TINTED CONTACT LENSES
Beyond Blue and Green: The Many Applications of Tinted Contact Lenses
By Janice M. Jurkus, OD, MBA, and Jeffrey
Colored contact lenses can change eye color, reduce glare, look wild and crazy and even fulfill medical needs.
Tinted contact lenses... bane of our existence or bonus to the practice? Cosmetic accessory, means of vision correction or medical necessity? Tinted contact lenses are all of the above. It all depends on how you prescribe the lenses and educate your patients.
Essentially four types of tinted soft contact lens designs are available today: opaque designs for dark colored eyes, enhancer tints for lighter eyes, prosthetic designs for disfigured eyes and theatrical designs just for fun. Although opaque and enhancer tinted lenses are available as annual and frequent replacement lenses, many practitioners and patients often prefer blister-packaged disposable lenses due to the lower cost and convenience. Each type of lens has a place in your practice.
Patients hear about tinted lenses from friends, relatives and advertisements but often wait for their doctor to tell them that they are candidates for this type of lens. All too often, we fit patients with a handling tint lens only to have them ask, at the end of the exam, if the lenses come in a color they would like.
Determining your patient's desires early in the prescribing process can make the procedure more efficient. Your patient information sheet should include a line that asks if the patient would be interested in contact lenses that change eye color. Fitting can then be streamlined to the specific lens type you deem best for the patient. If your support staff members wear contact lenses, suggest that they wear tinted ones. Patients who see different colored lenses on real people (rather than in pictures) are more likely to ask about availability. Your office newsletter could feature the various effects achieved with tinted lenses. Highlight the use of tinted lenses in monovision because many presbyopes have the disposable income for this cosmetic enhancement. Let patients know a professional fitting evaluation is needed to ascertain if tinted lenses are compatible with their eyes.
Opaque lenses are ideal for patients with dark eyes who would like to change to blue, green or simply a lighter color. Allowing the patient to try on different colored lenses enables them to see the difference before ordering lenses. Color selection can be challenging; some patients want to try on every color available. Don't let them do that. Part of our job is to guide the selection process. Ask the patient if he wants a dramatic color change or a more subtle change to narrow down the selection. In our experience, African-American patients will have a more dramatic effect while wearing blue lenses than while wearing hazel or green lenses. Latino patients will notice a greater change when wearing violet lenses than when wearing a honey lens. Remind your patients that the color effect is most noticeable between one and six feet away.
During the fitting process, many doctors form opinions of what looks best, both fit-wise and cosmetically. Keep your cosmetic opinion to yourself. Let the patient make the final decision after trying a maximum of two lens colors. What you think looks good may not be what the patient likes. When a patient asks which color is better, a response that highlights two points of view is honest and safe, but only the patient can decide which color lens meets her expectations. If the patient can't decide on a single color, suggest buying a box of each. After using the lenses on a daily basis, the patient will become comfortable with a specific color, and more lenses can always be ordered. Also recommend a set of a handling tint lenses since there will be times when the patient will want her true eye color to show.
The CIBA Vision FreshLook lens is the most widely recognized brand of opaque lenses. The traditional opaque pattern is still available, but increasing numbers of patients want a more natural change of color. The FreshLook Colorblends helps achieve this effect with its varying iris pattern.
Figure 1. Subject wearing a green CIBA Vision FreshLook ColorBlends OD and no lens
A new entry to the market is CooperVision's Expressions lenses. They are available in blister packs, designed for monthly replacement. Expressions lenses have an aspheric design that can reduce spherical aberration and sharpen acuity. The color print is a three-layer, smooth surface design that contributes to comfort. The availability of different designs, patterns and materials allows us to prescribe the type of lens that is most compatible with the patient's cosmetic, visual and physiological needs. Both brands offer multiple colors for the iris and a clear central pupil (Figures 1-3).
Patients wearing opaque lenses need extra education. Since the clear pupil aperture may be smaller than the pupil size, patients may notice slightly fuzzy vision in the peripheral field. Patients may report a slight shadow or peripheral haze. This may be more noticeable under mesopic conditions such as driving at night or while at the movies. If the patient knows this ahead of time, the symptoms will not be as upsetting when they first appear. If the patient uses more than one color lens, recommend different color cases. This way, the patient can open only the case with the desired lens color, preventing possible contamination.
With the advent of frequent replacement tinted lenses, keeping track of replacement schedules can become challenging. Make the replacement schedule easy to remember. If two-week replacement is best for the patient, recommend replacing the lenses every payday, assuming the patient is paid twice a month. The less frequently-used color should be replaced at least quarterly. To be on the safe side, suggest disinfecting the lenses just prior to use if more than two weeks has elapsed. A rapid disinfection system, such as QuickCare (CIBA Vision) or OptiFree (Alcon) makes this easy.
Figure 2. Subject wearing a green CooperVision Expressions OD and no lens OS.
Enhancer tints are used for lighter colored eyes. Often these lenses have color throughout the entire central 11mm of the lens. CIBA Vision, Bausch & Lomb, CooperVision, Alden Optical and Metro Optics offer stock lenses in a variety of enhancing colors. Another interesting way to offer tinted lenses is by using an in-office tinting process such as the system offered by Softchrome, Inc. The patient's eye color is matched to a display palette of artificial eyes. Sample tinted lenses are placed on the palette's eye, allowing the patient to see the change without actually wearing a trial lens. The patient's habitual lenses are then tinted in the office to match the sample.
