Coloured contact lenses provide an exciting opportunity for many consumers to experiment with changing or enhancing their natural eye colour. Whether desired for once-off use for a party or special occasion, or for more regular every-day wear, these cosmetic lenses are increasing in popularity.
However, unlike regular prescription contact lenses, coloured contact lenses have a novelty appeal that exposes them to the pitfalls of unregulated sale.
Optometrists that stock and promote coloured contact lenses with Therapeutic Goods Administration (TGA) approval, have a valuable opportunity to educate patients about their safe wear while expanding their business into a new market.
If a proportion of your patient demographic consists of young females, chances are you’ve been asked about prescribing coloured contact lenses. A recent article, Cosmetic Contact Lens- Related Corneal Infections in Asia, published in the American Journal of Ophthalmology, states “cosmetic, coloured, limbal circle or decorative contact lenses, often worn by young emmetropic females to modify or enhance the appearance of the eye, are becoming more prevalent, particularly in South East Asia”.
one third of all infections in contact lens wearers in Asia… were in users of coloured lenses, which predominantly came through non-practitioner supply routes
The study revealed some interesting findings. Firstly, cosmetic contact lens wearers who presented with corneal infections were generally young, female, and wearing lenses made from hydrogel materials, as opposed to silicone hydrogel, and manufactured with the pigment located on the back (cornea facing) surface of the lens.
These likely poorer quality lenses are easily manufactured and involve a “process of tamping pigment on finished lenses”. This is in contrast with high quality coloured contact lenses with laminate designs “where the pigment or coloured mask is incorporated between layers of polymer during manufacture and consequently the pigment layer is more stable and is not in contact with the ocular surface”.
Professor Fiona Stapleton from the University of New South Wales School of Optometry and Vision Science (UNSW SOVS), and lead author of the study, points out that while infections from contact lens wear are rare, occurring in around four per 10,000 wearers each year, “It’s fairly well accepted that coloured or decorative lens wearers are at a higher risk than wearers of lenses to correct refractive errors.
“This is partly due to lens quality and partly the lack of education of wearers, about hygiene and wear practice.”
The problem lies with how wearers source their coloured contact lenses.
“In terms of practitioners and lens supply, the finding in Asia that raised a flag was that one third of all infections in contact lens wearers in Asia (and up to 50% in some countries) were in users of coloured lenses, which predominantly came through non-practitioner supply routes,” said Prof Stapleton.
The study found that 11% of cosmetic wearers had purchased their lenses via the internet, compared with only 1% of refractive wearers. This reduces their access to compliance and wear information, increasing the risk of improper use and therefore, the likelihood of infection.
This lack of education accounts for why wearers of cosmetic contact lenses are slightly more likely to share their lenses with others and expose their lenses to water, by for instance, not removing them while showering, and not air-drying their cases.
While this data is specific to an Asian population, it raises important concerns for our own circumstances in Australia. The increased popularity of coloured contact lenses overseas is mirrored, with consumers of a similar demographic here desiring decorative contact lenses for cosmetic purposes.
THE CASE FOR COLOURED CONTACT LENSES IN AUSTRALIA
Sydney-based optometrist Suhyun Kweon, study co-author, says more than half of her patients come in for a contact lens consultation, of which two thirds are first time contact lens wearers. Approximately a quarter of these patients request coloured contact lenses.
Ms Kweon says it is common for her patients to request coloured contact lenses to change the natural appearance of their eye.
“One of my patients requested daily contact lenses because she does not feel confident when she doesn’t wear coloured contacts,” said Ms Kweon, adding that, “she thought that there was no difference between clear and coloured CLs”.
Providing information about coloured contact lenses on your website is one way to reach people you don’t already have contact with
Christina, a regular contact lens wearer, told mivision that she made the transition to incorporating coloured contacts into her daily routine, just as she would any other accessory. Opting for her preference of blue or hazel coloured lenses, Christina’s desire was to change the colour of her eyes to suit different occasions.
“I use them like how I wear different kinds of makeup or clothes. I just like different looks,” she said.
While demand for bold coloured lenses is particularly high among international markets, and often associated with fancy dress, Australian consumers, in general, prefer lenses with a ‘natural’ aesthetic that enhance the wearer’s natural eye colour or offer a subtle alteration.
THE PROBLEM WITH REGULATION
Many reputable prescription contact lens manufacturers have seized the opportunity to expand their lens offerings in order to supply optometrists with quality cosmetic contact lenses they can offer their patients. Like their prescription contact lenses, these coloured lenses are certified through comprehensive accreditation processes, which are undertaken by third party governing bodies and involve audits of the entire manufacturing process. Certifications include TGA approval in Australia and, internationally, CE Marking in Europe, and Food and Drug Administration approval in the US.
Alcon, for example, offers a range of coloured contact lens options to suit patients looking for a natural-looking coloured eye change. The company’s Air Optix Colours range includes 12 different coloured contact lens that blend naturally with light and dark eyes, and can be used with or without vision correction. As well as this, the Dailies Colors range offers four colours in daily disposable contact lenses, which are designed to enhance eye definition and make eyes appear bigger and brighter.
The problem is that no such quality guarantee exists for coloured contact lenses sold through non-practitioner supply routes.
