Print Article: The Acrylic Eyes of Frederic Harwin
From Northwest: The Sunday Oregonian, December 11, 1983
By Lionel L. Fisher
Photographs by Randy L. Rasmussen
A new eye.
Vibrant. Gleaming. As full of youthful life, if not sight, as its blue-irised twin. That was the Medford boy's dream.
It brought him and his parents to the Devers Memorial Eye Clinic in Portland and to ocularist Fredric Harwin, who routinely blends an artisan's exacting skills with an artist's creative mastery.
It brought him to the end of a nightmare. And it gave him new hope.
"It was a stupid freak accident," said Donald Rose's father, recounting the decade-old tragedy. His eyes still redden at the memory. He'd been doing woodwork in his garage, the toddler watching, curious, eager, constantly underfoot like children everywhere.
It happened in a split second the father would instantly have traded for several years of his own life. Intent on his work, a Phillips screwdriver in his hand ... the boy suddenly leaning into sharp metal. "It slid into the center of his eye," the father said softly. "Like butter," he added almost to himself.
Young Don retained his Injured right eye with Its limited peripheral vision until his 14th summer. Then glaucoma. And hemorrhaging. Finally surgery. Enucleation the doctor called it - removal of the entire eyeball, leaving a dark void, and the eyelid slumping forlornly into the cavity. Six weeks later, the family made the trip to Portland - in search of one of Fredric Harwin's miracles.
"I do nothing with blades," Harwin tells the teen-ager right off. The sturdy, sandy-haired boy listens Intently. "I'm an artist. I work with brushes. I sculpt and I paint."
|‘I do nothing with blades. I’m an artist. I work with brushes. I sculpt and paint’|
Don and Harwin will travel an Intense, two day, four-visit journey together. For Harwin, It will be another all-out effort to crowd his talent and skills to their limit. For Don, Harwin's success or failure will determine the very quality of his life.
Built with the broad chest of an NFL running back, the man with the surgeon's hands and the artist's sensitivity begins.
As the two of them sit across from each other at a table just 15 inches wide, Harwin stares deeply into the boy's eye, visually dissecting the gossamer layers of tissue and color. "1 have to capture that eye," he says, "and there's only one way to do it. No one will ever look at you as closely again."
Harwin has two goals: Optimal comfort and cosmetic appearance. The first will come from technical proficiency born of experience, the second from the same innate talent and mastery of medium required of any painter putting brush to canvas.
The fitting and casting process - painstaking In its refinement - begins with the ophthalmic alginate Harwin injects into Don's socket. "It's the same stuff dentists use on your teeth," he says. "Mine isn't peppermint-flavored though, because you don't have any taste in your eye." He winks. "Or do you?"
The alginate sets quickly. Harwin removes it several minutes later, placing it in cold water until he can mix some casting stone to receive the impression. "The alginate measures your orbit," he says. "Most importantly, it traces the size and location of your implant, including the surrounding Incision and suture scars."
Implants are the calling cards of eye surgeons - left in the socket after their grim handiwork is done. Once made of metal or glass but now almost exclusively of synthetics, the implant usually is spherical. Four of the six optical muscles are re-attached to one another over the implant. And the plastic eye settles onto it, contour blending into contour, moving with the implant and held in place by the slight pressure of the eyelid.
The rejoined muscles shift in coordination with those anchoring the healthy eye, but the most Har.win can hope for is 50-percent regained mobility. "It's like slicing and retying a rope," he explains. "The muscles are now shorter, more restrictive." Looking directly ahead, Don Rose's acrylic eye will match his natural eye in back-and-forth movements, but it will lack the peripheral range of his living eye. So he will learn to move his entire head when he peers sideways. If he were to swivel only his eyes, just one of them would respond fully.
Harwin melts ivory wax to pour into his mold. After the wax cools - still bearing the memory of Don's socket - he trims the model, then smooths its surface with an alcohol torch. Meanwhile his creative work has kept pace. His "paints" are dry pigments, pure monomer and an acrylic syrup monomer and polymer. With two tine sable brushes he begins his mini-artwork.
The heart of Don's new eye is a clear plastic disc that looks like a button - concave in back, convex where it faces out, simulating the shape of a cornea, a half millimeter smaller than the finished iris. Blending his pigments and monomer-polymer mixture, Harwin paints the base colors of the iris in reverse, working in radial fashion, covering each layer with a coat of syrup and alternately allowing each coat to dry.
"What we're dealing with here is illusion," Harwin tells Don, talking the whole time he works, explaining in detail, involving the boy fully so that when he finally takes possession of his new eye, it will be an old, familiar friend.
Harwin continues his narrative. The colorette, stroma and limbus make up the three "color" areas of the iris surrounding the pupil. The colorette usually looks yellow-ochre to brown and appears to be on a lower plane of the eye's structure. The stroma appears on a higher plane, as does the limbus, although it apparently is more translucent than the other two areas. So Harwin paints the limbus in succeeding glazes of thinned pigment, his head alternately bowed over the embryonic button of an eye, then inches away from the boy's healthy eye, which serves as an artistic model.
