1-Corrective Eye Surgery
Until contact lenses were popularized in the 1950s, eyeglasses for at least the past seven centuries had been the only practical way to correct refractive vision errors.
Now, several modern approaches to corrective eye surgery range from laser reshaping of the eye's surface in procedures such as LASIK and PRK to surgical insertion of artificial lenses to correct eyesight.
In LASIK, PRK, and similar procedures, laser energy reshapes the curvature of the eye's clear front surface (cornea) to alter the way light rays enter the eye. Artificial lenses surgically inserted into the eye also can refocus light rays to sharpen vision.
The Evolution of Corrective Eye Surgery
Over the past 25 years, surgical techniques, tools, and procedures for vision correction have evolved rapidly.
Radial Keratotomy (RK), used in the United States primarily during the 1980s, involved cutting spoke-like incisions to flatten the eye's surface mainly to correct nearsightedness.
But results, especially long-term, created problems for some individuals. Significant glare, regression, fluctuating vision, and other side effects such as night vision problems were common in patients who had RK for higher prescription strengths, while such side effects were less frequent in patients with lower prescriptions.
RK is now virtually obsolete as a primary vision correction procedure for these reasons and because of advances in laser vision correction procedures.
Photorefractive Keratectomy (PRK) was the first successful laser vision correction procedure used to remove (ablate) tissue directly from the eye's surface to change the curvature of the cornea. PRK, also known as surface ablation, was performed outside the United States during the 1980s and received FDA approval in 1995. PRK is still commonly used, but LASIK (see below) is by far the most popular laser procedure today.
However, PRK has made somewhat of a comeback in recent years because of studies indicating that PRK and LASIK produce similar outcomes. Also, nerve regeneration in the eye's surface appears to take place faster with PRK than with LASIK following a procedure, which could have implications for reducing dry eye and other complications that might occur until the healing process is complete.
Because PRK is a surface procedure, there also is no risk of surgical flap complications. PRK does not involve creating a thin, hinged flap on the eye's surface, as occurs with LASIK. PRK also appears to be a safer procedure in cases when a person's cornea may be too thin for LASIK surgery.
Laser-Assisted in situ Keratomileusis (LASIK) is like PRK, except that a thin, hinged flap is made in the eye's surface. This flap is lifted, and then laser energy is applied underneath to reshape the eye. The flap is replaced and functions as a natural bandage.
Wavefront technology used for measuring vision errors in custom LASIK helps achieve very precise outcomes
LASIK's main advantage over PRK is that there is little or no discomfort immediately after the procedure, and vision is usually clear within hours rather than days. Different forms of LASIK exist, many that depend on how the flap is created:
• LASEK involves creating an ultra-thin hinged flap in the thin outer covering (epithelium) of the eye and floating it away from the eye's surface with alcohol so that laser reshaping of the eye can occur.
• Epi-LASIK is like LASEK, except that a special cutting tool is used to lift the flap.
• Bladeless, Blade-Free, or All-Laser LASIK involves use of another laser rather than a mechanical cutting tool to create the flap in LASIK. Because the laser used for this purpose originally was made and marketed by IntraLase Corp., all-laser LASIK was sometimes also called IntraLASIK. In 2007, Advanced Medical Optics (now Abbott Medical Optics) obtained the IntraLase technology and integrated it into the company's CustomVue excimer laser platform (iLASIK). Other brands of bladeless LASIK now are available, including the Ziemer Femto LDV, marketed as zLASIK.
• Wavefront LASIK or PRK (also known as wavefront-guided, wavefront-assisted, or custom LASIK/PRK) incorporates ultra-modern analysis, known as wavefront, to measure precisely how light travels through the eye. Excimer lasers with built-in wavefront analysis can detect and automatically adjust for subtle vision errors when laser energy is applied to reshape the cornea. Studies suggest wavefront-guided LASIK helps maintain contrast sensitivity and reduces the risk of night glare after LASIK surgery, explained in our Q&A about custom LASIK.
[Find out if you are a good LASIK surgery candidate.]
Conductive Keratoplasty (NearVision CK by Refractec) uses a tiny probe and low heat radio waves to apply "spots" around the periphery of the eye's clear front surface. This relatively non-invasive method steepens the cornea, to provide near vision correction for people who are farsighted. CK also can be used to correct presbyopia or enhance near vision for people who have had LASIK or cataract surgery. CK received initial FDA approval in 2002.
Implantable lenses are another option for vision correction surgery.
Implantable Lenses (Visian ICL and Verisyse), similar to contact lenses, first received FDA approval in 2004. These surgically implanted lenses primarily are considered appropriate for higher levels of nearsightedness. When implantable lenses are used, your eye's natural lens is left in place. Both of these lenses have a long track record of use, including more than 13 years in Europe.
Refractive Lens Exchange is another non-laser, internal eye procedure. RLE is much like cataract surgery. But instead of removing the eye's natural lens that has grown cloudy due to cataract formation, RLE involves removing a clear natural lens and replacing it with an artificial lens of a different shape, usually to reduce or eliminate high degrees of farsightedness.
RLE also might be considered as an option for correcting other types of vision problems, such as nearsightedness. But RLE has a higher risk of complications, compared with other vision correction procedures. For these reasons, RLE typically is used only in cases of severe vision correction needs.
Cataract surgery also can now be considered a vision correction procedure. New lens implants developed for cataract surgery can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, called multifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.
While Medicare and health insurance will cover basic costs of cataract surgery, you can elect to pay out-of-pocket for the extra costs of these more modern lenses that potentially can restore a full range of vision. This is why cataract surgery now also can be viewed as a refractive surgery procedure, but only when you opt to pay extra for full vision correction.
[Read frequently asked questions about presbyopia-correcting IOLs.]
Which Corrective Eye Surgery Procedure Is Right for You?
Because our eyes change as we age, the type of laser eye surgery or other vision correction we need also may change. Certain approaches to LASIK or other procedures that work well for younger adults, for example, may be inappropriate for older individuals.
In some cases, vision correction surgery may be ruled out entirely. Children under age 18 rarely would be considered candidates for laser vision correction because their eyes change too rapidly as their bodies grow and mature.
Also, some people have certain conditions or diseases that would make them poor candidates for certain vision correction procedures and better candidates for other procedures. Examples:
• If you have diabetes or other diseases that affect wound healing, you might be a better candidate for PRK or LASEK than certain types of LASIK.
• If you have thin corneas, PRK, LASEK, or implantation of the Visian ICL or Verisyse lens are examples of procedures that may be more appropriate for you than LASIK.
Keep in mind that, generally, anyone who is pregnant should not undergo any form of elective vision surgery, because hormonal changes might affect the treatment's accuracy.
Lifestyle also can make a big difference in the type of vision correction you need. A seamstress requires keen near vision. Computer users need good vision at intermediate ranges. And a pilot needs to preserve depth perception to make good spatially oriented judgments while flying.
Generally speaking, however, people in their 20s or 30s with mild to moderate farsightedness, nearsightedness, and/or astigmatism are usually excellent candidates for LASIK, PRK, Visian ICL, and other laser vision correction.
Severe Vision Errors and Corrective Eye Surgery
for Older People
If you are 40 or older or have severe vision problems, you may want to discuss these options with your eye surgeon:
• Monovision. With this approach, LASIK may be used to correct one eye for distance vision and the other eye for near vision as a solution for presbyopia, a focusing problem that affects all people beginning at around age 40.
However, some people cannot adjust to monovision. You might first consider wearing contact lenses providing monovision or trying it with "trial lenses" in your doctor's office, to make sure this approach works for you.
CK also provides a type of monovision, but with a more full range of vision in the corrected eye.
Examples of multifocal and accommodating intraocular lenses for cataract surgery and refractive lens exchange include (top, from left) the AcrySof IQ ReSTOR (Alcon), ReZoom (Abbott Medical Optics or AMO) and Crystalens (Bausch & Lomb). At bottom is the Tecnis (AMO).
• Multifocal or Accommodating IOLs. If you choose this type of lens for a refractive lens exchange or cataract surgery, your eye's natural lens will be replaced permanently.
