Eye wear frame selection

Eyewear Frame SelectionEyewear Frame Selection

Unit 1: Face Shape Analysis

OPTOM FASLU MUHAMMED

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

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


1. Angular (square/rectangular)2. Curvilinear (round/oval)

Two General Categories of Faces


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.

Seven Basic 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

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

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


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


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


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

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

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

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

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

Oval Face: Tips


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

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


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


Diamond Face: Tips


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

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


Round Face: Tips


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

Round Face: Tips


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

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


Square Face: Tips


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

Square Face: Tips


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

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


Base-down Triangle Face: Tips


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

Base-down Triangle Face: Tips


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

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


Base-up Triangle Face: Tips


Try frames that are wider at the bottom

Other choices include aviator, butterfly, or low-triangle styles

Frames with rounded tops and squared bottoms

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


Oblong Face: Tips


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

Oblong Face: Tips


Decorative or contrasting temples can add width to the face

Mid-level to low temple position can reduce the length of the face

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


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


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

To Narrow and Lengthen a Wide Nose:

Use a clear or metal bridge that sits close to the nose

Use nosepads

Nose


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


To Narrow Wide-set Eyes: Use a dark colored bridge Use wide frames to center

the eyes in the lenses

Eyes


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


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



ReviewUnit 1: Face Shape Analysis

Contrast

The frame shape should _____ with the face shape.

ReviewReview

True

A perfectly balanced face can be divided into five parts vertically and three parts horizontally. (True/False)

ReviewReview

True

All face shapes are a combination of curvilinear and angular lines. (True/False)

ReviewReview

Longer

High or mid-height temples on a round face help make the face appear _____.

ReviewReview

c. keyhole bridge

Which of the following will help lengthen a short nose?a. low bridgeb. colored bridgec. keyhole bridge

ReviewReview

True

A large face can be balanced by a slightly oversized frame (True/False)

ReviewReview

Scale (proportion, balance, harmony)

Frame size should be in ____ with face size.

ReviewReview

ReviewReviewIdentify the face shape below:

Oval


Diamond


Round


Square


Base Down Triangle


Base Up Triangle


Oval


Oblong


EndUnit 1: Face Shape Analysis

A New Option for Keratoconus

Keratoconus Intacs -1 Day PKP -1 Week

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”

Reshape the Cornea for CL Success

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

Arc-Shortening Model for Treating Myopia: Preoperative Representation of the

Cornea

How does it work?

Arc-Shortening Model for Treating Myopia: Representation of the Cornea After

Placement of INTACS Inserts

How does it work?

History

Adjustable Ring1984

As conceived by Dr. Reynolds

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

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

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

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

Keratoconus Non-Inflammatory

Ectasia• Stromal Thinning• Disruption of Bowman’s

Membrane

Corneal Ectasia• Myopia• Irregular Astigmatism

Optical Correction• Spectacles– early• Contact Lenses– later

Keratoconus

Demographics• Estimates vary from

50 to 170 per 100,000

Obscure Etiology• Heredity• Allergies, Eye Rubbing

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?

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

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

Watch the Pre-op and Post-op mire INTACS Normalize Corneal Shape

The INTACS Procedure

Courtesy David Schanzlin, MD Shiley Eye Inst. UCSD

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

“ 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

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

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

Architecture Modification

Architecture Modification

Pentacam Images

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

INTACS Case Files

UCVA 20/40 BCVA: 20/25 MR: -2.00 Max K: 51.69 @ 89 RGP Tolerant

Case 2OD Post-OP

INTACS Optics

Maintains prolate cornea

Enhances structural integrity (second limbus)

Additive – Removable - Replaceable

Large, clear central optical zone

INTACS & The Prolate CorneaINTACS LASIKNormal

Cornea

In vivo Hartman-Shack analysis

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

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

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

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

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

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

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

INTACS – PKP Comparison

+8.00 (.)-2.00 X 180°-0.75TransplantIntacs

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))

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

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

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

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

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

Keratoconus Treatment Flow The Old Paradigm

Disease Identification

& ManagementSpectacles, Contacts,

Custom Lenses

Optometric Physician

Identification of Surgical

NeedContact Lens Intolerance

orCentral Scarring


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)

Keratoconus Treatment Flow The New Paradigm

Disease Identification

& ManagementSpectacles, Contacts,

Custom Lenses


Identification of Surgical

NeedContact Lens Intolerance

or Risk of Scarring


Work-Up, INTACS

Surgery, 1-Day & 3-Month

Post-Op1-2 Days Patient Recovery

Surgeon

Ongoing Follow-Up

Include Initial CL Fit


Post-Op Management &

Outcome Analysis

Re-Referral if Complications or Atypical Outcomes


Long-Term Follow-Up

Include CL Fitting, Periodic Monitoring (Defer PKP)


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 ?

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

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 …

Thank you !Thank you !

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