After completing the three-layer colors of the iris on the back surface of the button, Harwin scrapes away the paint in the center of his miniature painting to the pupil diameter he wants, using a cutting tool and lathe.
The average adult's normal pupil size is 3.5 millimeters, he informs Don, but he adjusts the diameter based on the individual's age, profession and social activities - factors that determine the standard enlargement of the pupil under varying light conditions.
|‘Is the appearance of a sightless eye so important?…Americans place a premium on cosmetic appearance’|
In some cases, Harwin actually creates two different-size pupils in his acrylic eyes. He performs this minor miracle by producing a large - say, 6-millimeter - pupil and casting it in acrylic.
After grinding down to half a millimeter over the first painting, he then fashions a smaller - 3.5- or 4-millimeter - pupil over the larger one. The smaller pupil is defined by surrounding glazes of light color painted In small, outward strokes. In sunshine or strong artificial light, these feathery glazes of color reflect the bright glare and simulate an opaque colorette. But in more subdued lighting, the overlying touches of color become nearly transparent, allowing the larger pupil to show through.
The technique, just developed by Harwin, is much more painstaking but certainly worthwhile, he says, in the case of patients with pupils that react drastically to changing light.
Next, Harwin covers the surface of the button with several coats of lamp black saturated with the syrup. Then he inserts the button front and center into the wax model to serve as the cornea of the artificial eye. He adds more wax to cement the cornea-iris portion to the model, and then smooths the sphere again.
Harwin uses the button's attached stem to insert and to remove the wax impression from Don's orbit during the first tests for iris centering, direction of gaze, overall comfort and other factors. In. Out. In. Out. Over. Over and over as he strives for perfect match of the "almond" contour of both eyes.
To duplicate the precise way each eyelid covers its accompanying iris, Harwin scrapes away suc.ceedingly more wax from his model, planing away until he achieves the exact matching effect. Finally satisfied, he again casts the wax model in stone, curing the white acrylic substance under pressure.
He begins working on the sclera. "That's the white portion of the eye," he says. "Scleras vary in their whiteness, some marginally, others dramatically. Most often, there's a bluish tint around the limhus, the outside edge of the iris, shifting to a yellow or yellow ochre."
He begins adding fine strands of red cotton thread to the painted sclera as the boy watches in fascination. "They're from an old sock," Harwin jokes. "I lost one of the pair. So what do you do with just one red sock?" With the bogus blood vessels arranged to his satisfaction, he coats the threads with acrylic syrup and bonds them to the surface.
All that remains is artistic and mechanical refinement. Harwin repeatedly compares the artificial and natural eyes, cutting back on the duplicate's acrylic surface with a scalpel blade, thinning areas so that underlying pigments can show through for textural effect, working backward to achieve his visual esthetics. Then he adds more tone and color - "playing artist," he whispers to Don with a conspiratorial wink.
Fredric Harwin combines the skills of a trained craftsman with the flair of an outstanding fine artist to create acrylic eyes so vibrantly alive it somehow seems unfair they should be sightless.
An internationally known medical illustrator, Harwin, 41, is co-author, along with Portland cardiac surgeons Bradley Harlan and Albert Star, of the "Manual of Cardiac Surgery," published in two volumes in 1980 and 1981. His 310 illustrations grace the full-color primers depicting cardiac operating procedures from the surgeon's perspective.
Harwin's work prompted this praise from the unrelentingly critical New England Journal of Medicine: "The book is blessed with a medical illustrator who is not content with the watchful passivity of a photographer. He obviously shares with his surgical co-authors the continuing ability to create and accommodate."
After earning a master of science degree in medical and biological illustration from the University of Michigan, Harwin served two years as director of medical illustration at Wayne County General Hospital, a teaching affiliate of the University of Michigan Medical Center.
He joined the Oregon Health Sciences University in 1969 as assistant professor and director of medical graphics. For the past 4 years he has been director of ocular prostheses at Good Samaritan Hospital's Wevers Memorial Eye Clinic, a job that competes for time with his position as consulting illustration editor for Springer-Verlag, a leading German publisher, and the free-lance illustration assignments he somehow shoehorns into his spillover schedule.
Harwin and the nation's 210 other ocularists trace their work to the late Renaissance when Venetian glassrnakers created the art of making glass eyes. The art flourished over the succeeding centuries, primarily in Germany, where generation after family generation handed down carefully guarded trade secrets. Closemouthed German grass blowers came to the United States, making national circuits, setting up for several days at a time in the larger cities to fit stock eyes or to provide custom-made versions. But World War If marked the end of the glass eye in the United States. German glass blowers no longer toured, and Americans were forced to launch their own research program into the artificial eye business.
Two U.S. Navy technicians, Phelps J. Murphy and Leon Schlossberg, conducted fundamental experiments with acrylic resins, particularly the clear synthetic material used in dentures, that formed the basis for fabricating modern ocular prostheses. And the crafting methods and acrylic materials are identical to those used in making dentures and bridges.
But it was an Oregonian who received the first American patent for a "method of making artificial eyes." It was granted on Feb. 5, 1946, to Sidney O. Noles, one of two optometrist sons of Portland optometrist Sidney G. Noles, who founded the city's Columbian Optical Company in 1905.
