During this Live Lecture, the following are discussed:
• New Muscle Hook Prior to 3D printing
• Difficulties of developing new instruments and teaching tools
• 3D Printing Solutions
• New Inventions in the Horizon
Lecturer: Dr. Donny Suh, Ophthalmologist from The University of Nebraska, USA.
(To translate please select your language to the right of this page)
DR SUH: Okay, great. Good morning, or good evening, depending on where you are. My name is Donny Suh, I’m the Orbis volunteer faculty and also the chief of pediatric ophthalmology at the children’s hospital and medical center in Omaha. And a professor at the University of Nebraska. Thank you very much for joining us today. I think this is going to be very entertaining, educational, but informative talk. It doesn’t really particularly it’s not anything specific about pediatric ophthalmology, but I’m going to be talking about 3D technology and how it actually impacts us in our field. So the objectives I hope everyone can hear me okay. Okay. So the history I’m first I’m going to talk about the history of eye muscle surgery. And then briefly talk about how we do it. I’m going to show a video. And I would like to share my old invention, the Suh grooved hook. And talk about the new inventions that I have been working on this year. And then financial disclosure. The Suh grooved hook was actually developed a few years ago and all the proceeds go directly to Orbis. And all the new inventions, our university and I own the patent. And none of the products that I’ll be discussing is in production at this point. So before I start, I would like to have an idea of who I’m actually talking to. This webinar is something that I’m not very familiar with. But I would like to have the general audience some participation. So if you could actually answer this question. What is your profession? If you could click one of those. And if it’s others, please type in what field of like, how you’re related to ophthalmology. Lawrence, how long should we give?
>> We’ll give them about 10 more seconds.
DR SUH: Okay. Sure. Okay. Great. This will help me to taper the talk, depending on the who the audience is. Okay. Again okay, perfect. So we have we have some pediatric ophthalmologists and general ophthalmologists and others. And I want to see what the others are. So Q&A, and then is it answer right here? Answer by text?
>> So there’s two chats under more. So we have a medical student with ophthalmology interests and someone also in medical retina.
DR SUH: Perfect. Thank you.
>> And ocoluplastic.
DR SUH: I want to talk about strabismus. It’s from the 1600s and came from strabismos, crooked or twisted. Here’s a patient with dystropy. John Taylor attempted to perform the surgery by cutting the conjunctiva. It was poorly documented. In 18389, Louis Stromeyer proposed cutting the muscles. But not performed until 1839. The first on a muscle was Johann Friedrich Dieffenbach from Germany. He had an instrument like a sickle, and cut the muscle. And the success rate of the surgery wasn’t very high because there was no way of controlling the amount of the correction. So a patient with dystopia would end up with a large tropia by cutting the muscle. And it went on until 1922 with Jameson. Substitute tenotomy is when you cut the muscle by graded muscle recession using a Jameson muscle hook. And this was only possible because around that time a sterile suture was developed. It was a cat gut that was developed in 1906 with the iodine, not Betadine. And here is the muscles attached to the eyeball. And we typically place the muscle hook underneath the muscle and raise it and then we place the muscle suture just anterior to it. So I’m going to show you a video of what this I’m going to show you a video of what this will look like. So, Lawrence, can you see this okay?
>> You’re going to have to re share your desktop for us.
DR SUH: Okay. Just a second. How do I do that?
>> It was the same way you pulled up your slides. Share screen, desktop.
DR SUH: Okay. Share the desktop. Can you see my screen right now? Or no?
>> We see you. You have to click on “Share screen” right next to” Q&A.”
DR SUH: Can you see it?
>> It’s on the Zoom bar.
DR SUH: Is that okay? We don’t see your screen yet.
>> Now we do. You can open the videos.
