eye wear frame selection
TRANSCRIPT
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Eyewear Frame SelectionEyewear Frame Selection
Unit 1: Face Shape Analysis
OPTOM FASLU MUHAMMED
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A Basic Guide to Face ShapesA Basic Guide to Face Shapes
Frame shape should contrast with face shape
Frame size should be in scale with face size
Eyewear should balance personal proportion
Three Keys: Essential Elements:
The seven basic face shapes
Identifying shape, analyzing proportions
Selecting frames that enhance features
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The oval face is considered the ideal face shape in the western world
The oval face is epitomized by Leonardo DaVinci’s Mona Lisa
The Ideal Face Shape
A Basic Guide to Face ShapesA Basic Guide to Face Shapes
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1. Angular (square/rectangular)2. Curvilinear (round/oval)
Two General Categories of Faces
A Basic Guide to Face ShapesA Basic Guide to Face Shapes
Although faces may be classified as predominately composed of angular features or curvilinear features, it should be noted that all faces are a combination of angular and curvilinear lines.
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Seven Basic Face Shapes
A Basic Guide to Face ShapesA Basic Guide to Face Shapes
The combination of facial curves and angles is further subdivided into the seven basic face shapes
Round, oval, square, base-down triangle, base-up triangle, oblong and diamond
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Balance and Harmony:
How to Analyze Face ShapesHow to Analyze Face Shapes
Well-chosen eyewear can restore balance to the face
The optician must identify misproportions and determine how faces deviate from the oval ideal
The goal of frame selection is to find a frame that contrasts with the shape of the face and emphasizes the complimentary lines of the face
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1. The width of the face is divided into five sections about the width of an eye
2. Identify unequal sections such as narrow set eyes or wide cheeks
3. The face may be either too wide or too narrow when compared to the oval ideal
Measuring the Width of the Face
How to Analyze Face ShapesHow to Analyze Face Shapes
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4. A narrow fifth between the eyes indicates that the eyes are close together
5. A wide fifth between the eyes indicates wide-set eyes that are farther apart
6. Frames are chosen to make the eyes appear further apart or closer together to restore facial balance
Measuring the Width of the Face
How to Analyze Face ShapesHow to Analyze Face Shapes
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1. The face is divided into three horizontal sections:
a. Hairline to browlineb. Browline to tip of nosec. Tip of nose to chin
2. Identify unequal sections3. The face may be either too long
or too short when compared to the oval ideal
Measuring the Length of the Face
How to Analyze Face ShapesHow to Analyze Face Shapes
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1. Perfectly balanced faces are rare
2. Frames are used to balance facial inequities
3. If the middle third of the face is too long, a deeper frame will minimize the imbalance
Facial Proportion and Balance
Frames and Facial BalanceFrames and Facial Balance
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4. If the top third of the face is too long with a high forehead, low temples will help restore balance to the face
Facial Proportion and Balance
Frames and Facial BalanceFrames and Facial Balance
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1. Visualize dots placed on each side of a patient’s brow, cheek, and jaw
2. The dot method will help to identify the shape and size of the face
3. The dots can also help identify strong and weak points
Dot and Define:
Dots to Determine Face Shape Dots to Determine Face Shape
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4. Photographs of faces can be used to practice placing dots and identifying face shapes
5. Use polaroid snapshots of patients to demonstrate the system of analyzing face shapes and balance
Dot and Define:
Dots to Determine Face Shape Dots to Determine Face Shape
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1. The oval face is considered the ideal shape because of its mostly balanced proportions
2. Frames should maintain the natural balance of the oval face
Oval Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Oval Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Select frames that as wide or wider than than the broadest part of the face
Avoid low, swooping temples, which will unbalance the face
Keep frames in proportion to the face
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1. Diamond-shaped faces are narrow at the eyeline and the jawline with a small forehead and chin
2. Cheekbones are frequently high and dramatic.
Diamond Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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3. The diamond is the rarest face shape
4. Frames should widen the forehead and jaw and minimize the temples and cheekbones
Diamond Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Diamond Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Choose frames that are heavy on top but avoid low temples
Frame sides can be straight or rounded.
