COLORED LENSES
Color Your Contact Lens Practice
Increased cosmetic contact lens color and prescription options offer practitioners the possibility to expand their contact lens wearer base.
By Joseph T. Barr, OD, MS, FAAO, and Lisa Starcher

Efforts of nearly every major soft contact lens manufacturer have provided practitioners with a burst of colorful contact lens prescribing options. Internet-based contact lens providers also offer colored lens alternatives. Some colored contact lenses contain glitter, others claim to add radiance and still others feature major football team logos. Add the more natural-looking, internalized dye colors, which range from aqua and amethyst to turquoise, and Venus lenses and you can see that the options have never been greater.

Vistakon recently added Chestnut Brown, Hazel Green and Sapphire Blue (from top to bottom) opaque lenses to its line of Acuvue 2 Colours.

The lens technology is also better than ever. I never thought I would say this, but the nice waitress who served me at a recent meeting had the most natural-looking blue eyes. I could see that her natural eye color was brown only when I looked at her eyes from the side. Blended layers of colors, sophisticated computer graphics, improved comfort, numerous options and consumer advertising make these lenses a practice growth option for eyecare practitioners.

That is the good news. But television tabloid shows have exposed teenagers' cavalier attitudes about trading lenses and infections, which resulted from lenses purchased at nearly every type of retail store from beach shops to flea markets. The FDA's recent activities concerning cosmetic plano lenses as well as legislation introduced to make sure plano cosmetic lenses remain a prescription device and not a cosmetic have given some practitioners pause about their use.

The important issues are:

• These lenses can be wonderful, fun, cosmetic and vision devices when used properly
• Professional prescribing and ongoing care is required
• Distribution without a prescription whether by sale or by teenagers trading lenses must stop. If young people think these lenses are harmless it could result in an expanded public health threat

But let's not dwell on the concerns. Public awareness of these lenses, good news or not, increases interest. This article will offer you tips for improving your colored contact lens practice.

Opportunities

Most manufacturers of soft contact lenses have dramatically increased manufacturing and promoting cosmetic lenses in the last two years. That's a good indicator that these lenses present an opportunity for patient satisfaction and practice growth. A few examples of this trend include Vistakon's Acuvue 2 Colours (Figure 1), Ocular Sciences, Inc. and consumer giant Proctor and Gamble teaming to market Cover Girl Colors contact lenses, CIBA Vision's Glitter Eyes (which were later recalled) and Radiance lenses (which reportedly "shine and shimmer") (Figure 2) and CooperVision's Expressions (Figure 3), Crazy Lenses and NFL Crazy lenses. Table 1 lists most major providers of colored contact lenses.

It is likely that the retail market for colored lenses is nearly $250 million per year. That translates to roughly $1,000 per practitioner. Nearly 10 percent of contact lens patients wear cosmetic lenses. Ophthalmology Management's recent Health Products Research survey indicates that 14 percent of these wearers did not previously wear lenses, and 22 percent were switching brands. Only about 3 percent were toric lens wearers. Private optometry and ophthalmology practices average about 65 cosmetic patients per practice location, while chains average twice as many. These numbers may change with expanded consumer interest, advertising and availability of specialty (toric and multifocal) lenses. The survey also determined the percentage of contact lens patients who wear cosmetic lenses, based on age (Table 2).

Strategies for Success

New wearers are good cosmetic lens candidates, especially emmetropes who want to change their eye color whether for fun or more routinely. But current contact lens wearers are better candidates. A recent survey indicates that 88 percent of women are interested in tinted contact lenses. Some 50 percent of women who purchase colored lenses decide to do so impulsively at the location because of point of purchase material (posters, brochures, placemats), and 75 percent who try them buy them. Practices that succeed with colored contact lenses maintain an inventory to satisfy impulse shoppers. Stocking the lenses also lowers their per unit cost, so if practitioners use rebates they can offer colored contact lenses at a cost that is comparable to clear contact lenses, according to Jennifer Smythe, OD, FAAO.