DR SUH: This is a video. This is a video developed by our UNMC 3D team. We will place the muscle hook underneath the muscle and place the needle just anterior to it. And then secure the muscle in this fashion. And obviously there are many different techniques that’s available. And then and once you secure the muscle, we actually we cut the muscle off the globe and completely separate. And then we would rotate the eyeball, straighten it, and then we would secure the muscle so many millimeters posterior. And pass the needle through the original muscle insertion. And this is what you end up. And, of course, this is called the hang back technique. And let’s go back to the PowerPoint talk. Okay. Now, so second question that I want to share is that, do you perform Strabismus surgery? Yes or no? Okay. Perfect. Okay. So I hope that video actually demonstrated what we do. So and I’m going to actually we’re going to skip we’re not going to take a poll for the next question. So what are the most difficult types of strabismus surgeries? Anything these are some of the difficult cases that we do. Graves disease,Mobius syndrome, people with previous surgeries, muscle separations, con genital fibrosis syndrome and scarring. These are some of the cases that we perform that are difficult. And for those that perform the strabismus surgery, I’m sure they share my concerns. So what do you do in these difficult cases? And you don’t have to type in the answers. Because we actually have many who are not in the pediatric ophthalmology field. But in these difficult situations, I have to tell you, it is extremely difficult because these muscles are under great tension and these are scared or under great tension. And it’s actually very difficult to place a muscle hook underneath those tight muscles because there isn’t just there isn’t a lot of space. So there are five unique problems to these tight muscles. So first is because the eyeball is for example, in this particular case, the superior rectus muscles will be very tight, and it’s hard for me to actually rotate the globe to actually visualize the superior rectus muscle to hook the muscle. And second, because these muscles were tight for so long, it would result to adhesions of the tendon to the sclera. Even if you isolate and find that muscle, placing a muscle hook underneath is sometimes almost it’s impossible. And then even if the hook was somehow passed through, the passing a needle just anterior to the to the muscle hook to the tendon can be very dangerous because there isn’t a lot of space between the sclera and the tendon, as you can see here. And then and on top of that, to make things worse, the sclera is typically extremely thin. Underneath the tendon because of the chronic crash and ischemia. And so the sclera perforations resulting in potential infections or retinal detachment goes up dramatically in these patients with very difficult cases. And as you can see here, very thin and scarring. So this can be extremely stressful. So to address these concerns, various grooved muscle hooks have been developed.
we actually have Dr. Ken Wright and Dr. Ed Wilson, there are various grooved muscle hooks that have been developed. And this is my version of it. And it’s got five unique features. First is I’ve made it very skinny. It’s a .8 millimeter thick, versus a 1.2 in a Jameson hook. And I made it shorter. The length of the muscle hook is 8.5 millimeters versus 12.5. I made it thin to fit through a tighter space. And I also have a horizontal bar plate that’s 2.5 millimeters with a groove that’s .8 millimeters to guide the suture passage. What that means is when you place a muscle hook underneath the muscle or the tendon, the cross section view, this is what it looks like. So it actually has a groove right there. So you can actually pass the needle right through that groove without having to worry about potentially perforating the globe. So and then fourth unique feature is the knob. Actually I made it very sharp. And it’s pointy. So this is actually important because it actually helps me to find that plane the space between the tendon the space between the tendon and the sclera. And then I use that sharp knob to dissect and separate the separate the two tissue planes. So I use that instead of scissors and doing it blindly, if you will. Using this knob, I actually use it to dissect, to separate and create a space. And the fifth unique feature is I actually bent the handle. Why is that important? After you place a muscle hook, the nose gets in the way. Either the nose or the orbital rims get in the way. And the muscle hook actually gets in the way of me visualizing the tendon. So by bending it, you can actually see that it’s actually out of the way. You can the nose doesn’t get in the way. So the muscle hook won’t be sitting up this way. It’s actually bent. And so it’s actually lying flat. So after having developed this muscle hook, these tight, difficult cases actually became much less stressful. And so that’s what I have been using. And I wanted to share with you, what have I learned from this experience? First of all, the manufacturers and I’ve actually worked on this muscle hook for about ten years. This actually started way, way back. And it took me ten years to develop this. And I realized that it’s actually hard to find a manufacturer because they’re not interested. Because