By Sarah Marshall
Walter Reed National Military Medical Center
BETHESDA, Md., Feb. 26, 2015 – Louis Gilbert creates
handmade, lifelike prosthetic eyes in the dental laboratory at Walter Reed
National Military Medical Center here.
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.
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 America’ 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.”
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