Many practitioners recommend that you find an easy way to present the option, provide patient brochures, posters and office desk notices, encourage staff to wear the lenses, hold colored lens trial open houses and ask all patients directly or by questionnaire if they are interested in colored lenses. In the end, staff efforts are extremely valuable.

Although cosmetic lens comfort is now better than ever, keep in mind that lens fit and comfort vary. Trying a number of lens types, though time consuming, may prove worthwhile.

CIBA Vision's new FreshLook Radiance lenses in Autumn (top left), Eden (top right), Moonlight (bottom left) and Sunrise (bottom right).

To encourage patients to try colored contact lenses, Rick Silver, OD, in Santa Monica, CA, has staff members who wear them, and he keeps manufacturers' marketing materials in the contact lens training room. He also sometimes provides a free trial set of colored lenses in plano so patients can see what they look like with a different eye color. He says that among the 18- to 36-year-old population in his practice, a much higher percentage of females want to try colored lenses. In this group, patients usually choose one color or two at most that they consistently wear.

"Manufacturers have expanded many of their lens families to include colored lens options. We no longer have to use other lens brands that may not fit the same way or be as comfortable," Dr. Silver says. "Now I can say to many patients, 'If you want, I can order the same exact lens that you are currently wearing with color.'"

Practitioners should keep in mind that in most cases, patients are the ones who bring up the subject of colored lenses. If practitioners do not proactively suggest colored lenses to patients, then patients will go elsewhere to get them. This could compromise their eye health. Being proactive about recommending colored lenses and fitting them yourself will keep your patients' eyes healthy and will work as a patient-retention tool, according to Dr. Silver. He presents the option of colored lenses to patients during their contact lens fitting.

To make the best use of time in fitting colored lens patients, Dr. Silver recommends that practitioners empower a contact lens technician who can then take the patient through the colored lens decisions. His staff presents patients with a choice of two or three colored lenses to try on. "If patients don't know what color they want, my staff will choose lenses that go well with their coloring," says Dr. Silver. "My staff members have fit many of these lenses and they have experience with what color lenses will complement a patient's natural coloring, and what colors will clash."

Practitioners should consider setting a fitting fee that they are comfortable with for colored lenses. Dr. Silver adds a nominal fee to the patient's lens exam fee to compensate for the chair time spent in trying on colored lenses. "We call it a contact lens management fee," he says. "Patients find this fair, and it compensates us for the extra time we spend fitting these patients."

The Latest Colored Lens Addition

Ocular Sciences, Inc. (OSI), under a trademark licensing agreement with Proctor & Gamble, launched Cover Girl Colors brand soft contact lenses (Table 3) earlier this year.

OSI chose its Biomedics 55 spherical lenses as the base for Cover Girl Colors. The lens retains its shape well and is easy to handle, which benefits first-time wearers.

OSI used proprietary iris replication graphics technology in which designers and graphic artists studied photographs of actual eyes to identify distinctive fibrous elements within human irides. They created four design maps from combinations of these fibrous elements and etched the maps into steel plates called clichés. These plates were used to print replications of irides onto contact lenses. A clear hydrophilic coating applied to the anterior surface of the lens creates a barrier between the ink and the eyelid to ensure a smooth overall surface.

Lenses of Choice

Nearly all of the practitioners we communicated with use all colored lens types and brands, but some practitioners mentioned specific lenses.

Brian Chou, OD, FAAO, of San Diego, CA uses artificial pupil contact lenses to help re-establish a functional pupil when the normal pupil is irregular because of, for example, iris atrophy, aniridia or coloboma. These contact lenses may also benefit post-LASIK patients who experience night vision problems when the pupil enlarges beyond the treated cornea. The same companies that offer prosthetic contact lenses can provide artificial pupil lenses.

