Srilata S. Naidu, MD, and Kenneth Scherick, OD New York City

Edited by James E. Key, MD

Plastic contact lenses have come a long way from their development in 1947 by Kevin M. Tuohy. Today lenses are used not only to correct refractive errors but also to treat or compensate for ocular anterior segment pathology; relieve complaints of glare and halos; as well as to change eye color. To meet these needs industry has developed contact lenses in a variety of colors.

The 1980s witnessed the emergence of the first tinted soft lenses which were used to facilitate insertion and removal. This “visibility” tint was a pale blue. Wesley-Jessen produced the first “cosmetic” contact lens in opaque colors and enhancer tints.

Enhancer tint lenses, introduced in 1991, were a single-colored dot matrix pattern that was imprinted onto the front surface of the lens using photographic technology. Enhancer tints were most effective in individuals with light irides. Available colors were blue, green, amber, brown and aqua. The effect produced depended on the lens enhancer tint’s interaction with the patient’s own iris color.

The production of opaque colors in 1988 made it possible for individuals with dark irides to benefit also. Wesley Jessen’s FreshLook Colors come in hazel,

Today’s cosmetic lenses can serve a host of functions beyond the aesthetic.

All images: CIBA Vision

green, violet and blue. FreshLook ColorBlends blends three colors into one lens to provide a more natural look. The outer rim of color is a black limbal band; the inner rim surrounding the papillary aperture is brown and the central portion may be blue, honey, green, gray, brown, turquoise or amethyst. Vistakon has produced Acuvue 2 Colours and Acuvue 2 Colour Enhancers, which incorporate color into the substance of the lens.

Treating Pathology
A variety of ocular pathology can be treated with colored contact lenses. Astigmatism can be corrected with toric colored lenses (DuraSoft 2 Optifit for Torics and DuraSoft 3 Optifit for Torics). Patients with corneal arcus may be pleased with the black limbal band (polar) contact lens of CIBA Vision Natural Touch. Individuals with photophobia, glare, polyplopia, polycoria, iritis and aniridia obtain much relief from opaque lenses.

Patients with leukocoria or completely opacified corneas may want to simulate a natural look to match the contralateral normal eye. The Narcissus Foundation, Specialized Foundation of Wesley Jessen, and Adventures in Color will manufacture customized lenses if provided with a photograph of the normal eye and corneal measurements.
The ability of these customized lenses to improve an individual’s self-esteem can be dramatic and quite gratifying.

Entertainment
The entertainment industry has long benefited from the ability to change an actor’s appearance using theatrical lenses. Wesley-Jessen’s WildEyes, Cooper Vision’s Crazy Lens and Adventures in Color provide fun designer lenses in styles such as “Red Hot,” “Cat Eye,” “Alien,” “White Out” and “Smile Face.” These designer lenses have also found a market amongst teenagers.

Enhanced Performance
Some lenses are tinted to improve performance in certain activities. The Prosoft lens features a teal tint that masks all background colors except optic yellow. This blue-blocking lens is marketed to improve the ability to locate fast-moving tennis balls and improve tennis performance.

Cosmetic lenses are attracting increasing interest among male lens wearers.

At the beginning of 2000, there were 2.2 million consumers of opaque contact lenses, and the segment of this population with plano prescription who are requesting colored lenses is increasing.

The age range of the typical colored lens consumer is 16 to 36. Sixty percent of the colored contact lens market is female. However the interest among men has been increasing as techniques for them to improve their appearance (cosmetic surgery, skin- and hair-care products) have become more acceptable in mainstream society.

Fitting Challenges
With the increased use of contact lenses for cosmetic purposes comes the potential for fitting problems and complications. One of the most common problems is proper lens centration. It is critical that the contact lens fitter ensure that there is good centration so that the patient’s pupil coincides with the fixed papillary aperture of the color contact lens.

Under normal circumstances, a pupil will become miotic in bright illumination and dilated in dim light. Individuals who wear colored contact lenses have a fixed 5 mm papillary aperture surrounded by opacified lens. In bright light, a normal patient’s own pupil may constrict to 2 mm, therefore making it visible behind the colored lens. However, during the night, a patient may find that his ability to maximally utilize available lighting is limited by his fixed contact lens pupil aperture.

Sudden eye movements may also move the patient’s pupil over the opaque region of the lens. On the other hand, individuals who may benefit from a fixed 5 mm pupil are those with aniridia, traumatic iritis and polycoria who may be suffering from photophobia, glare, polyplopia and other symptoms of anterior segment disease.

Cost Complications
Colored contact lenses generally cost more than clear lenses. They are available as 14-day disposable and annual replacement lenses. A newly recognized phenomenon is that patients who find the cost prohibitive may use lenses for longer than recommended and increase their risk of contact lens-related complications, including keratitis. Interestingly, some may even opt to wear a ripped colored contact lens rather than go without matching colored lenses in their two eyes.

Consumers with a plano prescription, in particular, may not understand the need for a proper initial fitting examination, regular follow-up eye examinations or proper lens care and handling. There have also been increasing reports of individuals, especially teens, sharing colored and designer lenses with their friends for the purposes of fun without realizing the danger of infections and other complications.

Colored contact lenses have found a niche in the consumer marketplace. The last 20 years have shown a remarkable expansion in colors and designs that appeal to individuals from all walks of life. They provide patients a fun and fashionable optical alternative. They can also be beneficial in masking disfigured eyes and in alleviating symptoms of anterior segment disease. As with any other contact lens, patients should be educated regarding proper handling and disinfection care. 

Dr. Naidu is an associate professor of ophthalmology at New York University School of Medicine. Dr. Scherick is a clinical instructor in contact lenses at NYU and practices in Manhattan.