Dr. Chad Rosen is assistant professor at Michigan College of Optometry. He spends time fitting specialty contact lens patients in clinic and enjoys lecturing on contact lens topics.
Dr. Stephanie Ramdass is the clinical research fellow at Michigan College of Optometry, Ferris State University, Vision Research Institute in Big Rapids, MI. Her research interests include the application of scleral lenses on normal eyes and in tinted for
From the first introduction on the cinematic screens for visual effects in 1950 to its mainstream use today for masking both natural iris pigment and ocular disfigurement, colored contact lenses are an important addition to your contact lens toolbox. Industry has made fitting this type of lens more appealing by offering improvements in color matching techniques and healthier materials compatible with commercially available inks and dyes.
From the first introduction on the cinematic screens for visual effects in 1950 to its mainstream use today for masking both natural iris pigment and ocular disfigurement, colored contact lenses are an important addition to your contact lens toolbox. Industry has made fitting this type of lens more appealing by offering improvements in color matching techniques and healthier materials compatible with commercially available inks and dyes. However, trend analysis reveals that as a category, colored or tinted contact lenses remain the least fitted type of soft contact lenses among eyecare providers over the last decade.1
While economic principles of supply and demand may lead us to believe that lack of consumer interest is the sole cause for low number of tinted lens fits in clinical practice, modern medicine suggests otherwise. Numerous techniques exist for patients who are interested in modifying their eye color. These patients will seek out alternative methods to accomplish this, often outside of their eye doctorÃ¢€™s offices.
Silicone iris implants, laser ablation of iris melanocytes, and even corneal tattooing have been introduced in different parts of the world to offer patients alternatives to change their eye color or improve cosmesis. Although there are many patients who would greatly benefit from safe and effective surgical options, there are others who get drawn in by the awe of what end up being sight-threatening procedures. Complications may include elevated eye pressure, intraocular inflammation, and corneal edema that often result in additional surgery to salvage ocular health of affected patients.
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As eyecare providers, it is our duty to have a working knowledge of products available that can improve a patientÃ¢€™s quality of life by altering his natural eye color or providing functional vision improvement. For those looking to simply alter the color of their eyes, cosmetic products are available. Alcon Air Optix Colors are monthly replacement silicone hydrogel lenses that can alter the color of a patientÃ¢€™s iris color. Johnson & Johnson Vision Care 1-Day Acuvue Define are a daily disposable lens that can enhance the natural eye color of a patient. These are two examples of soft contact lenses used primarily for cosmetic purposes.
Patients may present to your office with visual symptoms that impact their daily function. Photophobia is a common functional symptom due to systemic conditions such as oculocutaneous albinism (OCA), achromatopsia, or trauma. In these cases, patients may need a contact lens that blocks or filters light so they arenÃ¢€™t as sensitive to it. The contact lens serves as a prosthetic device to help the patient achieve her best functional ability.
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While Ã¢€Åprosthetic contact lensÃ¢€Â may seem difficult or daunting to eyecare practitioners, it simply requires attention to detail to troubleshoot your patientsÃ¢€™ challenges. For example, when a 48-year-old patient comes into your office and explains that he is having trouble reading up close, you may ask questions about lifestyle and daily activities to provide him with the best recommendation. The same holds true for patients who present with an iris abnormality that has decreased their ability to perform certain tasks; we ask them questions about their struggles and visual capability to provide a proper recommendation that may benefit them. We also consider the patientÃ¢€™s age and lifestyle factors such as occupation, hobbies, and typical daily routines.
Figure 1A 4-year-old girl with OCA presented to the clinic with her mother. The mother asked, Ã¢€ÅMy daughter wears her sunglasses all the time, even indoors. Is there anything that you can do for her light sensitivity?Ã¢€Â The first question that needed to be answered was whether or not this young girl was mature enough for contact lenses. After assessing her, it was clear that she had transillumination defects (TIDs) in both eyes, causing light to scatter inside the eye and not focus solely on the macula.
The solution was to create an annular tint that was dark black and had a clear 4.0 mm pupil (see Figure 1). After fitting her with the lenses and allowing her to wear them, her mother and father noted how much of an improvement they saw. Their little girl no longer needed to wear sunglasses all the time, and she made eye contact with them for the first time.
There are many patients who experience insecurities about their physical appearance where there is evident facial asymmetry. An 18-year-old with a history of monocular vision loss secondary to a Toxocara parasitic infection early in life entered the exam room with a shy demeanor and her head down. She presented with iris heterochromia, a whitened right pupil and anisocoria. When the visual acuity of an affected eye is no light perception, the clinical considerations are more for improving social functionality of the patient rather that improving visual function.
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Using the Biocolors contact lens diagnostic set, a custom colored contact lens was designed in a piggyback fashion to match this patientÃ¢€™s unaffected left eye (see Figures 2A-C). Important considerations when designing the final lens included pupil size under normal room illumination, appropriate horizontal visible iris diameter measurements, and the specific layering sequence of the individually tinted diagnostic lenses. The smile on this teenagerÃ¢€™s face knowing that she could now be confident in making eye contact in social environments was a rewarding experience for all parties involved.
Tinted contact lenses can be used for purposes other than cosmetic enhancement or significantly impaired eyes. They can be used with athletes for various sports or activities (see Figure 3). As we know, athletes are looking for any edge they can get over their competition. While no specific tint has been proven to work better than another, many athletes will have a preference for what works best for them.
When fitting these patients with tinted lenses, you can use an in-office tinting system to create tint options, or you can custom order a lens for the athlete and ask to have it tinted a specific color and density. There are a number of labs that have tinting capabilities, so just ask your manufacturer.
Any time you are considering prescribing a tinted contact lens, remember a few additional details. Whether the lens is to be used for cosmetic purposes or for visual function, you must consider the material that is being used and the prescription in the lens. Tints and high prescriptions decrease the amount of oxygen to the cornea, so you must monitor your patients to ensure their eyes are healthy enough for a tinted contact lens. Close evaluation during your exam to ensure there is no corneal edema or neovascularization is essential for using this modality.
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Table 1There are many types of patients who may benefit from tinted lenses, either cosmetically or functionally. As a practitioner, finding ways to set you apart from the doctor down the street is crucial. Using tinted contact lenses for those who might benefit from them is one way to carve a niche in your area. Not only can you receive financial benefits from specialty contact lens prescribing, but you can also help patients improve their daily function. All too often we see patients in our clinic who say, Ã¢€ÅI was never aware this was even a thing.Ã¢€Â
Familiarize yourself with the labs listed in Table 1 and contact any of them to find out how you can enhance your clinical practice through the incorporation of tinted contact lenses.
1. Efron N, Nichols JJ, Woods CA, Morgan PB. Trends in US Contact Lens Prescribing 2002 to 2014. Optom Vis Sci. 2015 Jul;92(7):758-67.