by common man.
   

Artificial Eyelashes

False eyelashes (sometimes called eyelash extensions) are worn by women (occasionally men) to thicken the upper eyelashes

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