these are a small number of cases that actually require special instruments. So we’re not talking volume. So it’s it’s for a specialist. And also, once you come up with an idea and try to make a revision, it’s impossible. It’s very difficult. And multiple revisions, you basically can’t do it. Because it costs the manufacturers too much money. And then it’s very time consuming. Like I said, it took me ten years. And then by the time you develop it, maybe it’s too late. Maybe someone else had developed it. And not to mention, the cost. And like I said, I realize people who invent things, you have to have passion for it. It doesn’t pay. After this experience I told myself, I will not do this again because it was just too painful. But then I had a Dory moment. I forgot it was so painful. And I developed a desire to develop a new needle driver that and what it is is that in certain situations we would have to place a needle in a very awkward place. Where the traditional needle drivers, you just can’t get to that point and this actually happens not just to pediatrics, but for people in oculoplastics, people in retina. It’s very awkward. So what ends up happening is you actually have to hold the needle holder you actually have to hold the needle holder with your non dominant hand and switch over and use it this way. And then try to place it. And then it becomes very uncomfortable. So I wanted to and I’m going to say I’m pretty sure that most of you have actually experienced this before. So I’m not going to take this. You wanted to come up with a needle driver that looks like this. Looks just like that. So I can place a needle in awkward places that are difficult to place posteriorly. So we came up with a drawing. And this was actually drawn by a very talented student. High school student. She’s now in college, Elise Morgan. And we came up with a nice drawing like this. And then I went to the manufacturer and said, please make this instrument. And they said, it’s impossible. They said, no. And the reason for that is that because of the sharp 90 degree angle, it will not close properly. It’s just not going to work. It’s impossible. That’s what I was told. So and I don’t know if you remember, this is actually one of my favorite slides. I actually got this from Dr. Scott Olitsky from Kansas City. Get your feet off my desk and get out of here. You stink and we’re not going to buy your product. You know, I feel like I hear this all the time from my manufacturers. This was actually it was actually quoted by Atari President Joe Keenan to Steve Jobs. And, you know, of course, I don’t have to tell you about Steve Jobs, he built one of the most successful companies ever in history. And he’s, you know, in many ways he’s inspirational. So I wanted to tell the manufacturer that it can be done. If you put your mind to it. So using a 3D printed prototype. We have 3D makers here at University of Nebraska. We converted the digital format, we converted the art drawing into a digital format and created the instrument. This is actually what it looked like. And you could actually see this. We actually made this. And the manufacturer was absolutely correct. We could not close the tip. It just didn’t work. It just so we actually had to make many modifications to the tip. And after three alterations, we were able to create we were able to create a plastic design that actually worked. So this was the final product. And then we actually went to the manufacturer and came up with our first titanium needle driver. This is actually what it is, right here. And this is what it looks like. So now we actually use this needle driver on an eye model, and then we actually try to we actually used it on a patient and this truly made the surgeries safer. I didn’t have to switch the instrument from my dominant to my non dominant hand constantly as I’m performing the surgery. So this was actually shown on an Orbis airplane. This is our Orbis flying eye hospital where we actually performed the surgery inside. And I was actually in Orbis. A trip to Qatar back in March of 2017. So these are wonderful doctors from actually, not just from Qatar, from the Middle East. And they’re watching the they’re watching the surgeries. So they were actually able to see me actually using the instrument. Using the instrument and an eye model live. And I was able to demonstrate how this instrument worked. And so this was truly ground breaking. And then this was only the beginning. So after that, I actually approached I looked the at syringes. The current syringes, we actually have we use these syringes that were developed many, many years ago. And these syringes, the problem with that in eye surgery is that, as you can see, I’m holding the instrument and then my index finger is out of the picture here. It’s way out there. And you’re trying to push that plunger, but then you actually have to in many times, we actually have to in many times we actually have to inject .1. In some cases, .01 cc. It’s very hard to control how much to inject. So and it just it’s very clumsy. It just doesn’t work. So especially for ROP, I typically use .025 cc. And trying to do this can be very, very difficult. And here I am actually holding on to the syringe, and my fingers are typically not long enough to actually reach that plunger to inject while the patient is moving. I usually