COLORED CONTACT LENSES
Colored Contact Lens Update
The benefits and downfalls of today’s available lenses for cosmetic, prosthetic, and special effect use.
By Mitch Cassel, OD
We all have different eye coloring that results from light reflecting the concentrated pigment melanin on the iris. The more pigment you have, the darker your eye; blue, grey, and green eyes are lighter due to less pigment. Disease, trauma, and aging can lead to changes in eye color. In fact, our eyes begin changing color from the time we are born—or with the use of colored lens designs for various applications.
The colored contact lens industry has not changed that dramatically since 1987, with the first introduction of soft lenses to change eye color. There are three primary soft colored lens types from various companies that are presently being used in the eyecare industry to change eye coloring: transparent tinted lenses, dot matrix computer-generated lenses, and custom hand-painted soft lenses.
Transparent Tinted Lenses Transparent lenses are useful for cosmetic enhancement of subtle natural eye coloring, with more dramatic or natural results when a patient has a lighter eye color (a dark brown iris color is difficult to change with this lens type) (Figure 1). The benefits of these lenses are many. To start, they are inexpensive; this allows for more frequent replacement due to their affordable pricing. They are also comfortable and reproducible. In addition, power ranges, base curves, and optional lens materials are readily available because you can tint many lens materials. It is possible to create natural color tones when overlapping tints to a lighter eye color. And, clear openings are available for the pupil. This type of colored lens can also be used for sports applications, mild disfigurements, and color blindness. Generally, limited chair time is need to fit these lenses.
Figure 1. Transparent tinted soft lenses.
There are also some challenges and disadvantages of these lenses. Transparent tinted lenses are often unsuccessful on certain darker iris colors (such as darker browns, black, etc.). In addition, color or reduction of light can be noticed if a uniform tint is applied, which may interfere with a patient’s color perception. These lenses may be available in limited powers.
Dot Matrix Computer-Generated Lenses An increased amount of color patterns are now available with this lens type, ranging from more natural tones (Figure 2) to special effect novelty contact lens patterns. Comfort has been enhanced over the years due to various lens base materials. These types of colored lenses have several advantages, including being inexpensive, comfortable, available in optional power ranges, and reproducible. They also require limited chair time. Iris detail, including limbal rings and coronas, are available as well.
Figure 2. A dot matrix tinted soft lens.
These designs also have several challenges or disadvantages. For instance, the standard pupil opening restricts vision with dim illumination; this is dependent on the pupil size. These also are available only in limited powers (no high minus or torics). The pupil size, iris diameters, colors, and base curves are also limited. In addition, dot matrix lens designs may appear artificial.
Custom Hand-Painted Lenses These consist of U.S. Food and Drug Administration (FDA)-approved dyes applied to approved soft lens materials (including 38% polymacon and 55% HEMA-based materials). This lens type offers patients custom color options, including varying iris diameters, pupil sizes (clear and occluded), color choices, and designs (Figure 3).
Figure 3. An example of a custom hand-painted soft lens.
One of the advantages of these designs is the fact that they can be custom designed to incorporate any color, iris detail, and/or lens design. They are also available in custom measurements for lens diameter, base curve, pupil, iris diameter, and iris alignment (for strabismus use). It is possible to match the lenses to a patient’s natural eye coloring. These lenses can also be used for severe disfigurements of the eye or for total cosmetic changes.
Potential disadvantages include the expense of the lenses, the longer delivery time (due to the custom design), and a longer chair time needed. As with other designs, the pupil opening may restrict vision with dim illumination, and these lenses are available only in limited powers (e.g., no toric powers are available).
Applications of Colored Contact Lenses
Colored contact lenses can be used for cosmetic, prosthetic, and special effect applications.
Cosmetic Enhancing or dramatically changing a patient’s cosmetic appearance is a common request in any eyecare practice. Patients’ requests can range from subtle or dramatic natural color changes to increased iris diameters, limbal rings, and iris detail with flecks and coronas. These may be needed in various power ranges from plano to torics.
There are several challenges with cosmetic lenses. The soft contact lens manufacturing industry continues to strive for the most natural coloring, design, and detail to represent a real eye. There are limited options to achieve a natural soft color contact lens that is comfortable, disposable, inexpensive, available with a larger selection of natural colors with more detail, and available in a larger power range.
Prosthetic The most rewarding application when using colored contact lenses in the eyecare profession is to impact your patients with life-changing results using highly effective prosthetic lenses. The psychological benefits for patients are immeasurable. Many patients suffer psychological challenges as a result of scarred or disfigured eyes secondary to congenital defects or traumatic injuries. Your role as a primary care provider is to help inform patients of the various contact lens options available that can minimize the psychological challenges that these patients encounter daily. In addition to quality of life changes, using these lenses can eliminate a range of issues, including diplopia and photophobia.
There are also some challenges with prosthetic lens designs. Practitioners often face difficulties in terms of color reproducibility, the need for various trial lenses (including scleral lens diameters to reposition an iris for strabismic alignment purposes), patient comfort issues, and excessive chair time. There are many experienced prosthetic lens specialists to whom eyecare providers might refer a patient if they feel the case is warranted.
Special Effect Contact Lenses The use of colored contact lenses to provide unusual eye effects for actors in television and movies, as well as patients’ novelty use, has increased (Figures 4 and 5). Safety is the primary concern when using special effect contact lenses (regardless of whether or not they include vision correction). Special effect lenses can provide a wide range of effects, including bloody eyes; color changes; aged, diseased, or blind eye effects; or unusual designs just for fun.
Figure 4. An example of a special effect lens.
Figure 5. Two examples of cosmetic lenses being used to alter an actor’s appearance for a theatrical performance.
A general eye examination and a contact lens fitting for each patient is necessary for legal purposes and to help prevent serious eye injuries, including corneal ulcers and abrasions. The FDA, the American Optometric Association, and the Entertainment Industries Council are making consumers—especially teenagers—aware of how to safely wear these contact lenses.
There are also challenges with special effect lenses. Given that safety is the most important issue when fitting a special effect contact lens either on an actor’s or a patient’s eye, it is imperative for everyone to have an eye examination despite the ease of purchasing lenses on the Internet without a prescription.
Familiarizing yourself and ancillary staff members with various color lens options, color lens manufacturers, and the various applications can add a new dimension to your practice. This will not only increase your revenue, but also help change some of your patients’ lives. CLS
Dr. Cassel has a contact lens practice in New York City where he provides special effect custom contact lenses to the motion picture and television industries. He owns an Optical boutique in Rockefeller Center and is president of Custom Color Contacts, a soft prosthetic contact lens company. He also is a consultant to Alcon and Johnson & Johnson Vision Care Inc.