Rimless frames Square frames or frames with
a straight top and curved bottom
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1. The round face is full with few angles
2. The width and length are in roughly equal proportions
3. Frames should make the face appear longer and thinner
Round Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Round Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Eyewear that creates angles or horizontal lines will make the face appear more angular
Slightly angular frames will narrow the round face
Avoid excessively rounded or square styles which will exaggerate facial roundness
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Round Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
High or mid-height temples help create a longer profile
A clear bridge widens the eyes
Colored temples add width Frames should be wider than
they are deep
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1. The square face is characterized by a strong jaw line, a broad forehead, and a wide chin and cheekbones
2. Frames should make the face look longer
Square Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Square Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Gently curved narrow styles will minimize squareness and lengthen the face
The frames should be wider than the widest part of the face
Frames should be more horizontal than vertical
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Square Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Select frames with weight on top
Oval shapes with mid-level to high temples
Color or skiving (ornamental engraving) on the frames’ upper temporal corners will lengthen the face
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1. The base-down triangular face has a narrow forehead that widens at the cheek and chin areas
2. Frames should add width to the forehead while softening and narrowing the appearance of the jaw, chin, and cheeks
3. The ideal face for glasses
Base-down Triangle Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Base-down Triangle Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Frames should accent the eye area and be wide enough to balance the jaw line
Frame tops should be slightly heavy and contain skiving
Frame bottoms should angle inward
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Base-down Triangle Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Avoid low temple styles and use mid-level to high temple styles—depending on the length of the face
Use square, straight-top aviators or metal frames with rimless bottoms
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1. The base-up triangular face is characterized by a very wide forehead and high cheekbones which narrows gradually to the chin
2. Frame should add width below the eyeline to offset the narrow chin
3. The worst face for glasses
Base-up Triangle Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Base-up Triangle Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Try frames that are wider at the bottom
Other choices include aviator, butterfly, or low-triangle styles
Frames with rounded tops and squared bottoms
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1. The oblong face is one that is longer than it is wide
2. Select a frame that is deeper than it is wide to create the illusion that the face is shorter
3. Frames should “break up” the length of the face to make the face appear shorter and wider
Oblong Face: Description
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
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Oblong Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Frames should have top to bottom depth
Shorten the face by using round, deep, or low-triangle shapes
Use frames with strong horizontal lines emphasized by skiving
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Oblong Face: Tips
Faces, Frames, and GuidelinesFaces, Frames, and Guidelines
Decorative or contrasting temples can add width to the face
Mid-level to low temple position can reduce the length of the face
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To Shorten a Face: Use mid- or low-temples; deeper,
narrower frames; or a low bridgeTo Lengthen a Face: Use mid- or high-temples; a high
bridge; shallow, wide frames; or frames with little or no color on the lower rim
Face
GuidelinesGuidelines
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GuidelinesGuidelines
To Shorten the Nose: Choose a frame with a low
or solid, colored bridge Avoid a keyhole bridge, a
high bridge, or a clear bridge
Nose
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GuidelinesGuidelines
To Lengthen the Nose: Choose a keyhole bridge,
a high bridge, or a clear bridge
Avoid a frame with a low or solid, colored bridge
Nose
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To Narrow and Lengthen a Wide Nose:
Use a clear or metal bridge that sits close to the nose
Use nosepads
Nose
GuidelinesGuidelines
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To Widen Close-set Eyes: Select frames with an
unobtrusive bridge Use a clear bridge with darker
colors placed at the outer edges of the frame
Narrow width frames help to center the eyes
Eyes
GuidelinesGuidelines
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To Narrow Wide-set Eyes: Use a dark colored bridge Use wide frames to center
the eyes in the lenses
Eyes
GuidelinesGuidelines
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A Small Face: Use thin metals and subtle
colors; lightweight frames; or rimless frames
Don’t overwhelm delicate features with heavy or exaggerated frames
Scale
GuidelinesGuidelines
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A Large Face: A large face can be balanced by
using a slightly oversized frame Heavy features can be balanced
by using heavier frames
Scale
GuidelinesGuidelines
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Eyewear Frame SelectionEyewear Frame Selection
ReviewUnit 1: Face Shape Analysis
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Contrast
The frame shape should _____ with the face shape.