have my nurse push that plunger for me as I’m holding on to the syringe very firmly. And this, I’m pretty sure many of you, actually, would concur, can be a very, very difficult situation. This is different than adult patients who are cooperative and follow instructions. But when you’re doing this on a premature baby, it is very difficult. And trying to inject that exact 0.025, even pre loaded on a syringe, can be very difficult. It’s unstable. It’s hard to hold it firmly with three fingers, and then having holding it with two fingers and then trying to push that plunger with one finger. So after many she’s actually my medical student, Helen, she helped me along with many others. And we actually came up with the the first Nebraska precision syringe. And this is actually exactly what it looks like right here. And what it is is that it actually has the plunger is actually attached it has an attachment. So you could actually use your finger to inject so you could have all three of your fingers just right in close proximity and then you could aspirate and you could inject. You could inject so here. You could aspirate and inject. So and potential use of the syringe can be immense. In an emergency room ICU, patients, trying to inject one or two units, operating room, pre and post op meds, animal research. We’re actually working with various manufacturers. We’re trying to find a manufacturer who can actually produce this. And then botox. This is another field that actually can be very difficult. So for botox, it’s been around since the 1980s with Dr. Scott’s original paper. Here what we do is that we isolate the muscle and then we inject the botox directly to it. But the problem is that here the problem is that there’s always a risk of perforation. And it does actually happen. And the reason for that is that as you inject the needle into the muscle, you’re if you don’t mind you’re doing it somewhat blindly. You don’t know exactly where that tip is. So that’s the risk of the perforation. And also the botox can actually get diffusion of the botox can actually result in various side effects, including ptosis. So to address this problem, a new botox forceps is being developed. And this is where it actually has I don’t have it in front of me right now. So this is exactly what it looks like. This is a forceps, it has a tooth. And then when the tooth is closed, it actually forms a groove, or a tunnel. And then the needle can safely be injected into that tunnel. So what it does is that when this this forcep is engaging the muscle, the muscle gets clumped and encapsulated within a tunnel. And then the needle can be injected into a that tunnel. And because of the teeth meeting at the bottom, it actually protects the sclera. And this actually has a broad forcep base of 7 millimeters at the base. And the tunnel is 4 millimeters at the bottom to ensure the muscle is consolidated in a confined space. And the injection into the tunnel provide safety and avoid a risk of perforation. And the curved handle gives better exposure. And it’s currently being made. And also, glasses. These glasses, the current problem with glasses that kids without years, like microtia, they walk around with glasses that are completely mangled. And they’re not sitting properly. And, of course, when they’re not looking through the optical center, they still can’t see. So with the help of very with the help of Mr. Hermsen, we made our first Nebraska microtia glasses. This is available throughout the world. You have no financial interest in any of this. And basically what it is is a special type of plastic that wraps around the top of the head. And your body heat actually helps to conform to the shape of your head. Regardless of the regardless of the shape of the head. Let’s say you have a microcephaly, macrocephaly, this conforms to the shape of your head and looks just like that. And this actually has gotten a lot of publicity with the help of the news. And I’m pretty sure I don’t know if you’ve actually, I think it’s been on TV. So this actually and this adapter right here, we actually provided to the patient at no cost around the world. So they can actually contact us, or contact me, and these glasses can be provided. These adapters can be provided at no cost to any of the patients. Now, like focusing on us, actually. One of the things that I would like to focus on one of the things that I have great interest in is actually ergonomics. Not because, you know, with the surge of doctors with increasing population, you know, we need to be we need to stay healthy. We need to practice longer. But unfortunately, our postures are horrible. It’s not just for the pediatric ophthalmologist. But this includes retinal surgeons as they’re doing the buckles. It’s actually, you know, plastic surgeons, dentists, urologists. You know? As I look around at my colleagues around the hospital, I realize that they are just they’re actually we have a great risk for neck upper neck and back injury. And actually causing many people to retire early. And with the surgical loupes, and if you actually try to keep your posture in a perfect vertical posture, you can’t see the surgical field because you’re looking straight ahead. So and I have actually tried every single surgical loupe that’s really out there that I could find. And nothing really worked. So I wanted to actually