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Around The Fleet

The Eyesmith

Dotting Eyes, Crossing Teeth

If eyes are the mirrors of the soul, then Louis Gilbert is a soul maker. From his dental laboratory at Walter Reed National Military Medical Center he is busy; creating handmade, lifelike prosthetic eyes that would make any soul proud.

Gilbert, a retired Navy dental technician, received training in maxillofacial prosthetics at the Naval Postgraduate Dental School. 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 expand his dental technician skills while learning the ins and outs of painting and creating facial prosthetics, which involves using the same materials as those used to make dentures.

Mastering the Eyes

Gilbert learned to master the various aspects of maxillofacial prosthodontics, but was very interested in "mastering the eyes," he said.

"It was more appealing to me. It was more creative," he explained.

After retiring from the Navy after a 20-year career, Gilbert began working as a Department of Defense civilian in 2006 at the former Walter Reed Army Medical Center that was located in Silver Spring, Maryland. Now in Bethesda, Gilbert has continued working with other skilled anaplastologists, who specialize in producing and fitting facial prosthetics.

The team here decided they would each concentrate on a particular aspect of their craft, with Gilbert focusing primarily on prosthetic eyes, or ocular prosthetics. Some of his colleagues have mastered silicone work, while others are able to make "specialized" eyes - like 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 said.

Constructing a Prosthetic Eye

The process of making a prosthetic eye typically takes about eight hours, Gilbert said. Also referred to as an ocularist, he 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. Gilbert can easily heat up this material and reshape 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 ensures 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.

Painting the Eye

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 look 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 said. 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.
Navy Photo

Rewarding Work, Happy Patients

Some eyes are more challenging, Gilbert said, for example, if an individual has a unique eye color. But, he added, 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," he said.

"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 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 -- Gilbert 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.

Nunez said she has felt insecure her entire life -- feeling she was "different." Her parents, she said, raised her to be strong and independent. 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

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, the laboratory manager, echoed similar sentiments. "We take great pride in making sure our patients are happy; that's most important," she said.

Guilford creates specialized eyes. "Basically anything they want, they can get here," she said.

Once Gilbert finishes making a mold to fit the patient's eye 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.

Captain Americas' Eye

She recalls making a Captain America eye for Army 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. Block lost his right eye but retained vision in his left eye. He also had his ocular bone and nose and cheekbone rebuilt.

Block was not aware that such life-like prosthetic eyes could be made, and he 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 children.

"They get really excited about it," he said.

As he always strives to be a role model and do what's right for his family, friends and his country, Block 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."