For patients who have defective color vision, a red (or other) contact lens worn on one eye may improve color discrimination, according to Dr. Chou. When patients view objects alternately between the eyes, the asymmetry in spectral sensitivity provides additional clues to color discrimination. Unfortunately, this technique fails in patients who have suppression. Dosco Medical (formerly World Optics) manufactures its ChromaGen soft contact lenses specifically for color deficiency.

Dr. Chou believes tinted lenses may improve contrast detection for certain sports. Blue-colored soft lenses marketed toward tennis players reportedly increase the contrast of the yellow tennis ball, but some have questioned the validity of this concept. Tinted sport lenses are available for golfers, trap shooters and skiers. In some cases, however, especially in the dark, the lenses may compromise vision.

For patients who currently wear contact lenses, Dr. Chou usually chooses a colored lens that is from the same family of lenses or the same manufacturer as the patients' current lenses. "If the patient currently wears CooperVision Frequency 55 lenses, for example, I would choose CooperVision Expressions lenses," he says. "Expressions are based on the Frequency 55 lens design, so I already know that the lenses will fit and perform well for that patient," he says.

If the patient is not a current contact lens wearer, Dr. Chou and his staff usually start with CIBA Vision ColorBlends lenses or with OSI's Biomedics Colors because they prefer the cosmetic appearance of these lenses for changing eye color.

CooperVision's Expressions lenses in Hazel, Topaz, Gray and Jade (from top to bottom).

When patients ask Dr. Chou about colored lenses, he usually asks if they want the colored contact lenses as their primary contact lenses or just for special occasions. "This information is important to me because if patients want to primarily wear the colored lenses, then I would try to correct even low astigmatism with a toric lens design such as the FreshLook ColorBlends Toric or with a design that features aspheric optics like Expressions lenses," he says. "If patients want to wear the colored lenses once a month or so for social occasions, then I am content with prescribing spherical colored lenses even if there is a moderate amount of leftover residual astigmatism."

Marty Carroll, OD, in Cheyenne, WY, prefers Vistakon's Acuvue 2 Colours lenses because the color is enclosed within the lens. He says that the lens wets well, which is necessary in his dry climate at an altitude of 6,200 feet. "We have had problems when switching a patient from a clear lens to a colored lens of the same brand, because of discomfort issues," he says. "We do not see that with Acuvue 2 Colours." He has also noticed much less GPC with this lens than with other colored brands.

Obviously for Hispanics and Blacks who want to enhance or change eye color, Dr. Carroll uses opaque lenses. He feels that enhancers work well on light irides, and patients really like the "brightness" of their new color. He has experienced some problems with large pupils and opaque lenses because of the clear pupil, especially in low light.

Ann Hoscheit, OD, in Gatonia, NC, uses Acuvue 2 Colours contact lenses primarily because of good comfort and selection tools (POP, computer software, color paddles, Web site) that minimize patient time spent trying on different colors. She tends to use the Acuvue 2 opaque lenses in Black and Hispanic patients because of the larger pupil aperature and increased comfort. "The 8.3mm base curve lens moves less, though adequately, on the eye compared to some other colored lenses," she says. "Neither patients nor practitioners like to see the colored lens move from the iris." Dr. Hoscheit also says that Acuvue 2 Colours lenses are less likely to be available at flea markets or tatoo parlours.

Dr. Silver tends to lean toward the CooperVision Expressions lenses and Cooper Prosthetic contact lenses. Many of his patients who request novelty lenses are teenage males. His practice prefers CooperVision's Crazy Lenses for these patients.

Conclusion

Many colorful contact lens options are available to your patients. You can expand your contact lens patient base if you are proactive in prescribing colored contact lenses, and you can help ensure the safety of your colored lens patients by providing these devices so they don't obtain them illegally.

Dr. Barr is editor of Contact Lens Spectrum and assistant dean of Clinical Affairs at The Ohio State University College of Optometry.

Ms. Starcher is managing editor of Contact Lens Spectrum.