These artificial lenses potentially can restore a full range of vision, but can also produce side effects such as decreased depth perception or night vision problems in the form of halos or glare.
Also, you may still need to wear eyeglasses or contact lenses or have a "laser touch-up," because it's possible the lenses will fall short of restoring a full range of vision. Be sure and discuss the pros and cons of these new lenses with your eye surgeon.
• Vision Correction for Severe Nearsightedness or Farsightedness. LASIK, PRK and other laser vision correction procedures do have their limitations and may not be the best option for you if you have severe nearsightedness or farsightedness. Some eye surgeons consider implantable lenses (Visian ICL and Verisyse) the best option for extreme nearsightedness.
Refractive lens exchange, in which the eye's natural lens is replaced with an artificial one, is a possible option for extreme farsightedness.
Particularly if you are older than 40, you also might need to consider multiple vision correction solutions to achieve the very best possible vision for your age and lifestyle. For instance, you might choose LASIK or PRK in your 30s to correct distance vision. Then, when you reach your mid-40s and your near vision is affected by presbyopia, you might follow up with an "enhancement" using conductive keratoplasty. With CK in one eye, you may be able to sharpen near vision blurriness caused by the age-related condition of presbyopia.
Most eye surgeons will tell you it's unlikely that any vision correction procedure can give you permanent, optimal vision for a lifetime. Just as you probably needed to change out eyeglasses and contact lenses in the past, you very likely will need a LASIK enhancement or other surgical correction as you grow older, to maintain good vision.
Also, keep in mind that all vision correction procedures have the usually slight risk of side effects that can range from mild to severe. So be sure you discuss all options and potential risks in detail with your eye surgeon or eye care provider before making any final choices.
2-Eye lid surgery
For complete eye health, your eyelids need to be as healthy as your eyes. Eyelid position is also important to your appearance. Excess eyelid skin, droopy eyelids or eyelids that turn inward or outward are common problems. They can cause eye discomfort, and even limit vision. Fortunately, such eyelid conditions are correctable by surgery.
Ptosis: Upper eyelid drooping
Ptosis ("toe-sis") is apparent at birth (congenital) or develops with age (involutional).
A child with congenital ptosis may tilt his or her head backward in order to see, so it doesn't always lead to poor vision. However, children with ptosis should be examined by an ophthalmologist because they can have other associated eye problems.
Surgery to correct ptosis is commonly recommended in the preschool years to make it easier for children to see and to improve appearance. The type of surgery varies depending upon how much the eyelids droop.
Involutional ptosis develops with aging. It may worsen after other types of eye surgery or eyelid swelling. Ptosis may limit the field of peripheral vision and produce and uneven appearance. Surgery may limit the field of peripheral vision and produce and uneven appearance. Surgery corrects the problem by shortening the muscle that opens the eyelid.
Excess eyelid skin
Over time, many people develop excess eyelid skin. Eyelid skin is the thinnest skin of the body, so it tends to stretch.
In the upper eyelid, this stretched skin may limit the peripheral field of vision and may produce a feeling of heaviness and a tired appearance. In the lower eyelid, "bags" form.
The excess skin in the upper eyelids can be removed surgically by a process called a blepharoplasty to improve the peripheral the peripheral field of vision and other symptoms. Removal of the excess skin in either the upper or lower eyelids my improve appearance. If excess fatty tissue is present it may be removed at the same time.
Ectropion: Outward turning of the lower lid
Stretching of the lower eyelid with age allows the eyelid to droop downward and turn outward. Eyelid burns or skin disease may also cause this problem. Ectropion can cause dryness of the eyes, excessive tearing, redness and sensitivity to light and wind. Surgery may restore the normal position of the eyelid, improving these symptoms.
Entropion: Inward turning of the lower eyelid.
Entropion also occurs most commonly as a result of aging. Infection and scarring inside the eyelid are other causes of entropion. When the eyelid turns inward, the eyelashes and skin rub against the eye, making it red, irritated and sensitive to light and wind.
If entropion is not treated, an infection with an ulcer may develop on the clean surface of the eye called the cornea.
With surgery, the eyelid can be turned outward to its normal position, protecting the eye and improving these symptoms,
Eyelid plastic surgery
Eyelid plastic surgery is almost always performed on an outpatient basis using local anesthesia.
Before surgery, your ophthalmologist (medical eye doctor) will perform an eye examination and make recommendations.
Photographs and visual field testing are often required by insurance companies before blepharoplasty and ptosis surgery.
If you are planning to have surgery , be sure to tell you ophthalmologist if you are taking aspirin or aspirin-containing drugs, blood thinners, or have a bleeding problem.
This surgery is generally safe; however, as with any surgery, there are certain risks:
• The ophthalmic surgeon will attempt to make both lids look similar, but differences in healing between the eyes may cause some unevenness in the appearance following surgery.
• A "black eye" is common but will go away quickly.
• The eye may feel dry after surgery, because it may be difficult to close your eyes completely. This irritation generally disappears as the surgery heals.
• Serious complications are rare. The risk of losing vision is estimated to be less than one in 500 surgeries. Infections and excessive scarring occur infrequently.
Eyelid plastic surgery procedures can be done safely in an out patient setting by your ophthalmologist. The improvement in vision, comfort and appearance can be very gratifying.
3-ARTIFICIAL EYES
ARTIFICIAL EYES OF GLASS AND PLASTIC
AND SUGGESTIONS REGARDING THEIR CARE.
Raymond E. Peters, Master Ocularist
Today
We are striving with untiring effort to provide only the finest in artificial eyes in glass and plastic. We shall endeavor to strive for perfection in all of our ocular impants and continue with vigor our research in experimental programs. We are grateful for the support we receive from doctors and their patients, and shall try to justify that support.
The making and fitting of artificial eyes is a highly specialized profession. Those engaged in this work require patience, skill, delicacy of touch and inherent talent for the matching of colors.
Leading Eye Physicians and the Optical Profession recognize that our artificial eye service is quite different from that offered by firms "handling artificial eyes as a sideline." They recommend their patients to us, realizing the fact that we have adhered to this specialized line of endeavor.
Types of Eyes - Plastic Eyes and Glass Eyes
Artificial eyes are made either of glass or plastic. When worn, both types of eyes look the same, give the same amount of comfort and the same degree of movement. The difference between the two materials is wearing quality, as plastic will give considerably more service.
Also, artificial eyes can be either made to order or fitted from stock. As the name implies, a stock artificial eye is one taken from a drawer and fitted to match the natural eye as closely as possible. While a good result can often be obtained with a stock plastic or glass eye, it is impossible to secure the degree of perfection attainable with a custom made artificial eye.
In the fitting of an artificial eye, there are many factors to be considered: the size and shape of the eye, the color size and position of the iris, the size of the pupil, the sclera shade and the amount of veining. These factors vary with each individual, which makes the fitting of a desirable stock prosthetic eye a problem in some cases. However, our eyemakers, who specialize in the fabricating of custom made glass and plastic artificial eyes, are not subject to the limitations associated with stock fittings as they can design an artificial eye to meet individual requirements.
Get important prosthetic eye information here.
Glass Eyes
Glass eyes are blown by highly-skilled artisans who require years of experience to master the intricate technique. In making the eye, the technician employs glass of varying degrees of hardness and color. First a bulb is blown of white glass. Then various colors of glass rods are used to obtain the iris portion, which is spun into the glass bulb. The sclera shade (white portion) is secured by using a softer glass blown under a lower flame. In the next step veins are fused into the sclera to resemble the natural eye as closely as possible. Then the eye is molded into its final shape, to suit the individual requirements.
Glass artificial eyes are fragile and the utmost care should be exercised in handling them, especially after they have been worn for some time. The chemical action of the secretions of the socket affect the glass, causing it to become brittle, to roughen, and to discolor. When this happens, the wearer will naturally experience a certain amount of discomfort.
