The Rise of 3D Printed Prosthetic Eyes

Recently there’s been quite a lot of attention on the use of 3D printing to manufacture artificial eyes (aka. ocular prostheses). This has largely been due to an announcement out of the UK that the world’s first 3D printed artificial eye was implanted in a patient.

Quite a cool milestone and application of 3D printing, and also happens to be a field I’ve been investigating for the past 6 months with some of my colleagues at the Herston Biofabrication Institute. We’ve just published a review of all research into the use of 3D printing for orbital and ocular prostheses, and you can access the full article for free here.

The graph above does a nice job of showing the overall trend for research on this topic, with the first ever paper dating back to 2004. Early studies like this certainly weren’t 3D printing eyes and implanting them in patients, but instead used 3D printing as part of the process, creating moulds and similar devices. The first time a 3D printed part was directly used as part of a prosthesis was in 2014.

Perhaps one of the best ways to demonstrate what is possible now using full-colour 3D print methods (material jetting) is the below video from Weta Workshop. While these may be eyes for monsters, the same principle is being used for human prosthetic eyes. One of the key differences between what Weta Workshop have achieved, and what is being done for patients, is the need for biocompatible materials, as well as the need for a patient’s eye to perfectly match their existing “good” eye.

While it’s early days in the clinical trial phase of implementing 3D printing for prosthetic eyes, there are many benefits which we summarised from our research, including:

  • Manual steps in prosthesis fabrication can be replaced by digital methods, potentially saving time
  • Less discomfort to patients through use of medical imaging or 3D scanning techniques
  • Weight reduction compared to traditional methods
  • Improved accuracy and fitting of prosthesis
  • Minimised need for gluing a prosthesis to the skin
  • Good realism of eye
  • Ability to easily re-print the same components in the future

Of course, there are currently some limitations as well, such as:

  • End-use 3D printed parts are typically not biocompatible and require coating with PMMA or used as a mould to cast with biocompatible material (although the UK trial shows that direct 3D printing of multi-colour biocompatible materials may be possible)
  • Experience in computer-aided design (CAD) technology is required, which is not part of traditional skillset for prosthetist
  • AM times are slow (although they can also happen overnight or while a specialist does other things)
  • Rough surface quality of parts requires additional post-processing e.g. polishing
  • Challenges associated with using 3D scanners e.g. patient movement or scanning anatomy with hair
  • Expert manual skills are still required for some steps of the workflow
  • Use of CT scanning for the purposes of creating a prosthetic increases patient exposure to potentially harmful radiation

Research to-date has been limited to small case studies and engineering experiments, making it difficult to understand whether outcomes will translate to the clinical context. It will be great to see how the UK clinical trial progresses, and hopefully provides improved outcomes for patients. Let’s watch this space!

– Posted by James Novak

3D Printing and COVID-19 in Data

Figure 2 Timeline

Following my previous post discussing some of the opportunities and challenges of using 3D printing to fill supply chain holes during COVID-19, I’m pleased to share the more detailed research I’ve been working on that supported my article in The Conversation.

Published here in an open access journal is an analysis of all 3D printing projects that were initiated during the first months of the pandemic. As a summary, the image above shows the timeline of these projects, and the types of products that were being produced. In total, 91 projects were documented in my research, with only 7 of these occurring before the World Health Organization (WHO) declaration of a pandemic on March 11. Most of these were based in Asia. The remaining 84 projects (92%) followed the declaration as the pandemic spread around the world and health systems rapidly struggled to meet the demand.

The figure above also shows that 60% of projects were for personal protective equipment (PPE) such as face shields and goggles, while 20% were for ventilator components, and a further 20% were for miscellaneous projects such as hands-free door openers.

200523 3D Print COVID-19 Data

Of the PPE projects, 62% were for face shields as shown above in the left chart. This includes the popular Prusa RC3 face shield pictured in my previous post, although the first documented face shield actually occurred on February 25 from The Hong Kong Polytechnic University. Obviously face shields are a relatively low risk product compared to components for a ventilators, and makers could easily 3D print these on desktop 3D printers.

The chart on the right above documents the types of 3D printing technologies used for each of the 91 projects. Perhaps it is no surprise that fused filament fabrication (FFF) was the most used, accounting for 62% of projects. Resin printing with stereolithography (SLA) or digital light processing (DLP) was the next most popular for 10% of projects, followed by multi jet fusion (MJF=9%), selective laser sintering (SLS=8%), continuous liquid interface production (CLIP=2%), and concrete was used in one project in China to 3D print concrete isolation houses for Xianning Central Hospital in Hubei. Interestingly, 8% of projects did not specify the 3D printing technology being utilised, suggesting that some projects lacked documentation or were reported by the media simply as “3D printing.”