And Erle Stanley Gardner, of all people, be stowed on 50. Noles a measure of immortality by including the Rose City optometrist's name in one of his Perry Mason mysteries, "'If he Case of the Counterfeit Eye." In the book's inevitable climactic courtroom scene, Mason's perennial - and forever vanquished - nemesis, District Attorney Hamilton Burger, summons professional witness Dalton C. Bates to the stand.
Bates identifies himself as a maker of artificial eyes who began his apprenticeship in Germany, then studied under Sidney 0. Notes in San Francisco. In real life, the Portland optometrist did, in fact, transfer his practice to the Bay area. Bates then goes on to, provide an astonishingly detailed and accurate description of manufacturing glass eyes.
Harwin's own apprenticeship consisted of a year's sabbatical taken from his medical illustration work. He spent it traveling around the country, honing his ocularist skills at 14 medical centers medical before his return to Portland, where he proposed the start-up of a facial prosthetic service at the Oregon Health Sciences University. But the staff at Pervers Memorial Eye Clinic persuaded him to assume a vacated practice. He accepted the position in 1978 and since has become outstanding in the field.
Most artists use a standard signature to identify their work. Fredric Harwin signs his work - well, the back of his work - but his personal trademark is different for each artifical-eye wearer. Over the cears Harwin's painted a fisherman's fly, firefighter's hat, scorpion, camel, whale, poodle, eagle, a motorcycle with a bright red gas tank, roses, rainbows, various astrological signs and a great many butterflies on his finished acrylic eyes.
But this artistic signature has a decidedly functional purpose - it reminds his patients to insert their artificial eyes right-side-up, thereby avoiding such incidents as the one described in a Smithsonian magazine article:
"My father-in-law came down for breakfast," writer Robert Warnick quoted a woman he'd overheard in his ophthalmologist's waiting room. "He sat down at the table across from me like he always does, and 1 began to scream and scream. I never screamed so in all my life. Here I'd been living under the same roof with that man for 15 ,years, and I never knew that he had a glass eye. And what did the old tool do that morning? He put it in upside-down!"
Harwin asks Don what private mark he wants on his new eye. After much deliberation, the boy chooses the image of an eye patch, his constant companion over the past six weeks, an unwelcome intruder that now can be thrown away. So be it, Harwin replies, and with several deft strokes he decorates the back of the eye accordingly. It will keep the Medford boy from skipping down to breakfast one carefree morning with an upside-down eye.
It is an hour and 15 minutes into Don's fourth and final visit. "We're in the eighth inning," Harwin tells him. The eye is ready. Harwin had made the final casting the night before, then smoothed and polished the plastic surfaces with fine pumice powder and soft cotton buffers. The ocularist coats the plastic eye with a lubricant, then shows the boy how to lift his eyelid and insert the eye with the aid of a small suction cup. The teen-ager manages nicely, releases the cup and sits with his eyelids tightly shut.
Harwin tells the boy to open his eyes, look up, down and to both sides, then alternately raise and lower his chin. Harwin removes the eye and takes it to an old-fashioned, foot-pedal-operated drill. "The lid's pushing out just a tad too much on the bottom," he says. A few minutes later the problem has been smoothed away. A last polishing on two lathes and the eye is ready.
Don reinserts it. "Good!" Harwin says. He asks how it feels. "Fine," the boy replies in youth's understated fashion. The moment of truth has arrived. Harwin hands him a mirror.
Don looks. He says nothing, just keeps looking. But a wide grin betrays his excitement. His parents, who have been watching quietly, beam their approval. Tears spring into Don's mother's eyes.
"Nice movement, good movement," Harwin says.
Harwin tells Don that his eyes will "fix" perfectly on another person's straight-on gaze at about 3 feet. Americans tend to guard their personal space jealously, and if Don were a European, the ocularist would have shortened the distance to 18 inches. If Don were destined to be exceptionally tall, Harwin would give his eyes a slightly downward gaze.
"Is the appearance of a sightless eye so important?" he asks rhetorically after Don and his grate.ful parents have headed home. Does it matter if a reconstructed nose looks natural?
"In another time and another place, perhaps not," Harwin continues, "but Americans today place a premium on cosmetic appearance."
And there are purely medical reasons, too, why artificial eyes are advisable. Without them, eyelids tend to atrophy and turn In on themselves, eventu.ally coming into contact with and irritating the sensitive linings underneath. Also, tear glands, de.signed to wash the eyes, have nothing to work on. So moisture pools in the socket, where it can lead to problems.
Beyond these sensible reasons lies the tact that Americans exist in a visually oriented society here great emphasis is placed on direct eye contact.
The cosmetic perfection to which Harwin aspires stares down on patient Kevin Dershon.
"We distrust people who don't look us straight in the eye," Harwin says. "It's like being offered a wet palm or limp handshake, indicative of moral weakness or dishonesty of character.
"Losing an eye is bad enough without forfeiting your sterling reputation as well."
In Medford, a young man looks life on the level - and forward to manhood - because of that conviction.
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