An artificial glass eye should not be worn after it becomes rough and discolored. In most cases such discoloration and roughness will take place in a glass eye after a year and a half or two years of wear. In rare cases discolorations may appear after a few weeks of wear, depending on the affect of socket secretions.
Occasionally patients experience no discomfort after wearing an artificial glass eye two years or more, but such cases are exceptional. It is a safe rule to renew the glass eye as soon as it begins to irritate and cause secretions to form.
Temperature Changes
Sudden changes of temperature or excessive heat may result in cracking a glass eye, or by reason of vacuum, cause an eye to collapse. For this reason, we caution our patients against placing hot towels directly over the artificial eye or cleaning eye in very warm or very cold water.
Occasionally, a glass artificial eye, due to temperature changes or other causes, will crack and the fracture will scarcely be noticeable. The fact that the glass eye is made with a vacuum tends to draw in the fluids of the socket, which forms a gas and causes the eye to break. In other instances, the eye does not actually break, but the fluid becomes contaminated, omitting a disagreeable odor. Wearers should examine a glass eye occasionally, particularly when irritation develops.
Reserve Glass Eye Desirable
One of the most unfortunate accidents that can happen to the wearer of a glass eye is to drop the eye and break it. Usually, such an accident takes place at the most unexpected and inopportune time. Only the wearer of an artificial eye can realize distress and mental anguish that can result from such a mishap.
For this reason, we recommend that patients, who wear glass eyes, have an extra eye on hand in the event of accidental breakage. This will eliminate the embarrassment caused by being temporarily deprived of an artificial eye.
We can assume no liability for any injury to the wearer through eyes breaking or cracking for any reason whatsoever, nor can we guarantee glass eyes against breakage. However, to prevent breakage, we recommend that the glass eye be kept in a sanitary condition. This will help to give the eye longer wear, more comfort and a better appearance.
Plastic Artificial Eyes
Our plastic artificial eye is considered the finest ocular prosthesis available today. This plastic eye is the result of several techniques perfected through a series of experiments carried on since 1941. Under our Patent No. 2692391 we believe that we have accomplished the most satisfactory method for duplicating the natural human eye.
According to our technique for making plastic eyes, the iris is hand-painted with oil paints suspended in liquid plastic. Only by hand-painting can "third-dimension" and true colors be reproduced. The conjunctiva, limbus and corneal curvature of a human eye are simulated by our skilled laboratory technicians. The illusion of veins and fatty substance is achieved by using plastic fibers and specially-prepared color pigments.
Plastic artificial eyes will not break, crack or shatter, thus removing forever the fear a patient may have that his artificial eye will break unexpectedly.
While the initial cost of a plastic eye is greater than that of a glass eye, in the long run the wearing of a plastic eye may result in an actual saving, due to the fact that the plastic is unbreakable. This does not mean, however, that a plastic eye need never be replaced. Natural changes in the socket require re-fitting of the plastic eye to maintain the best possible cosmetic effect. The appearance of the plastic eye, and its comfort, will indicate to the discriminating wearer when a new prosthesis should be fitted.
In cases of accidents due to chemical burns, gas or explosions, or in cases of deformed sockets or scarred corneas, plastic eyes have a definite advantage. For such cases, the technician can make an impression mold, affording an accuracy of detail, and making possible the fashioning of a plastic eye to minimize cosmetic defects as much as possible.
Proper Care of Artificial Eyes
Most eye physicians are of the opinion that artificial eyes can be worn continually and need only be removed for cleaning purposes. However, the eye physician should be consulted in each particular case.
For cleansing the artificial eye we recommend water and a mild soap, or any prescription that may be recommended by an individual doctor for the purpose of cleaning the eye. In the case of plastic eyes, the use of alcohol or other chemicals should not be employed in washing or cleaning the eye.
Infants and Children
Infants and children require special attention and should have their artificial eyes checked at regular intervals. Usually a larger eye should be fitted each year to induce stretching of the lids and development of the socket. If this is not done, further growth may be restricted and future results impaired.
Details in Fitting Artificial Eyes
There are so many details to be considered in fitting an artificial eye that too much attention should not be placed on one particular facet. Rather the artificial eye should be judged for its overall effect.
Many wearers insist on the artificial eye being as large as the natural eye. This is not wise since quite often a large eye produces a "stare", giving a very unpleasant effect. A discriminating eye wearer should guard against this possibility. It is better to have an eye a little smaller rather than larger so that the lids may properly cover the eye. Then, instead of attracting attention, the artificial eye will be unnoticed, and the maximum amount of movement will be secured.
It is preferable to be fitted with an artificial eye that produces a pleasing effect rather than one which is an "exact match." By varying the size of the iris or pupil the technician can often obtain a more desirable result. While an exact duplication of the iris color is important, size, shape, position, size of the iris, color of sclera (white portion of the eye) and the veining all combine to produce an effect that is truly life-like.
Correct pupil size for the individual patient is sometimes difficult to determine. The pupil dilates and contracts according to lighting conditions, and for most patients a medium size is the most desirable. However, some artificial eye wearers have very active pupils with considerable dilation or they have extremely light-colored irises, which drawn attention to the contrast between the pupil size of the artificial eye and the natural eye. For these patients we recommend a "night" eye, which is an extra eye with a larger pupil to be used for night wear.
Helpful Suggestions
It is important to remember that an artificial eye, which appears satisfactory to the wearer, may be an indifferent fit when viewed by the observer. After all, the observer is the one whom you desire to impress and who sees you as you really are. Your expressions when looking in the mirror are entirely different from your expressions when talking. The first are blank but the second are filled with animation, reflections of your ever-changing thoughts as reproduced by your facial muscles. We have occasionally been complimented for putting a "smile" in the artificial eye. The fact is that the wearer by his or her own facial expression puts in "the smile". We simply make it possible for the wearer to do so.
Wearers of artificial eyes should practice facial expressions to make the wearing of an eye as unnoticeable as possible. It is the work of the expert adapting the eye to produce the best cosmetic result possible but it is the outlook and the cooperation of the patient, which will determine if a really pleasing appearance is secured. The expert will strive to produce an effect, making the natural eye predominant, and thus detracting attention from the artificial one.
Although we urge you to study your facial expressions to secure the most pleasing results, we do not encourage self-consciousness. The tendency to self-consciousness should be overcome as soon as possible before it can become a part of your personality. You will find that if you will forget that you are wearing an artificial eye, others will pay no attention to it.
New patients, those who have undergone recent surgery, often feel they will never become accustomed to wearing an artificial eye. Some even believe that their lives are ruined. But, if these individuals could know the many fine and successful prosthetic eye wearers we have met through the years, they would not feel so depressed. Among our patients we number artists, entertainers, public office holders, working people, mothers and children, who are performing their daily tasks as capable as persons having two natural eyes. The secret of success for you is the same as for all individuals. Concentrate on your assets and good features. Forget your liabilities so that others may do so too.
Several of the following hints may be useful to you in detracting attention from your artificial eye. First of all, do not open your eyes too widely. Learn to contract your lids - learn to smile.
When you want to look in any direction, do not put the entire burden on your eye muscles. Turn your head or your body in the direction where you wish to look. In most cases, an artificial eye will move in unison with the natural eye, if the muscles are intact and if the eye is expertly fitted. However, if you have only limited motility, this fact will not be noticed by the observer if you are careful about facial expressions and will turn your head when looking to the side.
Some persons find that attractive spectacles or eye glasses of the non-shatterable type give a softened effect and make an artificial eye unnoticeable. We do not wish to suggest that all artificial eye wearers be burdened with glasses, if they do not want or need them. However, glasses often help to disguise an artificial eye, and non-shatterable lenses have the additional advantage of protecting the natural eye.
Occasionally, a prosthetic eye wearer will have an upper lid which is "short" or a lower lid that "sags". Improvement and correction in many cases depend on proper fittings as well as persistent massage or stretching of the lids.
Caution In Wiping Eyes
In wiping your artificial eye, always wipe toward the nose. This will prevent your eye from turning in the socket and assuming an incorrect position. Also, since your artificial eye rests on your lower lid and is supported by this lid, you should use caution when rubbing your lower lid, so that you will dislodge the eye. Never rub the prosthetic eye vigorously.