address this problem. And we actually made these surgical loupes with a 3D printer. And we made some modifications. And this is and after a few modifications, we came up with the first Nebraska surgical loupes. And this is what it looks like. And this surgical loupe is if you look with the current surgical loupe, it induces a bad posture. Like this. As you’re working on an eyeball or any type of surgeries. With this surgical loupe, it’s much lighter. The material is much lighter. So it’s less pressure on your nose. If you have a flat nose, like myself, it actually doesn’t slide down. And it’s much more comfortable because the weight is distributed throughout the head evenly. So you can’t even feel it. And also the correct and also it actually allows you to keep a posture that’s completely straight up and down. And the way that it does that is that it actually has a prismatic affect. So what I mean by that is that even though you’re looking at an image even though you’re looking at an image this way, it actually, because of the prismatic effect, it actually moves the image that’s down here further out. Further out. I’m going to talk about that in a little bit a little bit more. And I’m actually trying to confirm that it truly relieves the pressure using various types of biomechanics. Using surface EMG. That’s what we are working on right now. And so this is actually the and I actually, you have to make some modifications to these surgical loupe with the help of the manufacturers. And this is actually made by Cue Optic. And, again, I have no financial interest. If you look carefully, this is what it looks like right now. If you look, the angle from the surface. So these glasses are actually having a curvature, a base curve that’s very steep. Very steep. And then the lenses the bifocal portion is actually pointing almost straight down. This angle here is almost 110 degrees. This angle here. So as you put this on, and then as you put this on. And this is what actually induces the prismatic effect. It’s the base curve and also the location of the loupes. And then the back portion the temple portion of the glasses actually me made modifications. This is actually what it looks like. Instead of having this cumbersome headpiece, it actually looks much more fashionable. And with this, I can be working on I can be working. Here, you can see the various models right here. You can be working on something right underneath your nose, but that image would get displaced further out. So that you could keep your head posture completely up and down. And this is actually what I actually have been using after I developed it. And right now we’re working with a manufacturer to fine had tune it. And this, personally, actually, completely eliminated all my neck and back pain. And this is actually the product that and we’re continuing to make modifications. And we actually changed the back piece to look like that. And the good thing about this is that you could put this on and then you could adjust it from the back. Like this. You could adjust it. You’d actually this piece right here slides back and forth. And then after you’re done with the surgery, you could just work around your neck. So it’s very comfortable. And because of the angle, it actually it actually sits very it actually sits very comfortably and prevents the sliding of the surgical loupes down further your nose. So it’s still a work in progress. I continue to fine tune it with the help of the with the help of the manufacturers. And lastly, shaken baby syndrome is another topic that I have great interest in. And unfortunately here in Omaha, Nebraska, we actually we have the highest prevalence of shaken baby syndrome in the United States according to the Omaha World Herald newspaper. So we actually see probably I see a case of shaken baby syndrome, about one a week. It’s actually so it’s kind of sad cases. And it’s the most common cause of death due to child abuse. And it is suspected that we have about five children per day that die from this condition. And then it’s the most common cause of traumatic death in children under the age of 12. And even if you survive from the shaken baby, many of them actually have a permanent sequelae in the form of motor, intellectual and visual deficits. The biggest problem is public unawareness. This is well known in the world of ophthalmology, but outside of the world of ophthalmology, it’s actually people don’t know. As a matter of fact there’s certain physicians who actually do not believe that this condition actually exists. Even now. Even today. So I was thinking, what can I do with our current technology, with the 3D printers, 3D images, virtual realities, what can I do to educate the general public awareness? So what we’re doing is that we are we have we are working on a virtual reality to simulate abusive head trauma to demonstrate the live retinal hemorrhages to educate the general public. So here let me just show you. Just a second. How do I stop and then go to the
>> So, Dr. Suh, you’re going to have to re share your screen. Share your desktop, like before.
DR SUH: Okay. Good. Okay. I see.
>> And then you can pull up the video. Just exit out of your PowerPoint.
DR SUH: Okay. Got it. Got it.
>> So you have to re share one more time.
DR SUH: Okay. I understand. I have to redo it. Okay. Can you see it now?
>> Yes, we see it.