ReviewReview
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True
A perfectly balanced face can be divided into five parts vertically and three parts horizontally. (True/False)
ReviewReview
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True
All face shapes are a combination of curvilinear and angular lines. (True/False)
ReviewReview
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Longer
High or mid-height temples on a round face help make the face appear _____.
ReviewReview
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c. keyhole bridge
Which of the following will help lengthen a short nose?a. low bridgeb. colored bridgec. keyhole bridge
ReviewReview
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True
A large face can be balanced by a slightly oversized frame (True/False)
ReviewReview
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Scale (proportion, balance, harmony)
Frame size should be in ____ with face size.
ReviewReview
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ReviewReviewIdentify the face shape below:
Oval
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ReviewReviewIdentify the face shape below:
Diamond
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ReviewReviewIdentify the face shape below:
Round
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ReviewReviewIdentify the face shape below:
Square
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ReviewReviewIdentify the face shape below:
Base Down Triangle
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ReviewReviewIdentify the face shape below:
Base Up Triangle
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ReviewReviewIdentify the face shape below:
Oval
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ReviewReviewIdentify the face shape below:
Oblong
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Eyewear Frame SelectionEyewear Frame Selection
EndUnit 1: Face Shape Analysis
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A New Option for Keratoconus
Keratoconus Intacs -1 Day PKP -1 Week
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Contact Lens Intolerant Keratoconus Steep K ‘s, 45 to 60 Changing refractions, eyes irritated, frequent
visits/re-fits Lenses not providing functional vision
Outright failure Shortened wearing time Inability to achieve 20/40
“keratoconus personality” exacerbated Apprehensive about transplant
Active, younger or risk averse
Objective - Bridge the gap between frustration and (PKP) “the point of no return”
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Reshape the Cornea for CL Success
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Oklahoma optometrist first conceptualized the idea in 1978
One of the early medical champions of contact lenses in the U.S.
Developed CorneaScope in late 1960s - led to today’s topography
Gene Reynolds, O.D.1921 - 1994
INTACS HistoryConcept for Corneal Reshaping
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Arc-Shortening Model for Treating Myopia: Preoperative Representation of the
Cornea
How does it work?
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Arc-Shortening Model for Treating Myopia: Representation of the Cornea After
Placement of INTACS Inserts
How does it work?
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History
Adjustable Ring1984
As conceived by Dr. Reynolds
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1978 – A.E. Reynolds, O.D. conceives of Intrastromal Corneal Ring (ICR)
1985 - First pre-clinical studies on Dr. Reynolds' product
1991 - First human clinical trials begun - Brazil
1996 - U.S. myopia clinical trial begun, 150º ICR- CE Mark approval of ICR in Europe, -1.00 to -4.50 D
1997 - Joseph Colin, MD inserts first ICR for Keratoconus
Milestones
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INTACS Design Features Precision
manufactured to ± 0.01mm: • 150° arcs PMMA• Unique hexagonal cross-
section design with 7mm wide optical zone
• Positioning holes for manipulation
Inserts placement:• In peripheral cornea• Between stromal layers
Stromal Lamellae
6.9 mm8.1 mm
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Stromal Lamellae
How INTACS Work…
Inserts placed at 75% corneal depth
Inserts separate corneal lamellae
Separation shortens corneal arc length
Central cornea flattens Increased flattening
achieved with thicker segments
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1999 - FDA approval for myopia, -1.00 to -3.00 D
2001 - Addition Technology purchased INTACS technology to pursue keratoconus indication
2003 - CE approval granted for keratoconus in Europe
2004 - FDA approval for keratoconus under Humanitarian Device Exemption (HDE)
2005 – Over 5000 INTACS corneal implants procedures for keratoconus performed worldwide
Milestones cont’d
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Keratoconus Non-Inflammatory
Ectasia• Stromal Thinning• Disruption of Bowman’s
Membrane
Corneal Ectasia• Myopia• Irregular Astigmatism
Optical Correction• Spectacles– early• Contact Lenses– later
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Keratoconus
Demographics• Estimates vary from
50 to 170 per 100,000
Obscure Etiology• Heredity• Allergies, Eye Rubbing
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Why Does the Cornea Bulge in Keratoconus?