The Nature and Care of the Plastic Artificial Eye
The artificial eye, being of an alien nature to the human tissue, causes a discharge in the socket. This in turn necessitates the removal and cleaning of the eye for reasons of comfort, hygiene and cosmetic appearance.
A certain amount of this discharge can be alleviated by the use of a lubricant on the prosthetic eye. This lubricant is called "Silicone Lubricant for Plastic Artificial Eyes" and is available at our offices. The amount of discharge varies in most cases due to a number of reasons:
1. Sensitivity of the wearer.
2. Ill fitting or rough surfaced eye.
3. Sinus conditions or head colds.
The amount of discharge will determine the frequency of removal and cleaning of the prosthetic eye.
The easiest and most proven method for removal of the prosthetic eye is the use of a RUBBER SUCTION CUP available at our offices. The suction cup must first be moistened for use. This is then squeezed and placed against the iris of the artificial eye. The suction cup now in place, depress the lower lid with the forefinger, then twist the eye COUNTER-CLOCKWISE and lift UP and OUT.
The eye socket is now rinsed with an aseptic solution which your Ophthalmologist will advise. An eye cup, atomizer or syringe can be used to disperse the aseptic solution in the eye socket. The artificial eye is cleaned with a mild soap and warm water. The artificial eye is then rinsed carefully, dried and lubricated with the above-mentioned SILICONE solution. The artificial eye is now ready for re-insertion.
The SUCTION CUP is again moistened, squeezed and placed against the artificial eye. The prosthetic eye is inserted under the upper lid, top first. The "top" of the artificial eye will be shown to you by your attending technician at the time of delivery. (1) Use the forefinger to retract the upper lid, then place the eye under the upper lid and push in as far as possible. (2) Allow the upper lid to fall into place while still holding the eye in position. (3) Using the forefinger, depress the lower lid until the eye is behind both lids. (4) Now release the lower lid and place the forefinger against the eye, holding the eye in place, while removing the suction cup. This is accomplished by squeezing the cup and lifting away.
4-Cataract surgery
A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the retina. If visual loss is significant, surgical removal of the lens may be warranted, with lost optical power usually replaced with a plastic intraocular lens (IOL). Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended.
5-Glaucoma surgery
Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many types of glaucoma surgery, and variations or combinations of those types, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor.
6-Refractive surgery
Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses
• Keratomilleusis is method of reshaping the cornea surface to change its optical power. A disc of cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power.
• Automated lamellar keratoplasty (ALK)
• Laser assisted in-situ keratomileusis (LASIK)
o IntraLASIK
• Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK
• Photorefractive keratectomy (PRK)
• Laser thermal keratoplasty (LTK)
• Conductive keratoplasty (CK) uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.
• Limbal relaxing incisions (LRI) to correct minor astigmatism
• Astigmatic keratotomy (AK), aka Arcuate keratotomy or Transverse keratotomy
• Radial keratotomy (RK)
• Hexagonal keratotomy (HK)
• Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe cut corneal button.
• Intracorneal rings (ICRs), or corneal ring segments (Intacs)
• Implantable contact lenses
• Presbyopia reversal
• Anterior ciliary sclerotomy (ACS)
• Laser reversal of presbyopia (LRP)
• Scleral expansion bands
7-Corneal surgery
• Corneal transplant surgery, is used to remove a cloudy/diseased cornea and replace it with a clear donor cornea.
• Penetrating keratoplasty (PK)
• Keratoprosthesis(KPro)
• Phototherapeutic keratectomy (PTK)[7]
• Pterygium excision
• Corneal tattooing
• Osteo-Odonto-Keratoprosthesis (OOKP), in which support for an artificial cornea is created from a tooth and its surrounding jawbone. This is a still-experimental procedure used for patients with severely damaged eyes, generally from burns.
8-Vitreo-retinal surgery
Vitrectomy
•
o Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.
o Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments [5].
• Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.
• Retinal detachment repair
o Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.
o A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.
o Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.
o Pneumatic retinopexy
o Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.
• Macular hole repair
• Partial lamellar sclerouvectomy
• Partial lamellar sclerocyclochoroidectomy
• Partial lamellar sclerochoroidectomy
• Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body [6].
• Radial optic neurotomy
• macular translocation surgery
o through 360 degree retinotomy
o through scleral imbrication technique
9-Eye muscle surgery
With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States [7].
• Eye muscle surgery typically corrects strabismus and includes the following [8]:
o Loosening / weakening procedures
Recession involves moving the insertion of a muscle posteriorly towards its origin.
Myectomy
Myotomy
Tenectomy
Tenotomy
o Tightening / strengthening procedures
Resection
Tucking
Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.
o Transposition / repositioning procedures
o Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first post-operative day, to obtain better ocular alignment [9].
10-Orbital surgery
• Orbital reconstruction / Ocular prosthetics (False Eyes)
• Orbital decompression for Grave's Disease. Grave's Disease is a condition (often associated with over-active thyroid problems) in which the eye muscles swell. Because the eye socket is bone, there is nowhere for the swelling to be accommodated and as a result the eye is pushed forward into a protruded position. In some patients this is very pronounced. Orbitial decompression involves removing some bone from the eye socket to open up one or more sinus's and so make space for the swollen tissue and allowing the eye to move back into normal position.
Other surgery
Many of these described procedures are historical and are not recommended due to a risk of complications. Particularly, these include operations done on ciliary body in an attempt to control glaucoma, since highly safer surgeries for glaucoma, including lasers, non-penetrating surgery, guarded filtration surgery and seton valve implants have been invented.
• A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma. A ciliectomy is 1) the surgical removal of part of the ciliary body, or 2) the surgical removal of part of a margin of an eyelid containing the roots of the eyelashes.
• A ciliotomy is a surgical section of the ciliary nerves.
• A conjunctivoanstrostomy is an opening made form the inferior conjuctival cul-de-sac into the maxillary sinus for the treatment of epiphora.
• Conjuctivoplasty is plastic surgery of the conjunctiva.
• A conjunctivorhinostomy is a surgical correction of the total obstruction of a lacrimal canaliculus by which the conjuctiva is anastomosed with the nasal cavity to improve tear flow.
• A corectomedialysis, or coretomedialysis, is an excision of a small portion of the iris at its junction with the ciliary body to form an artificial pupil.
• A corectomy, or coretomy, is any surgical cutting operation on the iris at the pupil.
• A corelysis is a surgical detachment of adhesions of the iris to the capsule of the crystalline lens or cornea.
• A coremorphosis is the surgical formation of an artificial pupil.
• A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.
• A coreoplasy, or laser pupillomydriasis, is any procedure that changes the size or shape of the pupil.
• A cyclectomy is an excision of portion of the ciliary body.
• A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.
• A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.
• An iridectomesodialsys is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.
• An iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.
• An iridencleisis, or corenclisis, is a surgical procedure for glaucoma in which a portion of the iris is incised and incarcerated in a limbal incision. (Subdivided into basal iridencleisis and total iridencleisis.)
• An iridesis is a surgical procedure in which a portion of the iris is brought through and incarcerated in a corneal incision in order to reposition the pupil. [13]
• An iridocorneosclerectomy is the surgical removal of a portion of the iris, the cornea, and the sclera.
• An iridocyclectomy is the surgical removal of the iris and the ciliary body.
• An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.
• An iridosclerectomy is the surgical removal of a portion of the sclera and a portion of the iris in the region of the limbus for the treatment of glaucoma.
• An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.
• A rhinommectomy is the surgical removal of a portion of the internal canthus.
• A trepanotrabeculectomy is used in the treatment of chronic open and chronic closed angle glaucoma.
