OCULAR PROSTHETIC WORKSHOP
Sunny M. Sanders, OD, FAAO
Southern California College of Optometry
Fullerton, CA
ssanders@scco.edu
Julie A. Schornack, OD, MEd, FAAO
Southern California College of Optometry
Fullerton, CA
jschornack@scco.edu
Abstract
This workshop provides an overview of prosthetic devices and procedures to inform and prepare the
optometrist to comfortably manage this special patient population in a practice setting. The emphasis will
be to teach the concepts and skills needed to evaluate, maintain, modify, fit and re-fit the various
prosthetic ophthalmic devices and provide the necessary patient education and follow-up. Hands-on
participation includes using contact lens modification equipment, power hand tools, buffing and polishing
compounds, and impression and casting equipment to demonstrate the skills needed to create and fit
artificial (reform) eyes, scleral shells or shell eyes, corneal prosthetic lenses, and hydrophilic prosthetic
lenses. Additionally, illustrative cases and patient management techniques will be presented.
Learning Objectives
1.
2.
3.
4.
5.
6.
To describe the specific ocular prosthetic devices and their usage.
To know the prosthetic device maintenance techniques and replacement considerations.
To understand the evaluation and care of the ocular tissue/socket behind the prosthetic appliance.
To understand the fitting procedures and techniques for the various prosthetic devices.
To be able to modify and fabricate prosthetic devices using the skills methods and procedures
presented.
To provide the sources and resources to incorporate this unique service in the optometric practice.
OCULAR PROSTHETIC TECHNIQUES FOR THE OPTOMETRIST
I. WHY PROSTHETICS?
A. Optometrists are uniquely positioned as primary care providers to use their knowledge and
training in anatomy, physiology, optics, contact lenses, low vision, ocular disease diagnosis
and treatment, and other associated areas to provide the various prostheses and necessary
care.
II. TYPES OF PROSTHETIC DEVICES
A. REFORM EYE (Artificial eye)
B. SHELL EYE
C. CORNEAL PROSTHETIC LENS
D. HYDROPHILIC PROSTHETIC LENS
III. SURGICAL PROCEDURES AND IMPLANT TYPES
A. TYPES OF IMPLANTS
1. SPHERES
2. MUSCLE ATTACHED
3. BIO-EYE HYDROXYAPATITE OCULAR IMPLANT
B. SIMPLE ENUCLEATION/NO IMPLANT
C. ENUCLEATION WITH AN IMPLANT
D. EVISCERATION
E. EXENTERATION
F. SECONDARY IMPLANTS
IV. PROBLEMS WITH IMPLANTS
A.
B.
C.
D.
E.
F.
MIGRATION
EXTRUSION
MOTILITY
NO SUPPORT FOR THE ARTIFICIAL EYE
FOREIGN MATERIAL EXPOSED
INFECTIONS
V. PROSTHETIC EXAMINATION REQUIREMENTS
VI. IN OFFICE PROSTHETIC PROCEDURES
A.
B.
C.
D.
PROSTHETIC EVALUATION
PROSTHETIC CLEANING AND POLISHING
MODIFICATION TECHNIQUES
REFITTING TECHNIQUES AND SKILLS
VII. COMMON PROBLEMS WITH PROSTHETIC DEVICES
VIII. CARE CONSIDERATIONS FOR THE HYDROPHILIC PROSTHETIC LENS
IX.
CARE CONSIDERATIONS FOR THE CORNEAL PROSTHETIC LENS
X.
CARE CONSIDERATIONS FOR THE PROSTHETIC EYE/SHELL
XI. POLISHING TECHNIQUES
A. CONTACT LENS MODIFICATION UNIT
B. HAND-HELD TOOLS
C. SPINDLED MOTOR UNITS
XII. WHAT TO NOT USE ON PROSTHETICS
XIII. MODIFICATION TECHNIQUES
A. USING THE CUT-DOWN STONE
B. WAX BUILD-UP TECHNIQUES
XIV. MODIFICATION OF SHELLS AND REFORM EYES
A.