Corneal tissue is abnormal• Too elastic?• Abnormal cross-linking of
collagen?
Loss of structural integrity of Bowman’s Layer?
Keratocyte apoptosis• Trauma (eye rubbing)
Corneal tissue bulges because it is too thin?
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Current Surgical Options - Keratoconus
10% to 20% of Keratoconus Patients Ultimately Require Surgery
Lamellar Keratoplasty• Interface haze limits visual result
Penetrating Keratoplasty• Most frequent procedure – 4,771 cases in 2004 (US)• 80-90% successful• Issues
Graft rejection rate 17.9% Continued astigmatism Endothelial cell loss (limited longevity of graft) Recurrence of Keratoconus
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INTACS… a New Surgical Option
Goal is to restore functional vision
• Effective functional refraction with soft, soft-toric, or rigid contact lenses
• Create cornea more receptive to contact lenses
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Watch the Pre-op and Post-op mire INTACS Normalize Corneal Shape
The INTACS Procedure
Courtesy David Schanzlin, MD Shiley Eye Inst. UCSD
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Pre-Op UCVA 20/200 MR: -4.75 + 5.25 X 005 = 20/40 RGP intolerant
Post-Op (Day 1)
UCVA 20/50++ MR: -1.00 + 2.75 X 150 = 20/20 Soft Toric
Courtesy David Schanzlin, MD Shiley Eye Inst. UCSD
Procedure Outcome
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“ Fitting CL’s on keratoconus patients who have INTACS is feasible and has a role in augmenting their vision” Nepomuceno, Boxer Wachler, Weissman, CLAE 2003 175-180
pre-op BCVA post-op BCVA post-op BCLVA Lens
31 F 20/32 20/25 20/16 soft toric
44 M 20/125 20/50 20/25 cust. RGP
34 M 20/63 20/40 20/20 cust. RGP
All were CF UCVA pre-op and 20/200 or better post-op
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INTACS Case FilesPre-Op
UCVA CF BCVA: 20/50 MR: -7.00 -6.00 @ 60 Max K: 46.60 @ 175 Custom RGP Intolerant
Case 1
Anterior Posterior
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INTACS Case Files
UCVA 20/80 BCVA: 20/30 MR: -2.00 -2.75 @ 60 Max K: 43.40 @ 14 Soft Toric
Case 1Post-Op
Anterior Posterior
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Architecture Modification
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Architecture Modification
Pentacam Images
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INTACS Case Files
UCVA CF BCVA: 20/50 MR: -4.75 + 5.00 @ 20 Max K: 55.78 @ 90 Custom RGP Intolerant
Case 2OD Pre-OP
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INTACS Case Files
UCVA 20/40 BCVA: 20/25 MR: -2.00 Max K: 51.69 @ 89 RGP Tolerant
Case 2OD Post-OP
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INTACS Optics
Maintains prolate cornea
Enhances structural integrity (second limbus)
Additive – Removable - Replaceable
Large, clear central optical zone
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INTACS & The Prolate CorneaINTACS LASIKNormal
Cornea
In vivo Hartman-Shack analysis
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Peer Reviewed Literature INTACS for Keratoconus
Primary Auth. Title Eyes
Levinger Keratoconus Managed with Intacs, Arch Ophthal, Oct 05 53
Uusitalo Treating Keratoconus with Intacs, JRS May 05 50
Alio One or Two Intacs for correction of Keratoconus, JCRS May 05 26
Colin Current Surgical Options for Keratoconus, JCRS Feb 03 0
Tunc Intacs for Asymetrical Astigmatism of Keratoconus, Journal of French Ophthal. Oct 03 9
Boxer Wachler Intacs for Keratoconus, Ophthalmology May 03 74
Colin Intacs and Refractive IOL to Correct Keratoconus, JCRS Apr 03 1
Siganos Management of Keratoconus With Intacs, AJO Jan 03 33
Colin Intacs for Treating Keratoconus, Ophthalmology Aug 01 10
Colin Utilization of Refractive Technology in Keratoconus and Transplants, Cur Opin Ophthal 2002 0
AlioChanges in Keratoconic Corneas after Intacs Expantation and Reimplantation, Opthalmology Apr