A word of caution if using a transparent enhancer tint that covers the pupil: The tint acts like a filter that subtly distorts color perception. The patient should be aware of this color shift. One of my patients, a physician, was fit with a yellow tinted lens. He returned to my office saying he couldn't wear the lenses at the hospital. They were comfortable and his visual acuity was excellent, but the yellow tint made his patients look like they had jaundice. However, the color change may be beneficial to some patients. Sport lenses use tints to enhance the perception of yellow or to reduce glare.
Not all tinted lenses simply change eye color; they can also be used as a base for the piggyback system. Keratoconic patients wearing a piggyback system may experience less RGP movement if a dot matrix opaque design is the soft lens base. Albino patients can appreciate the filter effect of an enhancer tint to reduce glare.
Figure 3. Subject wearing a green CIBA Vision FreshLook ColorBlends OD and a green CooperVision Expressions
True prosthetic contact lenses can change a person's life. Patients with scarred corneas, irregular irides or complaints of monocular diplopia can benefit from a prosthetic soft lens.
Prosthetic lenses can be stock designs or custom made. A stock design, such as the CIBA Vision prosthetic, offers a relatively simple way to fit the lenses. Trial lenses have a single, double or black iris background as well as a clear or black pupil. CooperVision offers its prosthetic lens in a variety of patterns. This lens is also easy to prescribe since loaner lenses are available, and delivery time for their stock design is usually less than one week.
Other prosthetic lenses are custom tinted. Alden Optical, Custom Color Contacts, Innovations in Sight, Marietta Contact Lens Service, Prosthetic Soft Lens Corp., Adventures in Color, Crystal Reflections and Specialty Tint offer custom lenses (Table 1). Hand- painted lenses are based on a photo of the patient's eye. Lighting is important when taking the photograph because the eye color can differ in the photo when compared to the natural eye. Black pupils can be tinted onto a lens as well. A higher water content lens, 55 percent, is best for the custom designs.
The following two cases illustrate the use of prosthetic lenses. A patient reported severe monocular glare and diplopia after cataract surgery and IOL implantation. The surgery was complicated and resulted in an irregularly-shaped pupil, pigment on the endothelium and iris atrophy. When wearing a double dot matrix iris design with a 3.70mm clear pupil, the patient reported reduced glare and the elimination of diplopia. Glasses with the patient's cylindrical correction and add power were prescribed. When wearing the glasses, the color difference between the lens and the natural iris on the contralateral eye was barely noticeable. The prosthetic lens allowed the patient comfortable single vision, eliminating the glare and diplopia experienced after surgery.
Another patient who experienced severe vision loss after multiple retinal, vitreal and cataract surgeries had no useful central vision and a complaint of severe glare and diplopia. A black pupil, 5mm in diameter, eliminated the central glare problem while allowing peripheral awareness to remain.
CIBA Vision's Wild Eyes, CooperVision's Crazy Lenses and theatrical lenses can be the bane of a practice if not handled professionally. The patterns available range from a cat eye design to white lenses to lenses with NFL logos on them. These are truly designed just for fun.
The best way to assure ocular safety is to suggest that the patient use theatrical lenses once and then toss them. Realistically, most people will want to wear these lenses a few times a year. Advise your patients that keeping the lenses wet and changing the disinfecting solution prior to use will help keep the lenses free of contamination. Tell your patients they should never share lenses because sharing lenses can allow the introduction of one person's ocular flora into another person's eye, escalating the risk of infection. The analogy of sharing a toothbrush usually brings that message home.
Many patients want to change the way they look, and colored lenses are an affordable way to do this. If we don't offer this choice, they may try to obtain the lenses elsewhere, such as the Internet. In researching this article, a web search for tinted contact lenses yielded 6,480 results.
Patients know about buying lenses online, and many sites make this process easy. When users are ready to place an order, most sites have a field that asks for the name and telephone number of their doctor. Few of the sites we visited explain to potential customers that the doctor would be contacted or that the prescription would have to be valid.
Most sites feature high-resolution graphics complete with gorgeous models practicing lens handling, snazzy graphics and Java applets. Some sites try to disguise themselves as information sites but are only trying to sell lenses. The online tinted contact lens market is incredibly competitive. If you search, you will find someone offering these products for lower prices, but there are often hidden costs involved. Using FreshLook Colorblends as a control, prices ranged from $27.95 to $39.99 per box.
As eyecare professionals, we have the opportunity to educate our patients, clear up misinformation and fulfill their cosmetic needs. Offering complete services and competitive lens pricing will help you meet the needs of your patients and increase your revenue. Everyone wants things to be easy. Allowing your patients to get all their lenses from your office makes sense.
Tinted lenses can enhance a patient's life. Careful and professional communication with your patients will allow you to provide them with this cosmetic contact lens option.
Dr. Jurkus is a professor at The Illinois College of Optometry
Dr. Sonsino is a resident of Cornea/Contact Lens Management at The Illinois College of Optometry