The Colors of Success
Colored contact lenses, from cosmetic to sports tints, have consumer appeal and can help build your practice.
By Kathy Shafer

Although colored contact lenses have been a growing part of contact lens practices for many years, eyecare practitioners seem somewhat entrenched in two camps: Those who enjoy fitting them and enthusiastically promote them to their patients, and those who believe that fitting them is problematic, takes too much time and disrupts office flow. Where do you stand?

Contact Lens Spectrum recently interviewed several eyecare practitioners who are in the first group to learn some keys to their success.

A Modality for Many Patients

When discussing colored lenses, we typically think first of cosmetic lenses for enhancing or dramatically changing eye color and of novelty lenses, which are purely for fun. But therapeutic lenses may offer an important life-changing option for some patients, while lenses tinted specifically to improve athletic performance are expected to gain interest with the recent introduction of the Nike MaxSight sport-tinted lens (Bausch & Lomb). Practitioners may focus on one or more of these categories.

Fitting Cosmetic Lenses

Patient Profile When asked which patients show the most interest in colored contact lenses, Dr. Tiffenie Harris said, "Mostly women, but don't rule out the men; they respond, too if you ask. They want to impress others and to enhance themselves as well." Dr. Harris is currently a clinical assistant professor and chief of Primary Care Service at Indiana University School of Optometry, but prior to her academic positions she spent most of her career in practice in the Detroit area. In her experience, the majority of colored lens patients are women, with younger women expressing the most interest. This seems to hold true for practices across the country. "Some teenage girls like to change eye color like they change lipstick color," continued Dr. Harris. "They frequently view eye color as a fashion accessory."

Intrigue with changing eye color crosses all ethnic groups. Dr. Melissa Lee, who is a clinical assistant professor at SUNY State College of Optometry, also works in a private practice in midtown Manhattan and sees a very diverse patient base. "My African American patients, Hispanic patients and Southeast Asian patients are usually very interested in colored lenses," she says. Interestingly, Dr. Lee and other practitioners interviewed find that patients who have dark eyes are more likely to want to change their eye color.

There's no particular occupational profile of a colored contact lens candidate. Retail professionals and patients who work in fashion and performing arts are obvious candidates, as are people who work with the public, are in sales or are in any position where appearance and style are paramount. Dr. Lee always observes how patients are dressed, particularly their accessories, as well as what they do for a living to help her determine who may be interested. But, even people who appear to be conservative can surprise you. For example, one of Dr. Harris' patients is a judge who has to have her hazel contact lenses.

Dr. Pamela Lowe views color contact lenses as an option for the majority of soft contact lens wearers who are adequate candidates. In her Chicago practice where she prefers to put her patients in single-use lenses, either daily disposable or 30-day continuous wear, she positions color contact lenses to patients, "as an adjunct to their everyday contact lenses. They're more for social use or special occasions, so we add them to their regular modality."

Marketing and Presenting the Colored Contact Lens Option Patients may ask their eyecare practitioner about the availability of colored contact lenses because of consumer ads or friends' experience with them. Many practitioners rely on manufacturer provided point-of-purchase materials in their contact lens areas to catch patients' attention. Also, patient questionnaires may help determine interest.

But the most successful practitioners bring up the subject themselves. Dr. Lee finds it easy to ask qualified patients, "Have you ever thought about trying to change your eye color to brighten up your eyes?" She especially asks this question if a patient already wears a lens brand that also offers colors, such as Vistakon's Acuvue 2 and Acuvue 2 Colours, because it's easy to transition such patients into colored lenses. This is an easy way to begin expanding to a colored contact lens practice.

For new contact lens patients who are candidates for a colored lens option, Dr. Harris finds out right away if they're interested. "As soon as a patient says he wants contact lenses, my instinct is to say, 'Will that be clear or color?'" She also doesn't want to miss opportunities. "Because more often than not, patients may have the desire to change their eye color but haven't communicated it. They're waiting for you as the professional to tell them what their options are," she says.

Keeping the Office Flow Smooth One of the most frequent practitioner complaints regarding colored contact lenses is that the fitting process, particularly patients choosing the right color, is too time consuming, disruptive to office flow and therefore not worthwhile or profitable. The practitioners interviewed disagree and in response offered several suggestions.

• Choose the Right Lens, Save Chair Time With new fits, especially if a patient wants colored contact lenses only for occasional wear, all practitioners agreed that it's important to fit the patient in the clear equivalent lens first. Make sure the fit is good and the patient is comfortable with the lens before moving to the color lens. Minimizing any differences in feel, fit or vision between the clear lenses and the patient's colored lens will minimize your chair time and potential for problems down the road.