04 5
Lemp Intacs Safety in Keratoconic Eyes, Invest Ophthalmol Vis Sci ARVO 04 164
Colin Correcting Keratoconus with Intracorneal Rings, JCRS Aug 00 10
Guell Are Intacs Usefull in Refractive Surgery, Curr Opinion Ophthal. 2005 222
Weissman Feasibility of Contact Lens Fitting on Keratoconus Patients with Intacs, CLAE 2003 3
Total Eyes Summarized 660
Unique Eyes Summarized 338
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INTACS Clinical Overview First case 1997: Joseph Colin, MD
• Decentered Cone
• Segment Placement Superior thin segment : 0.25 mm Inferior thick segment : 0.45 mm
• Very encouraging results Patient scheduled for immediate PKP, Transplant has been deferred 7+ years with acceptable
BSCVA Reduction in myopia and astigmatism Results stable over time
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Combined Studies 1997- 2003
Colin (2001) – 10 eyes • Ophthalmology 2001; 108:1409-1414.
Siganos (2003) – 33 eyes • American Journal of Ophthalmology 2003; 135:1:64-70.
Boxer-Wachler (2003) – 74 Eyes• Ophthalmology. 2003; 110:1031-1040.
European Clinical (2003) – 34 eyes • Accepted for Publication Ophthalmology
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Combined Studies 1997 - 2003 Follow-up shows stable and lasting
effect
Very Few Surgical Complications Observed
Postoperative Complications Superficial placement Segment migration Visual symptoms Lack of effect
Manageable with INTACS Removal 14/174 eyes (8%) Majority of patients returned to preoperative refraction upon
removal Several have gone on to have successful corneal transplantation
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European Keratoconus Study Results Summary
Dr. Joseph Colin (France) pioneered the use of INTACS in Keratoconus
First case in 1997
7 years follow up with stable results
Very few INTACS patients have required corneal transplants in 7 years
In the few cases where PKP was performed, no problems were reported
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European Keratoconus Study
Change in MRSE• Mean - 3.1 Diopters Corrected• Range -1.6 to 8.7 Diopters
Change in Cylinder• Mean - 2.9 Diopters Corrected• Range - 0 to 7.5 Diopters
Stability of refraction achieved at 3 to 6 months
• 75% within ± 1 Diopter• 50% within ± 0.5 Diopter
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European Keratoconus Study2 year data - Joseph Colin, MD*
96 of 100 eyes, initially referred for PKP, successfully implanted with INTACS and remain stable after 24 months
100% became contact lens tolerant, some patients became correctable with spectacles and a subset required no correction
80% have improved UCVA and 68% improved BCVA at year 2
Manifest refraction, cylinder, MRSE and pachymetry continued to improve at year 2 over year 1 and preoperative exams* Accepted for Publication JCRS
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INTACS – PKP Comparison
+8.00 (.)-2.00 X 180°-0.75TransplantIntacs
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INTACS - PKP ComparisonPKP
Irreversible Procedure Time: 1 Hour Rehab Time: 12-18
Months
Intraocular Procedure Lifetime Follow-up
required Complications
• Cataract• Glaucoma• Endophthalmitis• Rejection• Expulsive hemorrhage• Corneal ulcer• Neovascularization• Induced astigmatism• Disease recurrence• Risk of viral transference
INTACS Reversible Out-Patient
Procedure Time: 20-30 Minutes Rehab Time: 1-2 Weeks
(Visual Function Immediate)
Corneal Lamellar Procedure Periodic Follow-up Complications
• Unsatisfactory ring placement• Segment extrusion(All easily managed with segment removal))
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INTACS - PKP ComparisonPKP
Significant loss of endothelial cells
Permanently weakened cornea with risk of additional trauma
Outcomes: unpredictable, often unstable
INTACS
Endothelial cell loss, not clinically significant1
