Many people are coming into the offices of eye care professional’s wanting to change their eye color. Whether these patients are former contact lens wearers, new contact lens candidates, or people looking for a cosmetic enhancement, there are many colored contact lenses to choose from in today’s marketplace. Soft colored contact lenses should not be confused with pupil enhancement contact lenses, color vision deficiency contact lenses, or gas permeable colored contact lenses. Soft colored contact lenses are available as a specific color, opaque, or as a color enhancing soft lens.

Enhancement colored contact lenses cannot change the color of your iris. They simply can enhance or deepen the existing color. If someone has light blue eyes, a blue enhancer will change the shade of blue to a darker blue. The “visi-tint” or visibility tinted lenses do have a slight blue tint to them. The effect upon eye color or eye shade is usually minimal. The “visi-tint” is applied to increase ease of handling for the patient. With the slight blue tint the lens is much easier to locate when resting in a solution. Opaque colored lenses can change the color of your iris completely.

The color of your eyes is determined by the pigmentation that develops within the iris. According to Wolff’s Anatomy of the Eye and Orbit, “Most Caucasian babies are born with blue irides. This occurs because the dark pigment on the posterior aspect of the iris seen through the translucent stroma appears blue. As time goes on, pigment is deposited in the anterior limiting layer and the stroma and the color changes. If little pigment is deposited, the eye remains blue or grey. If there is more pigment deposited, the eye becomes brown. In darker races, the iridial stroma contains pigmented melanocytes at birth and this pigmentation increases. In these individuals the iris is not blue at birth.” However, not everyone is pleased with the choice that nature has provided to them. As a result, the colored contact lenses have grown in popularity because technology can now over-ride nature.

There are several contact lens companies that are manufacturing soft colored contact lenses including Advanced Vision Technologies, Alden Optical, CIBA Vision, CooperVision, Marietta Vision, Metro Optics, Preferred Vision Group, United Contact Lens, and Vistakon. These companies are manufacturing soft colored contact lenses with various base curves, different diameters, and varying Dk values. There are 1-day disposable, daily, and toric soft colored lenses that are available. Colors include hazel, green, grey, royal blue, aqua, evergreen, turquoise, honey, amethyst, gemstone green, brilliant blue, violet, pacific blue, sea green, Caribbean aqua, blue topaz, amber, slate grey, chestnut brown, violet rose, ocean blue, topaz, sapphire, cappuccino, yellow, ocean blue, emerald green, jade green, and hazel green. Since the primary fitting characteristics of any soft contact lenses will be affected by the base curve, thickness, prescription, and the diameter, there is a wide variety available for ECP’s to choose from in order to obtain the optimal fit for their patient.

CIBA Vision has a product line called “Wild Eyes” that would probably fall under the heading of colored contact lenses. However, these lenses are not intended for routine wear for most patients. They are specialty lenses that are quite unique. These lenses have a variety of names including wild fire, white out, zoomin, hypnotica, cat eye, red hot, ice fire, knockout, zebra, blackout, and jaguar (see figure). These lenses are most likely more appropriately termed costume colored contact lenses, novelty lenses or theatrical contact lenses. Halloween parties and actors or actresses trying to make an on-screen fashion statement are the likely market niche for these lenses. It is important to note that someone wearing these lenses could have a visual field loss and driving with these lenses should absolutely be discouraged to be on the side of caution.

Naturally, all of the usual standards of care apply to fitting colored contact lenses just as with any other lens. Even if it is a novelty choice, the health of the patient is the ECP’s primary concern. Proper management of contact lenses and appropriate education concerning every contact lens patient should include at a minimum insertion and removal training, proper use of solutions, wearing schedule, and “do’s and don’ts” of contact lens care. Providing online sites such as YouTube can further enhance the educational process for today’s patient. There are 50 sites on YouTube that explain how to “Insert and Remove Contact Lenses”. There are 2,580 links on YouTube that describe “Contact Lens Problems.” These YouTube posts can be modified or streamlined to fit a particular office’s needs. Of course, ECP’s should preview these sites in order to be certain that they meet the necessary standards of care.

Although the internet and technology can provide enhancements to patient education today, that is not always the case. There are sites that operate that are a concern to the public eye health.

Unfortunately, several sites on E-Bay do not have the protections that are necessary to safeguard the public. Another site on the Internet called “Turtle Contacts” states that “no prescription is needed” in order to purchase contacts on their website. One of the primary concerns is that children will be able to make purchases from these less than reputable locations and put themselves unknowingly in harm’s way. Children who purchase these lenses sometimes exchange them with others to try or to use. The infections and misuse that can result are an obvious consequence with the potential for massive ramifications. And, there is always the problem that contact lenses are provided to consumers without a valid prescription or with a prescription that has expired. An ECP should always be following every contact lens patient for annual examinations and eye health evaluations.

A recent example of serious ocular problems was published by a European eye journal, Acta Ophthalmologica, on March 15, 2011. This is one study of many that have described some problems associated with colored soft contact lenses worldwide that also implicates unregulated internet sites:

“Wearers of costume contact lenses, special colored contacts that dramatically change the

appearance of the eye, are significantly more likely to experience contact lens related eye infections, according to a European study. Researchers in France conducted the study at 12 university hospitals between July 2007 and July 2009 to evaluate the risk of eye infections among individuals who wore costume color contacts (also called theatrical contact lenses) compared with people who wore conventional (non-costume) contact lenses. All patients with contact lens-related eye infections anonymously completed a questionnaire to determine their contact lens wearing habits and other information associated with their contact lens wear. The study revealed that costume contact lenses were rarely dispensed by eye care professionals in France, and the risk of contact lens-related eye infections for people wearing theatrical lenses was more than 12 times greater than that of individuals who wore conventional contact lenses. The researchers also found that people wearing costume contact lenses tended to be younger than people wearing conventional lenses (average age: 21 vs. 27), and people wearing costume contact lenses were less likely to receive proper instructions about contact lens care, handling, and basic hygiene. The study also revealed that people wearing theatrical contact lenses tended to have more severe lens-related infections. 60% of eye infections among those who wore costume lenses resulted in a final visual acuity worse than 20/200 due to corneal injury and scarring, compared with 13% of eye infections associated with wearing conventional contact lenses.”

When not properly supervised by an ECP, do these companies provide educational information concerning the time of use for colored contact lenses? Are cleaning, disinfecting, and storage handouts provided to these people in order for them to properly care for these lenses? Unfortunately, the truth is oftentimes, NO. The public and the companies that are providing contact lenses online think that some contact lenses are novelty items instead of the medical appliance that they truly are today. What these companies should see are the corneal infections and corneal transplants that ECP’s have to deal with as a consequence to their behavior. These companies also need to be aware that they are placing the public at-risk in the name of profits. It is our job to inform and to educate the public as to why annual eye exams are important and to create a bond with our patients so that they do not have to visit us for pain and infections that improper contact lens usage can create. When used properly, under appropriate vision-care supervision, the colored contact lens experience should be one that compliments the user’s needs and does not threaten their health.