Dr. Esposito works in vision therapy and rehabilitation at the Midwestern University Eye Institute. She earned her Doctor of Optometry degree from the Arizona College of Optometry in 2013, and then served as a vision therapy/rehabilitation resident at the
Dr. Harris is a professor at Southern College of Optometry after being in private practice in Baltimore for more than 30 years. He serves as the president of the Optometric Extension Program Foundation and lectures internationally on topics of behavioral
Optometric practices offer tinted and colored contact lenses to aid in cosmetic enhancement; however, many eyecare practices are unaware of the therapeutic effects that tinting a lens (contact or spectacle) can offer.
Optometric practices offer tinted and colored contact lenses to aid in cosmetic enhancement; however, many eyecare practices are unaware of the therapeutic effects that tinting a lens (contact or spectacle) can offer. It is in our best interest to use our comprehensive knowledge and skill set to design therapeutic lenses and fit them appropriately. The reward of a successful fit and life-altering experience for the patient is priceless.
Color’s effects on the visual system have been discussed dating back to the late 1800s and early 1900s. Edwin Babbitt and Carl Loeb used colored light to treat physical and psychological conditions, including jaundice, weaknesses in the body, ailments, and mental affective disorders.
Today, colored lenses have been shown to help patients with a variety of different conditions. Some of the patients who were identified were those who suffered from photophobia, migraines, retinal dystrophies, oscillopsia, reading difficulties, and visual changes related to vestibular conditions.1-5
D.B., a 57-year-old male presented to The Eye Center at Southern College of Optometry with severe migraines, including auras that triggered when exposed to fluorescent lighting for as briefly as 15 minutes. At the time of first presentation, he wore very dark sunglasses and a baseball cap at work to help prevent the onset of migraines. To reduce overall brightness, he removed half of the tubes in each fixture. Occasionally, he needed to shut off all the lighting to prevent triggering the migraines.
D.B. was seen by a neurologist for his headaches, but his medical and ocular histories were otherwise unremarkable. D.B. was experiencing migraines daily which would last for up to four hours.
These migraines were so debilitating that he remained in bed, losing days of his life. He takes 100 mg of Imitrex (sumatriptan, GlaxoSmithKline) for his migraines to help with the pain. He is allergic to aspartame, caffeine, cheese, monosodium glutamate, and tryptophan.
Upon examination, his uncorrected distance visual acuities was 20/20 OU, and all other preliminary testing was normal. Refraction revealed OD: +0.50 -0.75 x 110 OS: +0.25 -0.50 x 110 with an add of +2.00 D OU. Anterior and posterior segment health is unremarkable.
We performed color sensitivity testing using the Intuitive Colorimeter (Cerium Optical Products). This logically and sequentially explored color space and helps find the optimal precision tint for the relief of perceptual distortions, or in this case, migraines.
The Intuitive Colorimeter changes three parameters of color: hue, saturation, and brightness. The patient views colors, which are projected onto text or other targets, through the instrument while the examiner changes the parameters and records graded subjective responses from the patient.
Based on the responses, a computer program helps to determine which combinations of filters will produce a color combination unique to the patient’s visual needs. There are 42 different reference filters, which can be used one at a time or, in rare cases, in combinations of four to five different reference lenses.
The program gives a specific transmission curve for the lens combination, which is testable and reproducible. Using the filters allows the patient to see the color suggested for him before tinting.
With D.B., testing indicated a preference with the spectrum narrowed to 180 at 30 saturation. Producing the right tint for D.B. required three reference lenses, one from the green set and two from the turquoise set (see Figure 1). This produces an overall 36 percent transmission with a peak at 500 nanometers.
The first step was to make a pair of glasses to this specification. The preferred color was then called into the lab (see Figure 2). The lenses still did not provide enough coverage, and he was still experiencing the migraines. We decided to try placing the tint closer to the surface of the eye using contact lenses to more effectively block light.
Using the SoftChrome In-Office Tint System, the lenses were tinted in house. The tinting system kit includes a choice of patterned templates to create pupil and iris combinations, the dyes, tinting equipment, and instructions. The lens used was CooperVision Biomedics XC (omafilcon). A blue tint was applied to the contact lens using the system instructions. A dark tint was required to relieve the migraine symptoms.
It took about five iterations of making the lenses progressively darker before we attained an appropriate transmission level. We poured activator solution (2 ml) into a container and added blue dye (15 drops). The solution was mixed with a syringe and transferred to a vial. The lens was left to tint for 45 minutes.
After the time had passed, the lenses were put into a neutralizing solution to restore pH balance to the lens. Then they were transferred to a multi-purpose solution for storage, which was changed several times to be sure no dye was coming out of the lenses.
We tinted only the pupil with the first lenses in order to improve cosmesis. Though these were promising, it turned out that they still did not provide enough coverage. The most successful tint pattern was a full diameter very dark tint (see Figure 3). The result was a profound change in the patient’s life.
The benefits to tinting contact lenses in-house include faster delivery time, color modification options, and the ability to apply a tint for therapeutic use to lenses of any available power combination. You can buy lenses that are already tinted; however, if darker or lighter colors are needed, you would need to order many different lenses, increasing the turnaround time. For a patient that is suffering the way D.B. was, the sooner the lenses were finished, the better.
The patient was able to wear the tinted contact lenses full time during the day in any lighting condition without experiencing headaches, though it should be noted that he removed them once he got home. His acuity through the lenses is 20/20 OU.
The patient stated, “I am not tired at the end of my work day due to the exposure to the fluorescent lighting, nor do I get migraines as easily. I can tolerate being at work, and I do not have to consider quitting my job. It is amazing, and I thank you again for what you have done for me-giving me a normal life back.”
Color is a powerful tool. Tinting contact lenses and/or glasses for therapeutic reasons can be time consuming, but it can be a rewarding experience for both the clinician and patient. The use of therapeutic tinting has existed for many years within the field of optometry, and many optometrists I’ve spoken with are evolving their own methodologies.
Many people struggle with visual disturbances on a daily basis. Whether it is light sensitivity, reading problems, or even visual sequelae related to vestibular issues, color helps many of these patients live a normal life. The use of color through filters and/or lenses should be considered for those who are struggling from visual disabilities. A single color can be the difference in changing someone’s life for the better.
1. Cardona G, Borras R, Peris E, et al. A placebo-controlled trial of tinted lenses in adolescents with good and poor academic performance: reading accuracy and speed. J Optom. Apr-Jun 2010;3(2):DOI: 10.1016/S1888-4296(10)70013-3.
2. Chronicle EP, Wilkins AJ. Colour and visual discomfort in migraineurs. Lancet. 1991 Oct 5;338(8771):890
3. Patel RE, Evans B, Wilkins AJ. Precision tinted lenses in migraine. Optometry Today. May 2003;39-43.
4. Ray NJ, Fowler S, Stein JF. Yellow filters can improve magnocellular function: Motion sensitivity, convergence, accommodation and reading. Ann N Y Acad Sci. 2005 Apr;1039:283-93.
5. Simmers AJ, Gray LS, Wilkins AJ. The influence of tinted lenses upon ocular accomodation. Vision Res. 2001 Apr;41(9)1229-38.