References
1. ^ Surgery Encyclopedia - Ophthalmologic surgery
2. ^ Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Hi Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761
3. ^ a b Surgery Encyclopedia - LASIK
4. ^ Surgery Encyclopedia - PRK
5. ^ a b Surgery Encyclopedia - Corneal transplantation
6. ^ intercornealrings
7. ^ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
8. ^ MDAdvice.com - Pterygium removal
9. ^ http://news.yahoo.com/s/afp/irelandbritainhealthoffbeat
10. ^ http://www.wihrd.soton.ac.uk/projx/signpost/steers/STEER_2001(6).pdf
11. ^ vitrectomysurgery
12. ^ a b Surgery Encyclopedia - Photocoagulation therapy
13. ^ Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.
14. ^ Surgery Encyclopedia - Scleral Buckling
15. ^ Surgery Encyclopedia - Retinal_cryopexy
16. ^ Shields JA, Shields CL. Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture. Ophthalmic Surg. 1988 Nov;19(11):774-80. PMID 3222038.
17. ^ Surgery Encyclopedia - Eye Muscle Surgery
18. ^ Surgery Encyclopedia - Blepharoplasty
19. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
20. ^ Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006
21. ^ Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.
22. ^ Surgery Encyclopedia - Enucleation
23. ^ a b c Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.
24. ^ Surgery Encyclopedia - Exenteration
25. ^ a b Cvetkovic D, Blagojevic M, Dodic V. ["Comparative results of trepanotrabeculectomy and iridencleisis in primary glaucoma."] J Fr Ophtalmol. 1979 Feb;2(2):103-7. PMID 444110.
Now, several modern approaches to corrective eye surgery range from laser reshaping of the eye's surface in procedures such as LASIK and PRK to surgical insertion of artificial lenses to correct eyesight.
In LASIK, PRK, and similar procedures, laser energy reshapes the curvature of the eye's clear front surface (cornea) to alter the way light rays enter the eye. Artificial lenses surgically inserted into the eye also can refocus light rays to sharpen vision.
The Evolution of Corrective Eye Surgery
Over the past 25 years, surgical techniques, tools, and procedures for vision correction have evolved rapidly.
But results, especially long-term, created problems for some individuals. Significant glare, regression, fluctuating vision, and other side effects such as night vision problems were common in patients who had RK for higher prescription strengths, while such side effects were less frequent in patients with lower prescriptions.
RK is now virtually obsolete as a primary vision correction procedure for these reasons and because of advances in laser vision correction procedures.
Photorefractive Keratectomy (PRK) was the first successful laser vision correction procedure used to remove (ablate) tissue directly from the eye's surface to change the curvature of the cornea. PRK, also known as surface ablation, was performed outside the United States during the 1980s and received FDA approval in 1995. PRK is still commonly used, but LASIK (see below) is by far the most popular laser procedure today.
However, PRK has made somewhat of a comeback in recent years because of studies indicating that PRK and LASIK produce similar outcomes. Also, nerve regeneration in the eye's surface appears to take place faster with PRK than with LASIK following a procedure, which could have implications for reducing dry eye and other complications that might occur until the healing process is complete.
Because PRK is a surface procedure, there also is no risk of surgical flap complications. PRK does not involve creating a thin, hinged flap on the eye's surface, as occurs with LASIK. PRK also appears to be a safer procedure in cases when a person's cornea may be too thin for LASIK surgery.
Laser-Assisted in situ Keratomileusis (LASIK) is like PRK, except that a thin, hinged flap is made in the eye's surface. This flap is lifted, and then laser energy is applied underneath to reshape the eye. The flap is replaced and functions as a natural bandage.
Wavefront technology used for measuring vision errors in custom LASIK helps achieve very precise outcomes
LASIK's main advantage over PRK is that there is little or no discomfort immediately after the procedure, and vision is usually clear within hours rather than days. Different forms of LASIK exist, many that depend on how the flap is created:
• LASEK involves creating an ultra-thin hinged flap in the thin outer covering (epithelium) of the eye and floating it away from the eye's surface with alcohol so that laser reshaping of the eye can occur.
• Epi-LASIK is like LASEK, except that a special cutting tool is used to lift the flap.
• Bladeless, Blade-Free, or All-Laser LASIK involves use of another laser rather than a mechanical cutting tool to create the flap in LASIK. Because the laser used for this purpose originally was made and marketed by IntraLase Corp., all-laser LASIK was sometimes also called IntraLASIK. In 2007, Advanced Medical Optics (now Abbott Medical Optics) obtained the IntraLase technology and integrated it into the company's CustomVue excimer laser platform (iLASIK). Other brands of bladeless LASIK now are available, including the Ziemer Femto LDV, marketed as zLASIK.
• Wavefront LASIK or PRK (also known as wavefront-guided, wavefront-assisted, or custom LASIK/PRK) incorporates ultra-modern analysis, known as wavefront, to measure precisely how light travels through the eye. Excimer lasers with built-in wavefront analysis can detect and automatically adjust for subtle vision errors when laser energy is applied to reshape the cornea. Studies suggest wavefront-guided LASIK helps maintain contrast sensitivity and reduces the risk of night glare after LASIK surgery, explained in our Q&A about custom LASIK.
[Find out if you are a good LASIK surgery candidate.]
Conductive Keratoplasty (NearVision CK by Refractec) uses a tiny probe and low heat radio waves to apply "spots" around the periphery of the eye's clear front surface. This relatively non-invasive method steepens the cornea, to provide near vision correction for people who are farsighted. CK also can be used to correct presbyopia or enhance near vision for people who have had LASIK or cataract surgery. CK received initial FDA approval in 2002.
Implantable lenses are another option for vision correction surgery.
Refractive Lens Exchange is another non-laser, internal eye procedure. RLE is much like cataract surgery. But instead of removing the eye's natural lens that has grown cloudy due to cataract formation, RLE involves removing a clear natural lens and replacing it with an artificial lens of a different shape, usually to reduce or eliminate high degrees of farsightedness.
RLE also might be considered as an option for correcting other types of vision problems, such as nearsightedness. But RLE has a higher risk of complications, compared with other vision correction procedures. For these reasons, RLE typically is used only in cases of severe vision correction needs.
Cataract surgery also can now be considered a vision correction procedure. New lens implants developed for cataract surgery can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, called multifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.
While Medicare and health insurance will cover basic costs of cataract surgery, you can elect to pay out-of-pocket for the extra costs of these more modern lenses that potentially can restore a full range of vision. This is why cataract surgery now also can be viewed as a refractive surgery procedure, but only when you opt to pay extra for full vision correction.
[Read frequently asked questions about presbyopia-correcting IOLs.]
Which Corrective Eye Surgery Procedure Is Right for You?
Because our eyes change as we age, the type of laser eye surgery or other vision correction we need also may change. Certain approaches to LASIK or other procedures that work well for younger adults, for example, may be inappropriate for older individuals.
In some cases, vision correction surgery may be ruled out entirely. Children under age 18 rarely would be considered candidates for laser vision correction because their eyes change too rapidly as their bodies grow and mature.
Also, some people have certain conditions or diseases that would make them poor candidates for certain vision correction procedures and better candidates for other procedures. Examples:
• If you have diabetes or other diseases that affect wound healing, you might be a better candidate for PRK or LASEK than certain types of LASIK.
• If you have thin corneas, PRK, LASEK, or implantation of the Visian ICL or Verisyse lens are examples of procedures that may be more appropriate for you than LASIK.
Keep in mind that, generally, anyone who is pregnant should not undergo any form of elective vision surgery, because hormonal changes might affect the treatment's accuracy.
Lifestyle also can make a big difference in the type of vision correction you need. A seamstress requires keen near vision. Computer users need good vision at intermediate ranges. And a pilot needs to preserve depth perception to make good spatially oriented judgments while flying.
Generally speaking, however, people in their 20s or 30s with mild to moderate farsightedness, nearsightedness, and/or astigmatism are usually excellent candidates for LASIK, PRK, Visian ICL, and other laser vision correction.
Severe Vision Errors and Corrective Eye Surgery
for Older People
If you are 40 or older or have severe vision problems, you may want to discuss these options with your eye surgeon:
• Monovision. With this approach, LASIK may be used to correct one eye for distance vision and the other eye for near vision as a solution for presbyopia, a focusing problem that affects all people beginning at around age 40.
