A New Approach To Fitting Prosthetic Contact Lenses


A New Approach To Fitting Prosthetic Contact Lenses

Leroy G. Meshel, MD
May 2000

New black and light lens under-printing and cosmetic lens technology aids doctors and patients.

Old, outdated methods sometimes linger, especially with prosthetic contact lenses for patients with visually damaged or disfigured eyes. I've been fitting patients with prosthetic contact lenses for years because it pleases me professionally and personally to turn a person's life around with a simple piece of plastic. I've had patients who walk into my practice wearing dark sunglasses, combing hair over an eye or sitting with their backs to others in order to mask their eye disfigurement. After I fit them with a prosthetic lens, these same patients shed the shades and threw back their hair with confidence and a smile. I'm delighted to witness a wonderful metamorphosis every time it happens.

Until recently, this labor of love could honestly have been called a labor. Prosthetic lenses were custom-designed for every patient. The delivery time lasted longer than patients and doctors wished. Such customization meant that the lenses were expensive. That scenario has changed. In 1997, Wesley Jessen acquired the Narcissus Medical and Research Foundation, which I founded in 1974, and applied cosmetic lens technology to making prosthetic lenses.

ColorBlends Technology Added

In late 1999, the Wesley Jessen Special Eyes Foundation added FreshLook ColorBlends three-in-one cosmetic lens technology to prosthetic lenses. The new technology produces a natural-looking eye pattern. Practitioners can now select a standard combination for a truly customized lens. The process is much faster than the old way of sending photographs of the patient's eye back and forth to a lens manufacturerer.

Figure 1. A patient with leukoma trauma.

Figure 2. The same patient wearing a prosthetic lens.

I recently fit a patient with a leucomatous eye. The unaffected eye was hazel, one of the most difficult colors to match. I tried a FreshLook ColorBlends brown lens on the patient, but the lens looked too bright. I then placed a black background printed lens on the patient's eye, and piggybacked the brown lens on top of it. Now I had a near perfect color match.

This patient had a 12.5mm cornea. I judged the pupil to be 3.7mm in diameter. I ordered a lens based on those pieces of information ­ color, black underprinting and size of pupil. No photographs or color charts to match. The result is a near perfect match with a natural-looking color and pattern in a reliably reproducible lens. When the lens needs to be replaced, in one year or five years, I'll know what to order, and what will arrive, thanks to reproducibility of these lenses with the new three-in-one color technology.

When to Fit a Prosthetic Lens

Prosthetic lenses are now made for sighted and non-sighted eyes, with or without lens power. Indications for use in non-sighted eyes include:

  • Abnormalities of the globe (buphthalmos)
  • Abnormalities of the cornea (corneal leukomas)
  • Abnormalities of the iris (colobomas)
  • Abnormalities of the lens (cataracts)
  • Vitreoretinal abnormalities (extreme photophobia)

Indications for use in sighted eyes include:

  • Corneal scars and other corneal abnormalities (bullous keratopathy, chronic uveitis with band keratopathy, keratorefractive surgery)
  • Abnormalities of the iris (heterochromia, colobomas, iridectomy, polycoria)
  • Lens abnormalities (aphakia and pseudophakia with photophobia, subluxated lens)
  • Vitreoretinal abnormalities (vitreous abnormalities maculapathies with photophobia
  • Extraocular muscle disorders (diplopia)
  • Amblyopia
  • Systemic disorders (econe dystrophy, albinism)

More Than Clear Vision

The Special Eyes Foundation manufactures ready-to-use lenses in 23 colors, 19 of which can be underprinted in either gray or black. With those combinations achieving a good match is much easier. Practitioners can purchase trial lens sets with black and light underprinted lenses on which can be piggybacked a brown, blue or green lens.

"A good match" is a key operational phrase. While fitting patients with a prosthetic lens can be tremendously rewarding, it does carry with it some unique challenges. Patients whose eyes have recently been damaged by trauma are often the most difficult patients to fit ­ not clinically, but emotionally. In their minds, they still see their eyes as healthy and haven't quite accepted the loss. In these situations, a practitioner also becomes a counselor.

While we can't restore vision to this patient, we can restore a feeling of normalcy, a most cherished gift. Practitioners like me don't fit prosthetic lenses because we see it as a financial practice-builder. (In 1999, I treated 42 prosthetic lens patients in my practice; most practices see far less.) Rather, we work with these patients because of the larger rewards: the heartfelt smiles, the deep gratitude and even the local public relations that can result.

Patient need is clearly there. The Wesley Jessen Special Eyes Foundation distributed 3,000 lenses in 1999, and the potential U.S. market alone is estimated to be five times as large if patients who could benefit knew about prosthetic lenses. The Foundation anticipates 20 percent growth per year, as more practitioners and even patients become aware of the availability and affordability of these lenses.

Fitting prosthetic lenses doesn't generally add a new revenue stream to the practice, but neither does it cost the practice much, if anything. Thanks to the advances in technology, these lenses are no longer complicated to fit.

My advice is this: if you have patients who could benefit either cosmetically or visually from a prosthetic lens, do them a favor. These patients will thank you from the bottom of their hearts. 

Dr. Meshel is medical director of the Wesley Jessen Special Eyes Foundation. He practices in Daly City, CA.