DR SUH: Okay. Perfect. So here we already have we’re in the works right now with our iExcel department, they specialize in 3D and virtual reality. Here we have an image of an eyeball shaken at .5 to 1 hertz. And we are seeing very severe hemorrhages if the back of the eye. And as you shake further and go up to 2 hertz, you could see increase in the amount of retinal hemorrhages. And then as you go up to 3 to 4 hertz, that’s when you will see a significant increase in retinal hemorrhages and potentially retinal detachment and retinal cases. So what we’re doing is we’re creating a virtual reality where an audience can actually wear these special glasses and they can hold on to the image and they can shake it at different speeds and they will be able to see the retinal findings live. So okay. I’m going to close this. And then so can you see me okay?
>> Just share your desktop one more time so we can see your PowerPoint.
DR SUH: Is that okay?
>> Yep. Just pull up your PowerPoint and then we should be good. Yep.
DR SUH: Perfect. All right. And then, also, we’re developing a computer finite element model to determine the exact locations of the stress points. And also we are working on animal models to determine the vitrinal retinal traction during shaking. And we are incorporating this into our retinal image to determine how much force is applied to the eyeball at various frequencies. And then as I shake the eyeball at various frequencies, you can see the changes in the retina live. So this is a great way to demonstrate to the general public what can actually happen to the retina. And we can confirm it and verify it through our computer generated model and also the animal model. We can do that and support it. So no summary, actually I’m I have just a few more slides. What does Orbis mean to me? Actually I have been with Orbis for 17 years. And I actually grew up with my mother when I was young I grew up with my mother and my brother. It’s just been a wonderful experience. We had a very modest living condition, but it was just wonderful. But the problem was that one of the biggest obstacles was that my mother actually had an eye problem that we could not get it addressed. You know, for financial reasons, for many different reasons. So I told my mother that I actually wanted to be an eye doctor. I wanted to be the best eye doctor possible and help her. And this was actually her quote. She said that’s like grabbing a star from the sky. And the sky is truly our limit. And the reason I love Orbis so much is that what do I believe? And I actually thought this through, and the Orbis actually truly changed the way I look at things because even truly the sky is not our limit. You know, as we saw, we actually can, you know, through this webinar that we’re doing right now, and through this airplane with the lecture rooms inside the plane, we can actually give these types of lectures anywhere around the world. And this type of information can be disseminated very quickly. So that actually excites me a lot. And that actually, you know, encourages me to come up with more things. They can actually help our patients and help us. So I truly appreciate everyone paying attention for the last 40 minutes. And I would like to entertain any questions or thoughts. Please type in your questions and I’ll be happy to answer any questions for the next few minutes.
>> Thanks, Dr. Suh. You can go ahead and stop sharing your screen so we can see your whole face.
DR SUH: Sure.
>> We did get one chat in. Do you want to pull up chat, or do you want me to read you the question?
DR SUH: You want me to chat? Okay.
>> Do you see that last chat? Someone was wondering, did glasses and loupe start the selling? Maybe they’re wondering if they’re being sold.
DR SUH: Yeah. I will answer that question. But where is the question? How do I find it?
>> Do you have chat open or Q&A?
DR SUH: Just a second. You can see me right now, right?
DR SUH: Okay. Let me just chat. There’s a chat button at the bottom. Okay? I’m going to click it. Right?
DR SUH: Oh, good, perfect. Yes. The glasses and the loupes actually are being provided around the world. We actually have people contacting us and then we’re actually providing those glasses. Did the glass portion, of course, again I have no financial interest. I do not make a single cent out of this. The glasses portion they would have to portion, but the adapters we actually provide at no cost. So if they have any but for some reason if they cannot afford even the glasses, if they can contact us and we may be able to help those individuals. But, yes, they’re actually the doctor is providing at no cost to the patient. We’re to the selling them. We’re providing it. Anything else? I know this is type of talk was very different than the previous ones that the previous lectures. And this is very different than the lecture that I gave last time. And I hope this was informative and I hope it was I hope it was educational and I hope you enjoyed it. And if you have any further comments or come up with any if you have any feedback, please, you can contact Orbis. There’s a way Lawrence, there’s a way to contact you, right?
>> Yep. And we have a few more chats, if you see them.