Dr. Harris says that when she asks patients whether they're interested in colored lenses, the answer helps guides her toward a lens brand that might be right for the patient at the start, saving her valuable chair time. She explains, "I learned that years ago the hard way. A new patient would see the colored lens marketing material in the dispensing area and ask 'Can I do that?' Then I'd have to start all over again. I prefer not to waste my time."

With her approach Dr. Harris also minimizes potential lens transition issues because she sends the patient home with both color and clear or visibility tint lenses of the same brand and prescription. This virtually eliminates issues of the colored lenses fitting different or feeling different to the patient than the clear lenses.

Dr. Harris conjectures that problems may arise if practitioners have a favorite lens brand that isn't available in colors or in a color that the patient wants, but they still send the patient home with that clear lens. "Then when the patient gets their colored lenses of a different brand that may be stiffer or bigger, they're going to feel the difference and say that it's not comfortable," she says. "It makes good practice sense to send the patient home in the same prescription, toric or sphere, base curve and diameter of the clear version of the color that they want. That will save the refit time."

If she fits a patient for color but he changes his mind, Dr. Harris will tell him that he can order colored lenses from her practice in the future, then notes in the record that his prescription is for clear or colored lenses to save steps for the staff if the patient does choose to add color later.

Sometimes fitting colored contact lenses does require additional time. You may need to refit existing patients who request color but whose current lens brand isn't available in color. Also, patients choosing opaque lenses need additional education on possible effects to their peripheral vision and on what to expect in low light when their pupil dilates beyond the size of the contact lens pupil aperture.

• Limit Patient Options First, narrow their color options by making suggestions. Dr. Harris admits that it does take time for patients to "shop" their colors, but she suggests, "If you as a practitioner educate patients on which colors you think will work best for them after looking at their eye color and skin tone, then patients will likely try the colors you recommend. They respect your opinion."

Dr. Lee agrees. "If you offer too many options, then patients may choose a color that's totally wrong for them, hone in on that one and then you can't get them out of your chair," she says. "I ask my patients some basic questions. 'Do you want to be bold or do you just want to complement your eye color?' 'Are you interested in a particular color?' I lead them to pick; I suggest one color that would work well and maybe give them one alternative."

• Utilize Staff After you narrow the range of options, let your staff handle the selection process, work with patients to try on lenses and help finalize their choice. It's helpful if one or more staff members wear colored contact lenses. Dr. Lowe's staff makes the color choice process interactive. Their contact lens area is next to their open optical where patients also wait if necessary. "That's where the fun part comes in," Dr. Lowe says. "We make it interactive not only with the staff, but also with other patients. We ask patients who are waiting, 'How do you think these look?'" she says. "We actually enjoy it when we have a colored contact lens fitting. It's similar to when patients are picking a frame: They narrow it down and then start asking everyone's opinion. We feel the way you run your optical is the way you should run cosmetic contact lens color choices."

Staff members, of course, perform all application, removal and care and handling instruction. Consider more intensive training for colored contact lens patients. Dr. Harris says some colleagues have told her that they don't like to fit colors because the patients seem more likely to develop infections. She hypothesizes that the reason for this relates to lifestyle, not the colored lenses. The chosen color becomes part of the patient's identity. She says, "These patients will sometimes not allow others to seem them without their color lenses. So what do they do? They sleep in them overnight; they completely over wear them, and that promotes infection." So her practice emphasizes care, disinfection and replacement schedules. She says, "We must be cautious and really listen to our patients when they want to wear colors. Get a feel for their lifestyle and educate them on taking care of their lenses so they don't incur any problems." It's also critical to emphasize the dangers of exchanging or trading contact lenses, including novelty lenses, especially with young patients and their parents.

Fees Generally, the eyecare practitioners we spoke to don't charge differently for fitting colored contact lenses. If an existing patient wants to start wearing colored lenses, some practices as a courtesy charge a reduced fee, or contact lens check fee, instead of a new fit fee.

Special Needs Tints

Prosthetic Lenses Fitting prosthetic lenses can be most rewarding. Normalizing the appearance of corneas damaged by trauma can truly change a person's life, such as that of a 14-year-old girl fit by Dr. Harris. "I convinced her mother that I could fit a cosmetic, prosthetic lens. It worked beautifully, and this girl just came out of her shell," she says.

Through her work at SUNY, Dr. Lee also sees patients from New York Eye and Ear and she has fit a great deal of specialty prosthetic lenses, both soft and GP, for patients who have opacified corneas or eyes that are disfigured for other reasons.

Although some eyecare practitioners may hesitate to take on a prosthetic fit, Dr. Lee says it's very straightforward. She usually starts with a relatively high (55 percent) water content material and fits the clear lens first. "Then I measure the pupil and check color in relatively bright conditions, such as standard room lighting, so that the prosthetic lens won't look too obvious and will match the undamaged eye in as many environments as possible." She aims to get as much iris detail into the custom painting as possible. Manufacturers of custom contact lenses can be very helpful. Table 1 lists companies, including custom laboratories, that manufacture colored lenses.