While this review provides an overview of the broad trends related to the 3D printing of health and medical products during the first months of the COVID-19 pandemic, ongoing research is needed to continue monitoring 3D printed products throughout the pandemic to understand longitudinal trends. For example, does the initial hype from March subside and a more stable pattern of research and collaboration continue through April and the following months? Do projects consolidate and merge, with others ending as regulations tighten, or traditional supply chains stabilise?

It will also be necessary to analyse 3D printed products and validate them, particularly as the health crisis continues for months or even years. Initial 3D printing projects, while well intentioned, were largely unregulated and a reflexive response to direct and immediate needs. As supplies stabilise, and the infection curve flattens, more time and resources can be devoted to research, building upon the NIH 3D Print Exchange database of approved designs, perhaps developing an approved FDA or TGA database of designs as well as 3D print technologies and materials. These may be necessary for any future outbreaks of the virus, as well as allowing for better preparation for future health, humanitarian and natural disaster crises that may require a similarly rapid response to equipment shortages.

If you want to find more of the data and read the detailed analysis, please read the article here. Additionally, you can freely access all of the data I collected for this research, and continue building off it, by accessing it on Figshare. I hope it is useful for building our understanding of how 3D printing can be deployed during a health crisis.

– Posted by James Novak

Millions of products have been 3D printed for the coronavirus pandemic – but they bring risks

Header Image High Res

** Please note: this is a copy of an article I wrote for The Conversation, published on 5th May, 2020, and is shared under a CC-BY-ND license. You can access the original article by clicking here.**

With the COVID-19 pandemic, an urgent need has risen worldwide for specialised health and medical products. In a scramble to meet demand, “makers” in Australia and internationally have turned to 3D printing to address shortfalls.

These days 3D printers aren’t uncommon. In 2016, an estimated 3% of Australian households owned one – not to mention those available in schools, universities, libraries, community makerspaces and businesses.

3DEC Lab

A collection of desktop 3D printers in the Deakin University 3DEC lab. James Novak

Across Europe and the United States, access to essential personal protective equipment (PPE) remains a concern, with nearly half of all doctors in the UK reportedly forced to source their own PPE.

In Australia, reports from March and early April showed hospital staff reusing PPE, and health-care workers sourcing PPE at hardware stores due to shortages.

The global supply chain for these vital products has been disrupted by widespread lockdowns and reduced travel. Now, 3D printing is proving more nimble and adaptable manufacturing methods. Unfortunately, it’s also less suited for producing large numbers of items, and there are unanswered questions about safety and quality control.

Sharing is caring

One of the earliest examples of 3D printing being used for pandemic-related purposes is from mid-February. One Chinese manufacturer made 3D-printed protective goggles for medics in Wuhan. With 50 3D printers working around the clock, they were producing about 300 pairs daily.

Designers, engineers, students, manufacturers, doctors and charities have used 3D printing to produce a variety of products including face shields, masks, ventilator components, hands-free door openers and nasal swabs.

Many designs are freely shared online through platforms such as the NIH 3D Print Exchange. This US-based 3D printing community recently partnered with the Food and Drug Administration (FDA) and the Department of Veterans Affairs, to assist with validating designs uploaded by the community. So far, 18 3D-printable products have been approved for clinical use (although this is not the same as FDA approval).

Such online platforms allow makers around the world not only to print products based on uploaded designs, but also to propose improvements and share them with others.

Just because you can, doesn’t mean you should

In a public health crisis of COVID-19’s magnitude, you may think having any PPE or medical equipment is better than none.

However, Australia’s Therapeutic Goods Administration (TGA) – our regulatory body for medical products – has not yet endorsed specific 3D-printed products for emergency use during COVID-19. Applications for this can be made by manufacturers registered with the TGA.

However, the TGA is providing guidelines which designers, engineers and manufacturers are working with. For example, Australian group COVID SOS aims to respond to direct requests by frontline medical workers for equipment they or their hospital need. So, local designers and manufacturers are directly connected to those in need.

3D printing provides a means to manufacture unique and specialised products on demand, in a process known as “distributed manufacturing”.

Unfortunately, compared with mass production methods, 3D printing is extremely slow. Certain types of 3D-printed face shields and masks take more than an hour to print on a standard desktop 3D printer. In comparison, the process of “injection moudling” in factory mass production takes mere seconds.