B.
C.
D.
MAKE EYES SMALLER
ENLARGE EYES
CORRECT SIZE AND SHAPE EVALUATION
ORDERING PROCEDURES
XV. TRIAL FIT METHODS
XVI. PROSTHETIC DEVICE DETERMINATION CRITERION
A. HYDROPHILIC PROSTHETIC USES
B. CORNEAL PROSTHETIC LENS USES
C. SHELL AND REFORM EYES
XVII. FITTING TECHNIQUES OPTIONS
A.
B.
C.
D.
E.
USING TRIAL EYE SET
USING “OLD” SCLERAL CONTACT LENSES
USING PATIENT’S EXISTING PROSTHETIC AS A BASIS
USING “WHITE SHAPES”
BY IMPRESSION MOLDING
1. USING SCLERAL LENSES OR FITTIING SHAPES
2. USING REFORM EYES
3. USING AN IMPRESSION TRAY
XVIII. PROSTHETIC DISPENSING CONSIDERATIONS
A.
B.
C.
D.
PATIENT EDUCATION ISSUES
PROSTHETIC CARE INFORMATION AND PROCEDURES
PROSTHETIC EVALUATION AND REPLACEMENT SCHEDULE
CARE SYSTEM DISPENSING
XIX. INSERTION AND REMOVAL TECHNIQUES FOR PROSTHETIC EYES
A. USING A SUCTION ROD
B. BY HAND
XX. REFORM EYE AND SHELL EYE WEARING AND REPLACEMENT SCHEDULES
XXI. LABORATORY STATIONS
A. STUDY THE EXAMPLES OF:
1.
2.
3.
4.
5.
6.
7.
8.
9.
REFORM EYES
SHELL EYES
SCLERAL CONTACT LENSES
GLASS EYES
IMPLANTS
WHITE SHAPES
IMPRESSION MOLDING SET
HYDROPHILIC PROSTHETIC LENSES
CORNEAL PROSTHETIC LENSES
B. SELECT A “PRACTICE” EYE
1. POLISH SCRATCHES USING CONTACT LENS MODIFICATION UNIT
2. POLISH SCRATCHES USING THE VARIOUS TYPES OF POWER TOOLS
AND PUMICE COMPOUNDS
3. MODIFY AND/OR CUT-DOWN THE PRACTICE EYES USING POWER TOOLS
AND APPROPRIATE BITS
4. PRODUCE A FINAL LUSTER FINISH AND/OR FINAL POLISH USING THE
VARIOUS POWER TOOLS AND PLASTIC ROUGE
C. WAX MODELING TECHNIQUES
1. APPLY UTILITY WAX LAYERS TO A PROSTHETIC EYE OR SHELL
TO PRODUCE THE MODIFICATION EFFECTS PER THE
ILLUSTRATIVE PROSTHETIC FITTING GUIDE
D. CASTING PROCEDURES
1. PREPARE A MODIFIED PROSTHETIC EYE FOR THE CASTING
STONE PROCEDURE
2. PERFORM ONE OF THE CASTING PROCEDURES
3. CURE THE CASTING STONE MOLD AND REMOVE THE
PROSTHETIC EYE SAFELY FROM THE CAST
4. PREPARE THE CAST FOR LAB TO FABRICATE NEW
PROSTHETIC EYE
E. IMPRESSION MOLDING TECHNIQUES
1.BECOME FAMILIAR WITH THE VARIOUS IMPRESSION MOLDING
APPLIANCES, COMPOUNDS AND TECHNIQUES
F. CASE EXAMPLES AND VIDEO DEMONSTRATIONS OF ORBITAL
IMPLANT AND PROSTHETIC INTEGRATION, MOTILITY ISSUES, AND
PROSTHETIC DEVICE HANDLING EXAMPLES
G. ESSENTIAL EQUIPMENT AND SUPPLIES
XXII. READING REFERENCES
1. Monoplex Bulletins 1-46. American Optical Corporation, Optical Products
Division, Southbridge,Mass.