Provides structural integrity, PKP still an option without complication
Outcomes: predictable, case dependent
1Two-Year Endothelial Cell Assessment following INTACS implantation, Azar et al, J Refract Surg. 2001 Sept-Oct
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Conclusions: INTACS Intervention is Superior to Transplant
Goal of INTACS is to restore functional vision • Effective functional refraction with soft, soft-toric, or rigid
contact lenses is likely• Creates cornea more receptive to contact lenses
INTACS implantation reduces corneal coning• Central cone is flattened• Asymmetrical cones are repositioned centrally
Post-surgical recovery• Visual improvement can be immediate • Vision stabilizes in months rather than a year or longer
High potential to defer transplant
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INTACS Case Files
UCVA CF BCVA: 20/45 MR: -6.25 -4.75 @ 175 Max K: 54.43 @ 79 Custom RGP Intolerant
Case 3OS Pre-Op
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INTACS Case Files
UCVA 20/80 BCVA: 20/30 MR: -.50 -3.00 @ 135 Max K: 51.69 @ 89 RGP Tolerant
Case 3OS Post-Op
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INTACS Removal & Replacement Summary
Easy to remove
In FDA study, no complications post-removal
Preliminary data indicates that the patients return to their preoperative refractive error in most cases
Patients are able to return to their original mode of correction or to pursue an alternative refractive procedure
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Keratoconus Treatment Flow The Old Paradigm
Disease Identification
& ManagementSpectacles, Contacts,
Custom Lenses
Optometric Physician
Identification of Surgical
NeedContact Lens Intolerance
orCentral Scarring
Optometric Physician
Work-Up, PKP Surgery, Post-
Op1 to 3 Months Patient
Recovery
Surgeon
PKP Post-OpCare
12 to 24 Months
Surgeon
Post PKP Fitting
Specialty Custom Lenses
Surgeon/Optometric Physician (Specialist)
Long-Term Follow-Up
Specialty CL Fitting, Regular Monitoring (Re-Graft 17.9%)
Surgeon/Optometric Physician (Specialist)
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Keratoconus Treatment Flow The New Paradigm
Disease Identification
& ManagementSpectacles, Contacts,
Custom Lenses
Optometric Physician
Identification of Surgical
NeedContact Lens Intolerance
or Risk of Scarring
Optometric Physician
Work-Up, INTACS
Surgery, 1-Day & 3-Month
Post-Op1-2 Days Patient Recovery
Surgeon
Ongoing Follow-Up
Include Initial CL Fit
Optometric Physician
Post-Op Management &
Outcome Analysis
Re-Referral if Complications or Atypical Outcomes
Optometric Physician
Long-Term Follow-Up
Include CL Fitting, Periodic Monitoring (Defer PKP)
Optometric Physician
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Contact lens intolerant keratoconus
Improve contact lens success, UCVA, BCVA
Defer PKP and associated risks
Keep on the conservative side of leading edge patient care technology
Retain patient loyalty and follow-up care
Why recommend INTACS ?
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Contact Lens Intolerant Keratoconus
K readings 45 to 60
Contact lenses not providing functional vision Outright failure Shortened wearing time Inability to achieve 20/40 Desire to forestall central scarring
Apprehensive about transplant
Or, if Surgical Intervention is Medically Necessary
Ideal INTACS Patients
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Those who strongly desire refractive surgery, but work-up exhibits concerning signs
Posterior anomaly Forme fruste keratoconus or pellucid-like
topography
Those who desire refractive surgery, but fear “no-return” of laser ablation
Wish to retain options for future conditions or technologies
Advanced, Additive, Removable Up to -3.00D sphere and 1.00D astigmatism
INTACS a refractive option for …
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Thank you !Thank you !