That said, 3D printing is flexible. Makers can print depending on what’s needed in their community. It also allows designers to improve over time and products can get better with each update. The popular Prusa face shield developed in the Czech Republic has already been 3D printed more than 100,000 times. It’s now on its third iteration, which is twice as fast to print as the previous version.

Prusa RC3 Face Shield

A Prusa RC3 face shield 3D printed on a desktop 3D printer. James Novak

Opportunity vs risk

But despite the good intent behind most 3D printing, there are complications.

Do these opportunities outweigh the risks of unregulated, untested product used for critical health care situations? For instance, if the SARS-CoV-2 virus can survive two to three days on plastic surfaces, it’s theoretically possible for an infected maker to transfer the virus to someone else via a 3D-printed product.

Medical products must be sterilised, but who will ensure this is done if traditional supply chains are bypassed? Also, some of the common materials makers use to 3D print, such as PLA, aren’t durable enough to withstand the high heat and chemicals used for sterilisation.

And if 3D-printed products are donated to hospitals in large batches, identifying and treating different materials accordingly would be challenging.

For my research, I’ve been tracking 3D-printed products produced for the pandemic. In a soon-to-be-published study, I identify 34 different designs for face shields shared online prior to April 1. So, how do medical practitioners know which design to trust?

If a patient or worker is injured while wearing one, or becomes infected with COVID-19, who is responsible? The original designer? The person who printed the product? The website hosting the design?

These complex issues will likely take years to resolve with health regulators. And with this comes a chance for Australia – as a figurehead in 3D printing education – to lead the creation of validated, open source databases for emergency 3D printing.

– Posted by James Novak

Read more: Can 3D printing rebuild manufacturing in Australia?

Oh That’s Handy – 3D Printed Prosthetic

20180114_e-Nable Prosthetic Hand

If you’ve been paying any attention to 3D printing over recent years, no doubt you’ve seen at least a few 3D printed prosthetics. From the Iron Man prosthetic arm to the prosthetics being 3D printed for our animal friends, 3D printing is ushering in a new generation of low-cost, customisable prosthetics. Perhaps you’ve even seen my build of the fully robotic InMoov hand which has been documented on this blog.

At the extremely affordable end of the spectrum for humans, Enabling the Future (also called e-NABLE) is one of the most well-known names, developing a range of  open source prosthetics since 2013, which can be freely downloaded, printed, assembled and sent off to those in need. As part of my research I have wanted to build one of the e-NABLE hands for a while now to understand more about them, particularly in comparison to the more complex InMoov robot arm. As pictured above, I’ve finally got around to printing the Phoenix v2 hand, which is wrist actuated to open/close the fingers.

When you look at all the details, it really is a clever design which is optimised for 3D printing on a desktop FDM machine, with almost no support material or waste, and tolerances that fit really well together. Anyone with a 3D printer could assemble one of these, most of the non-3D printed parts can be sourced at a local hardware store or found in your shed (screws and fishing line). The instructions are very clear, and there are loads of videos to help demonstrate the assembly process and how some of the technical aspects of the hand work. Because I printed in ABS rather than PLA plastic, the only small hurdle I had was in the thermoforming process of the gauntlet (the bent white piece that mounts to the users arm), which required me using a strip heater in the university workshop. If you find yourself in a similar situation, you can check out the details which were posted in one of my previous posts. However, I recommend using PLA if you have the choice to make this part easier, only requiring some boiling water as demonstrated in this video. In itself, this is a really cool technique that I will use in the future to create stronger parts; you can always learn a lot from 3D printing other people’s designs.

Overall the e-NABLE community really has done a great job in refining this design over the years, and I’m already working on some of my own iterations which will hopefully be fed back into the e-NABLE community in the future. If you’re looking for a project to build and learn from, or potentially getting involved in the community and building hands for people in need, Enabling the Future is definitely worth researching.

– Posted by James Novak

Inside 3D Printing Sydney Review

20160511_Inside 3D Printing Syd 1

As my brain still tries to process everything from the 2016 Inside 3D Printing Conference Sydney, I thought a bit of a review might be a good way to try and both sort out my thoughts, and share with you some of the things on show and discussed throughout the 2 day conference. This conference was shared with National Manufacturing Week, which actually makes up the bulk of the exhibitor stands in the image above – 3D printing only filled up the very right thoroughfare from the Fuji Xerox sign to the back (yes there’s a bit of a disappointed tone in my voice here).