However, some people cannot adjust to monovision. You might first consider wearing contact lenses providing monovision or trying it with "trial lenses" in your doctor's office, to make sure this approach works for you.
CK also provides a type of monovision, but with a more full range of vision in the corrected eye.
Examples of multifocal and accommodating intraocular lenses for cataract surgery and refractive lens exchange include (top, from left) the AcrySof IQ ReSTOR (Alcon), ReZoom (Abbott Medical Optics or AMO) and Crystalens (Bausch & Lomb). At bottom is the Tecnis (AMO).
• Multifocal or Accommodating IOLs. If you choose this type of lens for a refractive lens exchange or cataract surgery, your eye's natural lens will be replaced permanently.
These artificial lenses potentially can restore a full range of vision, but can also produce side effects such as decreased depth perception or night vision problems in the form of halos or glare.
Also, you may still need to wear eyeglasses or contact lenses or have a "laser touch-up," because it's possible the lenses will fall short of restoring a full range of vision. Be sure and discuss the pros and cons of these new lenses with your eye surgeon.
• Vision Correction for Severe Nearsightedness or Farsightedness. LASIK, PRK and other laser vision correction procedures do have their limitations and may not be the best option for you if you have severe nearsightedness or farsightedness. Some eye surgeons consider implantable lenses (Visian ICL and Verisyse) the best option for extreme nearsightedness.
Particularly if you are older than 40, you also might need to consider multiple vision correction solutions to achieve the very best possible vision for your age and lifestyle. For instance, you might choose LASIK or PRK in your 30s to correct distance vision. Then, when you reach your mid-40s and your near vision is affected by presbyopia, you might follow up with an "enhancement" using conductive keratoplasty. With CK in one eye, you may be able to sharpen near vision blurriness caused by the age-related condition of presbyopia.
Most eye surgeons will tell you it's unlikely that any vision correction procedure can give you permanent, optimal vision for a lifetime. Just as you probably needed to change out eyeglasses and contact lenses in the past, you very likely will need a LASIK enhancement or other surgical correction as you grow older, to maintain good vision.
Also, keep in mind that all vision correction procedures have the usually slight risk of side effects that can range from mild to severe. So be sure you discuss all options and potential risks in detail with your eye surgeon or eye care provider before making any final choices.
2-Eye lid surgery
Ptosis: Upper eyelid drooping
Ptosis ("toe-sis") is apparent at birth (congenital) or develops with age (involutional).
A child with congenital ptosis may tilt his or her head backward in order to see, so it doesn't always lead to poor vision. However, children with ptosis should be examined by an ophthalmologist because they can have other associated eye problems.
Surgery to correct ptosis is commonly recommended in the preschool years to make it easier for children to see and to improve appearance. The type of surgery varies depending upon how much the eyelids droop.
Involutional ptosis develops with aging. It may worsen after other types of eye surgery or eyelid swelling. Ptosis may limit the field of peripheral vision and produce and uneven appearance. Surgery may limit the field of peripheral vision and produce and uneven appearance. Surgery corrects the problem by shortening the muscle that opens the eyelid.
Excess eyelid skin
Over time, many people develop excess eyelid skin. Eyelid skin is the thinnest skin of the body, so it tends to stretch.
In the upper eyelid, this stretched skin may limit the peripheral field of vision and may produce a feeling of heaviness and a tired appearance. In the lower eyelid, "bags" form.
The excess skin in the upper eyelids can be removed surgically by a process called a blepharoplasty to improve the peripheral the peripheral field of vision and other symptoms. Removal of the excess skin in either the upper or lower eyelids my improve appearance. If excess fatty tissue is present it may be removed at the same time.
Stretching of the lower eyelid with age allows the eyelid to droop downward and turn outward. Eyelid burns or skin disease may also cause this problem. Ectropion can cause dryness of the eyes, excessive tearing, redness and sensitivity to light and wind. Surgery may restore the normal position of the eyelid, improving these symptoms.
Entropion also occurs most commonly as a result of aging. Infection and scarring inside the eyelid are other causes of entropion. When the eyelid turns inward, the eyelashes and skin rub against the eye, making it red, irritated and sensitive to light and wind.
If entropion is not treated, an infection with an ulcer may develop on the clean surface of the eye called the cornea.
With surgery, the eyelid can be turned outward to its normal position, protecting the eye and improving these symptoms,
Eyelid plastic surgery
Before surgery, your ophthalmologist (medical eye doctor) will perform an eye examination and make recommendations.
Photographs and visual field testing are often required by insurance companies before blepharoplasty and ptosis surgery.
If you are planning to have surgery , be sure to tell you ophthalmologist if you are taking aspirin or aspirin-containing drugs, blood thinners, or have a bleeding problem.
This surgery is generally safe; however, as with any surgery, there are certain risks:
• The ophthalmic surgeon will attempt to make both lids look similar, but differences in healing between the eyes may cause some unevenness in the appearance following surgery.
• A "black eye" is common but will go away quickly.
• The eye may feel dry after surgery, because it may be difficult to close your eyes completely. This irritation generally disappears as the surgery heals.
• Serious complications are rare. The risk of losing vision is estimated to be less than one in 500 surgeries. Infections and excessive scarring occur infrequently.
Eyelid plastic surgery procedures can be done safely in an out patient setting by your ophthalmologist. The improvement in vision, comfort and appearance can be very gratifying.
3-ARTIFICIAL EYES
AND SUGGESTIONS REGARDING THEIR CARE.
Raymond E. Peters, Master Ocularist
Today
We are striving with untiring effort to provide only the finest in artificial eyes in glass and plastic. We shall endeavor to strive for perfection in all of our ocular impants and continue with vigor our research in experimental programs. We are grateful for the support we receive from doctors and their patients, and shall try to justify that support.
The making and fitting of artificial eyes is a highly specialized profession. Those engaged in this work require patience, skill, delicacy of touch and inherent talent for the matching of colors.
Leading Eye Physicians and the Optical Profession recognize that our artificial eye service is quite different from that offered by firms "handling artificial eyes as a sideline." They recommend their patients to us, realizing the fact that we have adhered to this specialized line of endeavor.
Types of Eyes - Plastic Eyes and Glass Eyes
Also, artificial eyes can be either made to order or fitted from stock. As the name implies, a stock artificial eye is one taken from a drawer and fitted to match the natural eye as closely as possible. While a good result can often be obtained with a stock plastic or glass eye, it is impossible to secure the degree of perfection attainable with a custom made artificial eye.
In the fitting of an artificial eye, there are many factors to be considered: the size and shape of the eye, the color size and position of the iris, the size of the pupil, the sclera shade and the amount of veining. These factors vary with each individual, which makes the fitting of a desirable stock prosthetic eye a problem in some cases. However, our eyemakers, who specialize in the fabricating of custom made glass and plastic artificial eyes, are not subject to the limitations associated with stock fittings as they can design an artificial eye to meet individual requirements.
Get important prosthetic eye information here.
Glass Eyes
Glass artificial eyes are fragile and the utmost care should be exercised in handling them, especially after they have been worn for some time. The chemical action of the secretions of the socket affect the glass, causing it to become brittle, to roughen, and to discolor. When this happens, the wearer will naturally experience a certain amount of discomfort.
An artificial glass eye should not be worn after it becomes rough and discolored. In most cases such discoloration and roughness will take place in a glass eye after a year and a half or two years of wear. In rare cases discolorations may appear after a few weeks of wear, depending on the affect of socket secretions.
Occasionally patients experience no discomfort after wearing an artificial glass eye two years or more, but such cases are exceptional. It is a safe rule to renew the glass eye as soon as it begins to irritate and cause secretions to form.
Temperature Changes
Sudden changes of temperature or excessive heat may result in cracking a glass eye, or by reason of vacuum, cause an eye to collapse. For this reason, we caution our patients against placing hot towels directly over the artificial eye or cleaning eye in very warm or very cold water.
