BETHESDA, Md. (NNS) -- A staff member at Walter Reed National Military Medical Center has a specialized skill - one you wouldn't expect to find in Hospital Dentistry. Louis Gilbert, a retired Navy dental technician, works in a dental lab to create hand-made, lifelike prosthetic eyes.
While on active duty, Gilbert received training in maxillofacial prosthetics at the Naval Postgraduate Dental School (NPDS). The craft involves creating replacements for missing ears, noses and other facial parts missing due to birth defects, cancer, combat or trauma, he explained. He completed the NPDS maxillofacial laboratory prosthodontics course in 2000. The six-month course allowed him to expound upon his dental technician skills, while learning the ins and outs of painting and creating facial prosthetics, which happens to involve using the same materials as those used to make dentures.
Though he learned to master the various aspects of maxillofacial prosthodontics, he said, he was very interested in "mastering the eyes."
"It was more appealing to me. It was more creative," he explained, as he has always loved art.
After retiring from a 20-year military career, Gilbert began working as a Department of Defense civilian in 2006 at the former Walter Reed Army Medical Center. Now at Walter Reed Bethesda, Gilbert has continued working with other skilled anaplastologists, who specialize in producing and fitting facial prosthetics.
The team decided they would each concentrate on a particular aspect of their trade, with Gilbert focusing primarily on prosthetic eyes, or ocular prosthetics. His colleagues have mastered silicone work, while others are able to make "specialized" eyes, which may include a Marine emblem, or sports team logo, superimposed on the iris of a prosthetic eye. Patients have even asked for glow-in-the-dark prosthetic eyes.
Gilbert explained he and his colleagues often must "create something from nothing. That's the beauty of it. You have to be creative."
The entire process of making a prosthetic eye typically takes about eight hours, he said. Also referred to as an ocularist, Gilbert begins by making an impression of the eye socket, where the eye is missing. He uses an alginate, or wax-like, casting material, to make the impression. He can easily heat up this material and re-shape it during the fitting process, if need be, he said. He will later use this impression to make a mold of the eye.
Gilbert then sits in front of the patient, using the remaining eye as a guide as he paints the patient's iris on a small "canvas," a round circular fabric, about the size of a pinky nail. He might also use a photo of the patient's remaining eye, as a guide. He makes sure to capture every intricate detail of the iris, using oil-based paints. He also measures the patient's iris and pupil, on the remaining eye, to ensure the prosthetic matches.
Once he's finished painting the iris, he superimposes a "pupil" on top of the iris. A small round, acrylic dome is then placed over the iris and pupil, magnifying the colors. Altogether, the pupil and iris are attached to the mold. Gilbert then inserts the mold into the eye socket to check the alignment of the iris. He calls this part of the process "setting the gaze," making sure the iris is aligned properly.
Gilbert then completes the mold by painting the sclera, the white part of the eye. He has about a dozen shades of acrylic paint to choose from, for this part of the eye, including dark greys, yellows and different shades of white. He then uses red strands of thread to create veins in the eye, and finally, he adds a clear coat over the eye to seal the prosthetic.
"The goal is to be as natural and normal, and looks as normal, as possible, and to be comfortable," Gilbert said.
If there is no damage to the muscles behind the eye, then the prosthetic eye should still be able to move normally as well, he noted. Gilbert will continue to see his patients within the months following to ensure proper fit, as post-surgery swelling continues to go down. Long term, patients usually return about once a year for polishing, and to ensure the eye still fits properly.
Some eyes are more challenging, he added, if an individual has a unique eye color, but the hard work pays off - it's an incredible feeling to see the look on a person's face when they see themselves in the mirror for the first time with their new eye.
"It's exciting because I'm making them feel whole again," Gilbert said. "This is absolutely the best job. It's really rewarding."
About a year ago, Gilbert made a prosthetic eye for Jeannette Nunez shortly after her left eye was removed due to complications with glaucoma. Since childhood, she struggled with the disease that damages the eye's optic nerve, which connects the retina to the brain.
"My entire life, doctors have been telling me, one day we're going to have to take that eye out," Nunez explained. Knowing that day was coming did not make it any easier. That day came on March 17, 2014. What did make it more pleasant, was her experience at Walter Reed Bethesda, and working with Gilbert.
Six weeks after her surgery, she met the ocularist, and she was "instantly pleased," with his knowledge and his attention, she said. Nunez didn't feel rushed - he took the time to understand her concerns, and walked her through the process. When it came to making an impression of her socket, he made sure she knew step by step what was going to happen next.
Her entire life, she said, she has felt a veil of insecurity, feeling she was "different." Her parents raised her to be strong, and independent - and for the first time in her life, with her identical, dark brown eyes, she said, she has confidence in saying, "I believe what was instilled in me ... That was a revelation for me."
A TEAM EFFORT
In this highly specialized craft, Gilbert works closely with anaplastologists Gwen Guildford and Robert Robinson. The three have crossed paths over the years, each taking the maxillofacial course at NPDS, and each having served at one point on active duty at the former National Naval Medical Center. They each continue to do dental work as well, creating dental implants and dentures. They agreed, their "hearts belong here," and they go out of their way to ensure their patients are happy.
"It's a small group, as far as those of us in the field," said Robinson, who is the "go to" for silicone work. He creates facial prosthetics, such as nasal, facial, or ear prosthetics, using various forms of silicone to create life-like textures on the prosthetic. Robinson has been doing anaplastology for 17 years, and prosthetics for 25 years. He agreed, it is "heartwarming to see how [a patient] reacts when they look at themselves in the mirror for the first time with whatever we're able to make for them."
Guilford, laboratory manager, echoed similar sentiments. "We take great pride in making sure our patients are happy - that's most important."
The anaplastologist creates specialized eyes, or as she likes to call them "silly eyes." In terms of these eyes, she said, "Basically anything they want, they can get here."
Once Gilbert finishes making a mold to fit the patient's socket, and creates their natural looking eye, Guilford crafts the iris with a specialized design, be it a Purple Heart, Ranger emblem, diamonds, or a flower.
She recalls making a Captain America eye for Sgt. Thomas Block, who was severely injured Oct. 5, 2013. While on patrol with fellow Rangers in southern Afghanistan, an insurgent detonated a bomb strapped to her body, throwing him back 35 feet into a minefield. He lost his right eye, but retained vision in his left eye. He also had his ocular bone, nose and cheekbone, rebuilt.
Block was not aware they could make such life-like prosthetic eyes, and was particularly surprised to learn the work takes place in a dental lab. He asked for the Captain America shield, because it was already in the shape of a circle, like an iris, and the symbol seemed patriotic. He said he enjoys seeing others react to his eye, especially kids. "They get really excited about it."
As he always strives to be a role model, and do what's right for his family, friends and his country, he said, "[The Captain America eye] gives me a standard to uphold."
Block also expressed his appreciation for the "amazing care" he's received from the team in the dental lab.
"They work really well together," he said. "They make it easy for me, the patient, to feel comfortable wearing this prosthetic. They're here for us."
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