20160512_Inside 3D Printing Syd 2

Above you can see the size of the 3D printing conference itself – which I have to admit was a real shock to see when I walked in on day 1 expecting at least 100 people or more. Having been to RAPID last year in Los Angeles (you can read about my experience here) I guess I just expected a lot more interest in 3D printing by now in Australia! Our slow uptake despite having a significant share of the worlds titanium, which could be used right here for 3D printing, was certainly a common theme for discussion from many speakers, as were the trends and predictions for continued worldwide growth after the latest Wohlers Report for 2016. But well done to all the Queenslanders who made the trip down, I couldn’t believe how often I would speak to someone only to find out they were from my part of the world! Perhaps Inside 3D Printing should look at running in Brisbane next time?

The good news is there were some really great speakers, one of my favourites being from keynote Paul D’Urso about his pioneering use of 3D printing in surgery over the last 20 years. What I liked most was his candid insight into the tensions between what surgeons and their patients want (for example custom-fitting implants that heal quickly and are comfortable, custom tools and guides for surgeons to provide more accurate surgery, and 3D prints from CT scans for pre-surgical analysis and practice which saves time in the operating theater) as opposed to regulatory bodies like the FDA in the United States who are getting in the way of innovations like 3D printing and basically enabling large corporations to own the monopoly on expensive standardised medical equipment. He has a great proactive attitude of just getting in and improving implants and tools himself using 3D printing, and has founded Anatomics as a way to reach out to other surgeons with the tools and products he and his team have developed. A great “just do it” message which was really motivating.

Education was also a big theme, with speakers like Ben Roberts from Modfab and Stuart Grover from 3D Printing Studios sharing their experiences around educating children and the general public about 3D printing through various training programs and initiatives here in Australia. However it seems that there is still far too little being done to educate people about 3D printing, and indeed many other emerging technologies, and perhaps the low attendance at this conference is evidence of how far we have yet to go when compared with the same Inside 3D Printing conferences around the world which seem to generate very high numbers of attendance. A re-work of high school curriculum’s was a well received solution at the conference, with traditional wood-work and metal-work style classes needing to be reinvigorated with digital technologies to provide appropriate high-value skills to students due to the rapidly changing nature of jobs, with reports suggesting that by the year 2020 5 million jobs will be made redundant due to robotics and automation. One of the hurdles argued by Ben Roberts was that most teachers either don’t have the skills to teach CAD and 3D printing, or learned them 5 or more years ago and are now outdated. As someone very keen to help enable the next generation of designers through my regular training programs and visits to schools, along with being a part of the Advance Queensland scheme, I think this is an extremely important issue to tackle right now. Anyway, on to some of the fun things.

20160512_Inside 3D Printing Syd 3

Just like with RAPID, perhaps my favourite part of these conferences is the exhibition space – you never know what you’re going to see! Above on the left is the 3D printed jet engine from Monash University, Deakin University and Lab 22 (part of the CSIRO) which you may have seen in the media already. A lot of complexity with multiple 3D printing methods and materials used for the various parts, I just wish it was a working model! In the middle is a full-colour 3D printed hand, almost exactly the same size as mine. What’s unique about this print is that not only was it printed in 1 go, but that the outer “skin” material is soft and squishy like skin! This is a brand new printer from Fuji Xerox capable of printing with 5 material cartridges at once, and there is huge potential for this to create simulation models for training surgeons, or realistic copies of organs or tumors for surgeons to actually practice on prior to cutting open their patient. Lastly was a highly detailed SLS print of feathers as a fabric-like material at the 3D Printing Systems stand – just something a little more unusual compared to all the usual prints everyone normally displays.

20160512_National Manufacturing Week

Lastly just a few things that caught my eye throughout the other exhibits – on the left is one of the robotics displays for automating tasks like pick ‘n’ place – I think I could have a lot of fun with one of these next to my desk! In the middle was perhaps the most interesting display from my own research perspective, with CAD company PTC Creo beginning to enable Internet of Things devices to integrate into their software through the ThingWorx platform. Very much in line with my experiments using Rhino with the Grasshopper and Firefly plugins, however the addition of augmented reality is a really great touch – if you want to see a demo of their full system in action, check out their short 3 minute demo video of the bike being used in both the physical and virtual world. Lastly there were a few companies showing their CNC routers and laser cutters, some of them desktop in size – I just wish I could line them all up next to my 3D printer at home!

Overall a lot to soak up and plenty of new networks created with other attendees, I just hope next year there is an even bigger audience at the conference and even more amazing things happening.

– Posted by James Novak