Cosmetic contact lenses

Under UK legislation that took effect in 2005, zero-powered or 'plano cosmetic' contact lenses (non-corrective contact lenses designed to change the colour or appearance of the eye) are regulated in a different way from powered lenses.

Zero-powered lenses can only be supplied by or under the supervision of a registered optometrist, suitably qualified dispensing optician or medical practitioner. Supervision requires the registered person to be present on the premises, aware of the procedure and in a position to intervene if necessary. The seller/supplier must also make arrangements for the wearer to receive aftercare.

There is no legal requirement to give a patient a written specification after fitting with zero-powered lenses but the College of Optometrists and Association of British Dispensing Opticians have advised their members that it is in the patient's best interest to do so.

Cosmetic contact lenses are effective for changing eye colour and appearance, and are also used in various therapeutic applications such as masking disfigured eyes. They are often used for special effects in the film industry. With plano cosmetic lenses, biocompatibility with the eye is at least as important as it is with conventional prescription lenses, if not more important, since they may allow less oxygen to reach the surface of the eye than clear lenses, in addition to disrupting the tear film.

Appropriate handling, cleaning and disinfection techniques are essential and it is important to comply with the recommended wearing times and frequency of lens replacement.

Risk of infection

There have been reported cases of serious corneal ulcers and infections associated with wear of plano cosmetic contact lenses. Corneal ulcers can progress rapidly, leading to internal ocular infection if left untreated. Uncontrolled infection can lead to corneal scarring and vision impairment.

In extreme cases, this condition can result in blindness and eye loss. Other risks associated with the use of these lenses include conjunctivitis (an infection of the eye), corneal swelling, allergic reactions, corneal abrasion from poor lens fit and a reduction in vision, resulting in interference with activities such as driving.

There is evidence that contact lens users who buy their lenses through alternative supply routes may be more susceptible to poor hygiene procedures and to an increased risk of infection¹. A US study published found that consumers who bought contact lenses from sources other than their eyecare practitioner were less likely to comply with good eyecare health practices². Another more recent study found that those who purchase contact lenses via the internet or store do not follow a number of US Food and Drug Administration contact lens recommendations³.

Research from Australia shows a higher risk of developing microbial keratitis (a rare, but serious infection normally affecting only four in 10,000 contact lens wearers per year) when lenses are bought online. The risk associated with internet/mail order purchase of lenses was 4.76 times higher than when lenses were bought from an optometrist.

However, it should be stressed that problems with plano cosmetic lenses are generally associated with poor compliance and hygiene, and with unregulated lens sales. As with all contact lenses, provided they are handled and cared for properly and only used according to the prescribing practitioner's recommendations, the risk of eye infection is very low.

Consumers should understand that plano cosmetic contact lenses, like contact lenses intended for correction of vision, present serious risks to eye health if they are distributed without proper fitting by a qualified eye care professional, careful instruction and ongoing clinical care.

The legal requirements for sales of contact lenses are set out in the Opticians Act 1989, Section 27. The Opticians Act and the General Optical Council's statement on sale and supply of optical appliances are available from the GOC website.

References

1. Steinman, T.L., Fletcher, M., Bonny, A.E. et al (2005) Over-the-counter decorative contact lenses: cosmetic or medical devices? A case series. Eye & Contact Lens 31; 5: 194-200. 

2. Snyder, R.W., Brenner, M.B., Wiley, L. et al (1991) Microbial keratitis associated with plano tinted contact lenses. CLAO J. 17; 4: 252-5. 

3. Fogel, J. and Zidile, C. (2008) Contact lenses purchased over the internet place individuals potentially at risk for harmful eye care practices. Optometry 79 (1): 23-35. 

4. Stapleton, F., Keay, L., Edwards, K. et al (2008) The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology 115: 1655–1662.