Occasionally, a glass artificial eye, due to temperature changes or other causes, will crack and the fracture will scarcely be noticeable. The fact that the glass eye is made with a vacuum tends to draw in the fluids of the socket, which forms a gas and causes the eye to break. In other instances, the eye does not actually break, but the fluid becomes contaminated, omitting a disagreeable odor. Wearers should examine a glass eye occasionally, particularly when irritation develops.
Reserve Glass Eye Desirable
One of the most unfortunate accidents that can happen to the wearer of a glass eye is to drop the eye and break it. Usually, such an accident takes place at the most unexpected and inopportune time. Only the wearer of an artificial eye can realize distress and mental anguish that can result from such a mishap.
For this reason, we recommend that patients, who wear glass eyes, have an extra eye on hand in the event of accidental breakage. This will eliminate the embarrassment caused by being temporarily deprived of an artificial eye.
We can assume no liability for any injury to the wearer through eyes breaking or cracking for any reason whatsoever, nor can we guarantee glass eyes against breakage. However, to prevent breakage, we recommend that the glass eye be kept in a sanitary condition. This will help to give the eye longer wear, more comfort and a better appearance.
Our plastic artificial eye is considered the finest ocular prosthesis available today. This plastic eye is the result of several techniques perfected through a series of experiments carried on since 1941. Under our Patent No. 2692391 we believe that we have accomplished the most satisfactory method for duplicating the natural human eye.
According to our technique for making plastic eyes, the iris is hand-painted with oil paints suspended in liquid plastic. Only by hand-painting can "third-dimension" and true colors be reproduced. The conjunctiva, limbus and corneal curvature of a human eye are simulated by our skilled laboratory technicians. The illusion of veins and fatty substance is achieved by using plastic fibers and specially-prepared color pigments.
Plastic artificial eyes will not break, crack or shatter, thus removing forever the fear a patient may have that his artificial eye will break unexpectedly.
While the initial cost of a plastic eye is greater than that of a glass eye, in the long run the wearing of a plastic eye may result in an actual saving, due to the fact that the plastic is unbreakable. This does not mean, however, that a plastic eye need never be replaced. Natural changes in the socket require re-fitting of the plastic eye to maintain the best possible cosmetic effect. The appearance of the plastic eye, and its comfort, will indicate to the discriminating wearer when a new prosthesis should be fitted.
In cases of accidents due to chemical burns, gas or explosions, or in cases of deformed sockets or scarred corneas, plastic eyes have a definite advantage. For such cases, the technician can make an impression mold, affording an accuracy of detail, and making possible the fashioning of a plastic eye to minimize cosmetic defects as much as possible.
Proper Care of Artificial Eyes
Most eye physicians are of the opinion that artificial eyes can be worn continually and need only be removed for cleaning purposes. However, the eye physician should be consulted in each particular case.
For cleansing the artificial eye we recommend water and a mild soap, or any prescription that may be recommended by an individual doctor for the purpose of cleaning the eye. In the case of plastic eyes, the use of alcohol or other chemicals should not be employed in washing or cleaning the eye.
Infants and Children
Infants and children require special attention and should have their artificial eyes checked at regular intervals. Usually a larger eye should be fitted each year to induce stretching of the lids and development of the socket. If this is not done, further growth may be restricted and future results impaired.
Details in Fitting Artificial Eyes
There are so many details to be considered in fitting an artificial eye that too much attention should not be placed on one particular facet. Rather the artificial eye should be judged for its overall effect.
Many wearers insist on the artificial eye being as large as the natural eye. This is not wise since quite often a large eye produces a "stare", giving a very unpleasant effect. A discriminating eye wearer should guard against this possibility. It is better to have an eye a little smaller rather than larger so that the lids may properly cover the eye. Then, instead of attracting attention, the artificial eye will be unnoticed, and the maximum amount of movement will be secured.
It is preferable to be fitted with an artificial eye that produces a pleasing effect rather than one which is an "exact match." By varying the size of the iris or pupil the technician can often obtain a more desirable result. While an exact duplication of the iris color is important, size, shape, position, size of the iris, color of sclera (white portion of the eye) and the veining all combine to produce an effect that is truly life-like.
Correct pupil size for the individual patient is sometimes difficult to determine. The pupil dilates and contracts according to lighting conditions, and for most patients a medium size is the most desirable. However, some artificial eye wearers have very active pupils with considerable dilation or they have extremely light-colored irises, which drawn attention to the contrast between the pupil size of the artificial eye and the natural eye. For these patients we recommend a "night" eye, which is an extra eye with a larger pupil to be used for night wear.
Helpful Suggestions
It is important to remember that an artificial eye, which appears satisfactory to the wearer, may be an indifferent fit when viewed by the observer. After all, the observer is the one whom you desire to impress and who sees you as you really are. Your expressions when looking in the mirror are entirely different from your expressions when talking. The first are blank but the second are filled with animation, reflections of your ever-changing thoughts as reproduced by your facial muscles. We have occasionally been complimented for putting a "smile" in the artificial eye. The fact is that the wearer by his or her own facial expression puts in "the smile". We simply make it possible for the wearer to do so.
Wearers of artificial eyes should practice facial expressions to make the wearing of an eye as unnoticeable as possible. It is the work of the expert adapting the eye to produce the best cosmetic result possible but it is the outlook and the cooperation of the patient, which will determine if a really pleasing appearance is secured. The expert will strive to produce an effect, making the natural eye predominant, and thus detracting attention from the artificial one.
Although we urge you to study your facial expressions to secure the most pleasing results, we do not encourage self-consciousness. The tendency to self-consciousness should be overcome as soon as possible before it can become a part of your personality. You will find that if you will forget that you are wearing an artificial eye, others will pay no attention to it.
New patients, those who have undergone recent surgery, often feel they will never become accustomed to wearing an artificial eye. Some even believe that their lives are ruined. But, if these individuals could know the many fine and successful prosthetic eye wearers we have met through the years, they would not feel so depressed. Among our patients we number artists, entertainers, public office holders, working people, mothers and children, who are performing their daily tasks as capable as persons having two natural eyes. The secret of success for you is the same as for all individuals. Concentrate on your assets and good features. Forget your liabilities so that others may do so too.
Several of the following hints may be useful to you in detracting attention from your artificial eye. First of all, do not open your eyes too widely. Learn to contract your lids - learn to smile.
When you want to look in any direction, do not put the entire burden on your eye muscles. Turn your head or your body in the direction where you wish to look. In most cases, an artificial eye will move in unison with the natural eye, if the muscles are intact and if the eye is expertly fitted. However, if you have only limited motility, this fact will not be noticed by the observer if you are careful about facial expressions and will turn your head when looking to the side.
Some persons find that attractive spectacles or eye glasses of the non-shatterable type give a softened effect and make an artificial eye unnoticeable. We do not wish to suggest that all artificial eye wearers be burdened with glasses, if they do not want or need them. However, glasses often help to disguise an artificial eye, and non-shatterable lenses have the additional advantage of protecting the natural eye.
Occasionally, a prosthetic eye wearer will have an upper lid which is "short" or a lower lid that "sags". Improvement and correction in many cases depend on proper fittings as well as persistent massage or stretching of the lids.
Caution In Wiping Eyes
In wiping your artificial eye, always wipe toward the nose. This will prevent your eye from turning in the socket and assuming an incorrect position. Also, since your artificial eye rests on your lower lid and is supported by this lid, you should use caution when rubbing your lower lid, so that you will dislodge the eye. Never rub the prosthetic eye vigorously.
The Nature and Care of the Plastic Artificial Eye
The artificial eye, being of an alien nature to the human tissue, causes a discharge in the socket. This in turn necessitates the removal and cleaning of the eye for reasons of comfort, hygiene and cosmetic appearance.
A certain amount of this discharge can be alleviated by the use of a lubricant on the prosthetic eye. This lubricant is called "Silicone Lubricant for Plastic Artificial Eyes" and is available at our offices. The amount of discharge varies in most cases due to a number of reasons:
1. Sensitivity of the wearer.
2. Ill fitting or rough surfaced eye.
3. Sinus conditions or head colds.
The amount of discharge will determine the frequency of removal and cleaning of the prosthetic eye.