Indeed, the sale of cosmetic lenses is unregulated across all states and territories of Australia, except New South Wales (NSW) and South Australia (SA), as Andrew McKinnon, Chief Executive Officer of Optometry NSW/ACT explained.
their ability to obtain coloured contact lenses through unregulated vendors undermines optometry’s role in educating patients about the importance of lens hygiene…
“In both SA and NSW the regulation is that lenses can only be supplied on prescription by an optometrist. “In SA there is an enforcement regime for that regulation, but in NSW no such enforcement regime exists. So, there is a regulation saying that lenses can only be supplied under certain conditions, but no regulatory framework exists to enable that regulation to be enforced. In effect, there is no regulatory impediment in NSW.”
This means that even if Optometry NSW/ ACT becomes aware of the unlicensed sale of cosmetic lenses and writes to the outlet, nothing can be done should they ignore the legislation.
The problem is compounded further by internet sales of coloured contact lenses, for which there is no regulation across Australia. As a result, it is easy to purchase coloured contact lenses from online outlets such as party shops.
CONSUMERS DON‘T UNDERSTAND
With a focus on aesthetics over refractive correction, for many consumers, coloured contact lenses fall into a novelty category alongside other accessories associated with costume and party-related paraphernalia. People seeking coloured contact lenses for once-off use, for a Halloween party for example, will often regard them as an accessory that can be used as casually as any other, instead of treating them like the medical device they are.
Furthermore, their ability to obtain coloured contact lenses through unregulated vendors undermines optometry’s role in educating patients about the importance of lens hygiene in order to reduce the risk of infection.
This makes first-timers, with no existing relationship with a practitioner and likely no knowledge of contact lens hygiene, a major concern.
SENDING THE RIGHT MESSAGE
While the lack of education provided through the unregulated sale of coloured contact lenses remains frustratingly out of practitioner control, it is important to use the opportunities you do have to increase awareness. Providing information about coloured contact lenses on your website is one way to reach people you don’t already have contact with. Letting people know you supply coloured contact lenses can deter them from looking elsewhere and help them to initiate a conversation with you, a trusted practitioner.
Once you have made this connection, education about proper contact lens hygiene will naturally follow.
Ms Kweon says her process for prescribing coloured contact lenses is similar to any other contact lens consultation, however she also makes sure to ask her patients why they want coloured contact lenses in the first place. Ascertaining her patients’ intentions for coloured contact lens wear helps her understand the type of use they’re after and then educate them accordingly.
She reminds her patients that, “Irrespective of contact lens type, poor lens handling and hygiene ultimately cause ocular infections and/or inflammations.
“Education is key. I talk about things to avoid, such as to never sleep or shower with contact lenses on. I always recommend daily contact lenses, but if the patient seems to be committed and diligent, then I am happy to prescribe two-weekly or monthly contact lenses. This is just my personal preference, but I do not really recommend coloured contact lenses unless patients really want them.”
Professor Stapleton says getting the right messaging across is important.
“The messaging is that contact lenses are generally a very safe option but all lenses are associated with some risk and certain hygiene and compliance factors remain important,” she said.
“With cosmetic lenses specifically, we need to remind patients to avoid sharing lenses, don’t shower in lenses or let them come in contact with water, wash and dry hands before handling lenses, avoid sleeping in lenses, clean your storage case (if you use one) every day and dry it, and if you have a problem, see your practitioner as soon as you can. Even with daily disposable lenses, the message around no water, which cosmetic wearers may not otherwise get, is important.”
REDUCING THE RISK
While only comprising a small component of the contact lens market in Australia, as an optometrist, it is important to be aware of the increasing interest in coloured contact lenses and understand why patients may request them. When up against a plethora of online and unregulated competition, ensuring that new and existing patients are aware of the risks associated with misuse, and know to source their coloured lenses through their practitioner, is vital to keeping infection rates low.
As is the case in South East Asia, protecting uneducated wearers from poor-quality lenses obtained through unregulated vendors remains the greatest challenge to minimising the risks of avoidable contact lens-related infections.
The Extremes of Eye Customisation
Eyeball tattooing involves the permanent and non-reversible colouring of the sclera by injecting ink with a needle underneath the top layer of the eye, in several locations, so that the ink slowly spreads to cover the entire sclera. This rare practice is one strongly discouraged by The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) which views it as an extremely dangerous and unnecessary procedure.
In 2016, controversy arose after the NSW Government sought to regulate the practice of eyeball tattooing as opposed to banning the procedure entirely. The Public Health Act was amended to restrict eyeball tattooing to be carried out by a medical practitioner or other qualified person.
Melbourne-based body-modification expert Luna Cobra, responsible for pioneering eyeball tattooing, has spoken out about the seriousness of the procedure. He frequently tells his customers requesting eyeball tattooing to instead opt for quality contact lenses to achieve their desired eye appearance.
In the early 2000s the Netherlands Institute for Innovative Ocular Surgery invented extraocular implants, otherwise known as eyeball piercings, which involves surgically implanting jewellery between the sclera and the conjunctiva. The American Academy of Ophthalmology (AAO) says people should avoid eyeball piercings as there is not enough evidence to suggest they are safe, and can lead to complications.
Horror stories of both procedures causing blindness, serious infection, bleeding, and light sensitivity, and the fact that the long-term risks are not yet known, seem enough to deter most, though the interest still remains.