By Will Lakey MFA BCO, Ocularist at Prosthetics at Graphica Medica
In November 2021, there were reports in the news that the first 3D-printed artificial eye had been delivered to a patient at Moorfields eye hospital in London, England.
This is exciting, because although 3D printing has long been touted as a potential game changer for the manufacture of artificial eyes, there hasn’t been much visible progress. The ocular manufacturing process often feels archaic in its use of wax, oil paints, and alcohol lamps, but despite much effort very few technological innovations have made it to the mainstream.
I, for one, often feel more like an artisan than a medical provider. But that works for me as I have an art background and love to work with my hands. However, that also means that the quality of the final product leans heavily on the talent of the ocularist doing the work, and even the most talented ocularist can have a bad day. At the expense of the decades old “artisan” tradition, switching to digital processes has the potential to largely eliminate this weakness in the system. However, it’s hard to gauge how close we are to the widespread use of this technology based on the reports I have seen, which are written for the general public.
So, wearing my professional hat, here are a few of my questions and reactions to Moorfields’ 3D-printed ocular prosthesis.
Scanning
The news report states that the patient’s socket was scanned. Not much detail is given about how this works, but according to Fraunhofer IGD, a partner in this new process, the non-invasive scan takes 2.4 seconds using a modified medical scanner. This sounds great. And obviously, since they have successfully delivered the eye, it provided useful information. However, as any ocularist will tell you, an empty eye socket isn’t like a cave with hard walls that retain their shape when the artificial eye is removed. It is made of soft tissues that move and change when the ocular is removed, as well as when the patient looks around. There is often scar tissue that is less flexible, and under the tissue there are hard implants and bone that a poorly-fitted ocular can press upon, causing discomfort. I’ve seen sockets that had no space at all without the prosthesis inserted. This is not a problem for the traditional method where an impression material is squeezed into the socket, but without something to simulate the pressure an eye applies to those tissues, a digital scan wouldn’t tell you much about what shape the eye needed to be.
Fitting
The traditional process of fitting an ocular starts with an impression (an old fashioned scan, if you will). This is reproduced in wax, which is then modified through a sequence of subtle, and sometimes not so subtle, adjustments and changes that results in an eye that not only looks right, but is comfortable at the same time. The report states that with the new system, the “initial” appointment is reduced from 2 hours to 30 minutes. It then goes on to say that the entire process takes 2-3 weeks, but it fails to mention what happens in that time. The implication is that the patient is seen for 30 minutes and then 3 weeks later they receive their new digitally-manufactured eye. But adjustments will need to be made to the original scan and tested to optimize the fit, and I’d love to get more detail on how that was done, and what that process is like for the patient.
Waiting Times
One of the chief benefits mentioned in the reports, is the potential to reduce waiting times from 6 weeks to 3. How much of that reduction is achieved by simply outsourcing the manufacturing of the prosthesis to a third party, thereby freeing up the ocularists to spend more time seeing patients? I don’t want to be a cynic, and I’m always a fan of speeding up the delivery of ocular prostheses, but outsourcing is just another way to say you are employing more people to do the work. Only time will tell if the increased quality and efficiencies offered by the new digital processes will outweigh the costs.
It’s also worth mentioning that these waiting times are not reflective of the time it takes to actually manufacture an ocular prosthesis, but rather the number of patients in the system who need to be seen and the specific protocols employed by Moorfields. In some places in the US it’s possible to get an artificial eye in one day. This comes with its own problems, but it illustrates that the reduced wait times offered by this process are not a universal advantage, but specific to the busy departments found in the UK and elsewhere.
Materials
The reports don’t include information on the materials the new oculars are made from. I assume they are medical grade and safe. However, I am interested to know how those materials compare to the acrylic plastic that is currently used in terms of resistance to damage and how long the colors will last before they fade or change. It is entirely possible that the new materials will prove to be more robust than acrylic, but until they have been delivered in larger numbers and worn for a long period, we won’t know.
Conclusion
Whenever new technology is announced in the field of ocularistry there is usually a lot of excitement, especially on the part of the patients who might benefit from it. I won’t deny that I feel a little excitement when something like this pops up in the news, as I want this field to move forward and benefit from the technological advancements that are sweeping through the rest of the medical field. However, over the years I have witnessed the introduction of quite a few so-called advancements, but virtually none have made a lasting impact on the field. Even when the new process provides a tangible improvement in the final product, it doesn’t necessarily survive. To take an example from outside the field of ocularistry, consider the Concorde. This supersonic airliner reduced the flight time from London to New York from over 7 hours to just 3, but too few people were prepared to pay the price of a ticket. Despite its undeniable advantages over regular aircraft, the Concorde never turned a profit and eventually disappeared. Being better isn’t always enough.
Oculars might be physically small, but the challenges involved in making them are not. So we will have to wait and see if this latest foray into digitally-manufactured oculars will have what it takes to overcome them.