The easiest and most proven method for removal of the prosthetic eye is the use of a RUBBER SUCTION CUP available at our offices. The suction cup must first be moistened for use. This is then squeezed and placed against the iris of the artificial eye. The suction cup now in place, depress the lower lid with the forefinger, then twist the eye COUNTER-CLOCKWISE and lift UP and OUT.
The eye socket is now rinsed with an aseptic solution which your Ophthalmologist will advise. An eye cup, atomizer or syringe can be used to disperse the aseptic solution in the eye socket. The artificial eye is cleaned with a mild soap and warm water. The artificial eye is then rinsed carefully, dried and lubricated with the above-mentioned SILICONE solution. The artificial eye is now ready for re-insertion.
The SUCTION CUP is again moistened, squeezed and placed against the artificial eye. The prosthetic eye is inserted under the upper lid, top first. The "top" of the artificial eye will be shown to you by your attending technician at the time of delivery. (1) Use the forefinger to retract the upper lid, then place the eye under the upper lid and push in as far as possible. (2) Allow the upper lid to fall into place while still holding the eye in position. (3) Using the forefinger, depress the lower lid until the eye is behind both lids. (4) Now release the lower lid and place the forefinger against the eye, holding the eye in place, while removing the suction cup. This is accomplished by squeezing the cup and lifting away.
4-Cataract surgery
5-Glaucoma surgery
6-Refractive surgery
• Keratomilleusis is method of reshaping the cornea surface to change its optical power. A disc of cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power.
• Automated lamellar keratoplasty (ALK)
• Laser assisted in-situ keratomileusis (LASIK)
o IntraLASIK
• Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK
• Photorefractive keratectomy (PRK)
• Laser thermal keratoplasty (LTK)
• Conductive keratoplasty (CK) uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.
• Limbal relaxing incisions (LRI) to correct minor astigmatism
• Astigmatic keratotomy (AK), aka Arcuate keratotomy or Transverse keratotomy
• Radial keratotomy (RK)
• Hexagonal keratotomy (HK)
• Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe cut corneal button.
• Intracorneal rings (ICRs), or corneal ring segments (Intacs)
• Implantable contact lenses
• Presbyopia reversal
• Anterior ciliary sclerotomy (ACS)
• Laser reversal of presbyopia (LRP)
• Scleral expansion bands
7-Corneal surgery
• Penetrating keratoplasty (PK)
• Keratoprosthesis(KPro)
• Phototherapeutic keratectomy (PTK)[7]
• Pterygium excision
• Corneal tattooing
• Osteo-Odonto-Keratoprosthesis (OOKP), in which support for an artificial cornea is created from a tooth and its surrounding jawbone. This is a still-experimental procedure used for patients with severely damaged eyes, generally from burns.
8-Vitreo-retinal surgery
•
o Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.
o Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments [5].
• Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.
• Retinal detachment repair
o Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.
o A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.
o Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.
o Pneumatic retinopexy
o Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.
• Macular hole repair
• Partial lamellar sclerouvectomy
• Partial lamellar sclerocyclochoroidectomy
• Partial lamellar sclerochoroidectomy
• Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body [6].
• Radial optic neurotomy
• macular translocation surgery
o through 360 degree retinotomy
o through scleral imbrication technique
With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States [7].
• Eye muscle surgery typically corrects strabismus and includes the following [8]:
o Loosening / weakening procedures
Recession involves moving the insertion of a muscle posteriorly towards its origin.
Myectomy
Myotomy
Tenectomy
Tenotomy
o Tightening / strengthening procedures
Resection
Tucking
Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.
o Transposition / repositioning procedures
o Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first post-operative day, to obtain better ocular alignment [9].
10-Orbital surgery
• Orbital decompression for Grave's Disease. Grave's Disease is a condition (often associated with over-active thyroid problems) in which the eye muscles swell. Because the eye socket is bone, there is nowhere for the swelling to be accommodated and as a result the eye is pushed forward into a protruded position. In some patients this is very pronounced. Orbitial decompression involves removing some bone from the eye socket to open up one or more sinus's and so make space for the swollen tissue and allowing the eye to move back into normal position.
Other surgery
Many of these described procedures are historical and are not recommended due to a risk of complications. Particularly, these include operations done on ciliary body in an attempt to control glaucoma, since highly safer surgeries for glaucoma, including lasers, non-penetrating surgery, guarded filtration surgery and seton valve implants have been invented.
• A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma. A ciliectomy is 1) the surgical removal of part of the ciliary body, or 2) the surgical removal of part of a margin of an eyelid containing the roots of the eyelashes.
• A ciliotomy is a surgical section of the ciliary nerves.
• A conjunctivoanstrostomy is an opening made form the inferior conjuctival cul-de-sac into the maxillary sinus for the treatment of epiphora.
• Conjuctivoplasty is plastic surgery of the conjunctiva.
• A conjunctivorhinostomy is a surgical correction of the total obstruction of a lacrimal canaliculus by which the conjuctiva is anastomosed with the nasal cavity to improve tear flow.
• A corectomedialysis, or coretomedialysis, is an excision of a small portion of the iris at its junction with the ciliary body to form an artificial pupil.
• A corectomy, or coretomy, is any surgical cutting operation on the iris at the pupil.
• A corelysis is a surgical detachment of adhesions of the iris to the capsule of the crystalline lens or cornea.
• A coremorphosis is the surgical formation of an artificial pupil.
• A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.
• A coreoplasy, or laser pupillomydriasis, is any procedure that changes the size or shape of the pupil.
• A cyclectomy is an excision of portion of the ciliary body.
• A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.
• A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.
• An iridectomesodialsys is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.
• An iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.
• An iridencleisis, or corenclisis, is a surgical procedure for glaucoma in which a portion of the iris is incised and incarcerated in a limbal incision. (Subdivided into basal iridencleisis and total iridencleisis.)
• An iridesis is a surgical procedure in which a portion of the iris is brought through and incarcerated in a corneal incision in order to reposition the pupil. [13]
• An iridocorneosclerectomy is the surgical removal of a portion of the iris, the cornea, and the sclera.
• An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.
• An iridosclerectomy is the surgical removal of a portion of the sclera and a portion of the iris in the region of the limbus for the treatment of glaucoma.
• An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.
• A rhinommectomy is the surgical removal of a portion of the internal canthus.
• A trepanotrabeculectomy is used in the treatment of chronic open and chronic closed angle glaucoma.
References
1. ^ Surgery Encyclopedia - Ophthalmologic surgery
2. ^ Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Hi Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761
3. ^ a b Surgery Encyclopedia - LASIK
4. ^ Surgery Encyclopedia - PRK
5. ^ a b Surgery Encyclopedia - Corneal transplantation
6. ^ intercornealrings
7. ^ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
8. ^ MDAdvice.com - Pterygium removal
9. ^ http://news.yahoo.com/s/afp/irelandbritainhealthoffbeat
10. ^ http://www.wihrd.soton.ac.uk/projx/signpost/steers/STEER_2001(6).pdf
11. ^ vitrectomysurgery
12. ^ a b Surgery Encyclopedia - Photocoagulation therapy
13. ^ Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.
14. ^ Surgery Encyclopedia - Scleral Buckling
15. ^ Surgery Encyclopedia - Retinal_cryopexy
16. ^ Shields JA, Shields CL. Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture. Ophthalmic Surg. 1988 Nov;19(11):774-80. PMID 3222038.
17. ^ Surgery Encyclopedia - Eye Muscle Surgery
18. ^ Surgery Encyclopedia - Blepharoplasty
19. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
20. ^ Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006
21. ^ Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.
22. ^ Surgery Encyclopedia - Enucleation
23. ^ a b c Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.
24. ^ Surgery Encyclopedia - Exenteration
25. ^ a b Cvetkovic D, Blagojevic M, Dodic V. ["Comparative results of trepanotrabeculectomy and iridencleisis in primary glaucoma."] J Fr Ophtalmol. 1979 Feb;2(2):103-7. PMID 444110.
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