DR SUH: I’m going to do that. You can contact Orbis and I’ll be happy to respond to any other questions. And by the way, my email address, I’m going to actually type it in. This is my email address. And you could actually address your questions directly to me. So, here. Thank you. Okay. So second question is, where do you order and just email me and I will forward the information directly to our optical shop. And how to contact okay. Good. And what styles of frames does it fit? This particular frame fits to a spokes glasses. Spokes. And they are actually there’s an online information that you can actually get. Dear, Donny, thank you. John, thank you. Be able to test them in our patients. Yes, I was able to able to test them on real patients. There’s it doesn’t have any special coating because it’s completely made of titanium and it’s the same material that actually the that other surgical instruments are made. So it’s just there’s no paint. Yeah. Good question. That is actually some of the problems that I’m actually having with some of my other inventions. We are working on a special type of glasses, but it requires a certain glue. So we have to make sure that this glue is actually edible. That’s actually the limiting factor right now. Can you apply adapters to current loupes? This adapter, yes. It actually this is actually added on. But you actually most of the frames are actually most of the frames that we use, so the surgical loupe are mostly made out of titanium. So it’s actually and you actually have to carve it just a little bit to fit this adapter in. But, yes. It is doable. But you actually need special person who can actually make the adapter. Make the adapter. But, yes, it can be actually done. That’s as a matter of fact, this is like exactly what we did. This is an adapter that we developed. Email is not on screen? Lawrence, my email address is not seen. Can you share that?
>> Yep, I’ll share that.
DR SUH: Okay. Thank you. Does the glasses adapter work well with very heavy lenses. Yes. It’s actually most ideal for those patients with the very thick myopic or hyperopic corrections. It makes the glasses really light. So I would highly recommend it for those patients. Would would that adapter personnel be at Nebraska? Yes. The person who actually makes this, husband name is Mr. James Hermsen. He’s just a wonderful guy. And the reason I was able to actually do a lot of these things is because I’m working with some amazing people here at Nebraska in Omaha. And he’s right here in Nebraska. But you can actually send these adapters to anywhere in the country, or in the world, for that matter. And I’m pretty sure that if there’s someone that we can help, we would love to reach out and help. Well, thank you very much for your time today. I look forward to having okay. One more question. I’m going to take one more question. Have these adapters been used on special needs frames like specs for us? Tracy, can you repeat that question? Like which adapters are you referring to? Any model of 3D print der issue so I’m going to go back the glass adapters for patients. Yes. This adapter this adapter for the patients with the plagiocephalies and microcephaly, microtia, any type of deformities, this adapter can be made and can be adapted to any glasses. But it fits the best in this particular type of glasses called the spokes. Which is available anywhere. And also it’s available online. And then let me think. Oh. And also, I just want to make sure that this adapter is actually, when they wear it, your hair can cover it very nicely. It’s almost invisible. You can’t really see it. And you can also decorate it so it looks like a head band. Any model of 3D printer that can you know what? The that’s a great question. I’m going tell you, the 3D printer is being advanced. And it’s actually they keep modifying it and making it better and better. And we just I think we’re in the process of getting even a new 3D printer that costs more than my car. So I would not recommend any particular model of 3D printer at this point. Because it keeps on changing. It keeps on getting better and better. Because we want to be able to use metal for future 3D printing. So and with the current 3D printers, we don’t have that capability. And also the types of materials, you’re somewhat limited to. But I’m going to say that it’s just continuing to get better and better. And with that technology, I think we can be better with our creations and our final products. Well, thank you very much. I hope you let’s see. The glass adapter can you attach the lens part of the frame?I.E., no ear pieces? I didn’t understand that question. Can you attach the lens part of the frame, no ear pieces. Oh, yes, yes. Tracy, yes. You actually don’t need the frame. Actually you don’t need the frame at all. You can actually attach this directly to the lenses. And we have some of those models. That’s right. And the reason we actually put this in there is that to make it look more like real glasses. But you don’t need this temple at all. You can actually attach this directly to it and it works just fine. As a matter of fact, that’s what my friend, Mr. Hermsen, that’s what he wears. Thank you for sharing your wonderful morning or evening. Have a great day and I look forward to seeing you again at the future Cybersight talks.