Dr. Harris works only with stable, non-progressive conditions when fitting prosthetic lenses. Typically she fits the lens empirically by gauging the K of the damaged eye based on the fellow eye, considering that scarring or damage may have changed it to some degree. She makes necessary adjustments in the fit and looks for centration using a larger diameter lens to aid in stability.

Color Deficiency Some practitioners like Dr. Lowe have also ventured into fitting red-centered lenses to help patients who have difficulty with their color perception. Most of these fits have been policemen or security workers, although she fit one electrician whose need to recognize different colored wires was obvious. These patients approached her and so far each fit has turned out well. She fit all of them some time ago, so she now cautions that practitioners may want to check into any potential medical legal issues and advise patients to check with their employers (if the desire for better color differentiation is job related) to see if using these lenses on the job is allowed.

Sports-Tinted Contact Lenses

With the introduction earlier this year of Nike MaxSight, there's renewed interest in contact lenses tinted specifically for wear during sporting activities. Because the rollout of the lens appears to be very controlled, not many eyecare practitioners have had experience with the lens.

Walt Ramsey, OD, in private practice in Charleston, WV, was among the first practitioners to have the opportunity to work with MaxSight. He also has a personal interest in lenses tinted for sports because of his experience in competitive shooting sports. Dr. Ramsey explains the lenses this way: "They cut out the blue and red light rays on both ends of the spectrum that are most affected by the environment, dust, moisture and so forth. The theory is that the amber wave lengths in the middle of the spectrum are least affected, so these amber rays are better at cutting through the fog, debris and the pollution. The lens enhances the appearance of the ball by cutting out the stray rays or the stray extraneous light."

According to Steve Hitzeman, OD, director of Clinics and director of the Sports Vision Program at Indiana University School of Optometry, who has fit several athletes and has personally worn the grey-green lenses, "The initial reaction is 'Wow!' How that translates into performance in sport, it's really too early to evaluate." Dr. Hitzeman thinks that the amber lens is particularly good for baseball and soccer, and that golfers will really like the grey-green lenses once they try them. "I wear the grey-green lenses when I golf, and it's amazing how comfortable it feels to play in these lenses. I'm not sure that I can say that my performance is better, but everything looks sharper. I see the green more distinctly," he says. "Secondly, when I wear them I have no need to wear sunglasses for seeing in bright sunlight. There's still some exposure to UV, but most golfers don't wear sunglasses anyway because of distortion, fogging, slipping, etc., and they don't like anything on their face. From my experience, this is a really good alternative."

Cosmetically the lenses aren't attractive, particularly the amber lens. The grey-green lens is a very dark, large-diameter lens that makes the iris look much larger than it really is and looks very unusual. But as many amateur and professional athletes (as well as parents of younger athletes) will do almost anything reasonable to get the slightest edge in performance, appearance isn't a primary concern.

Dr. Ramsey is also cautiously optimistic. "I'm not convinced that wearing the correct tint will increase your performance, but I am convinced that wearing the incorrect tint will definitely detract from your performance." He sees a possible advantage in fast-moving ball sports and has fit some minor league baseball players who just raved about the lens for daytime games. "They just couldn't say enough good things about it," he says. Reactions were mixed for nighttime games.

Because MaxSight is a participation lens, patients should wear it only during sporting activity. That means the lens will always represent incremental business for eyecare practitioners and, because the lens is easy to fit, it could present a significant practice growth opportunity. Dr. Ramsey also believes that, "The main advantage of the lens is going to be the spin-off business it generates — the extra interest it will create in contact lenses, sports glasses, sunglasses, examinations and eye care. It will bring in patients who may otherwise not have come to their eye doctor's office. As an extra benefit, some of these people may find out about retinal defects and problems that otherwise may have remained undiagnosed until they become more serious."

Both practitioners are waiting for spring when many of the targeted sporting activities resume, and they hope to see Nike promote the lens at that time. In the end, Dr. Ramsey believes the success of the lens will depend on the patients' subjective evaluation of its performance. "That's going to be the question — not what the doctor can measure but what the patient thinks."

Worth Considering

Today, opportunities abound to provide your patients with colored contact lenses and thereby expand your contact lens practice. If you are among those who have held back in promoting these products, this might be the time to take another look. CLS

Ms. Shafer is an independent marketing consultant and freelance writer. She has more than 25 years of marketing experience in the medical/surgical device industry including more than 10 years in contact lenses and ophthalmic devices.

Contact Lens Spectrum, Issue: December 2005