Question of the Week
Febrary 28, 2005

Whether you wear contacts to help you see (corrective contact lenses), or to help you get the look you want (cosmetic contact lenses), it is important to note:

"Having contacts fitted by an eye care professional is very important because the cornea (clear outer layer of eye) can vary in shape, and eyelids interact with contact lenses in different ways, she explains. ... Examination by slit-lamp microscope is particularly important, because even if lenses feel fine to a patient, fit may be improper and even potentially dangerous. ... Although there are plenty of reputable sites that offer quality lenses, removing the eye doctor from the process is risky because contact lens wearers should undergo yearly eye exams to look for changes in eye health, explains Dr. Thakrar. ... Also, buying online doesn't provide a way for the patient to be checked after a few weeks to be sure the new lenses fit without irritation or infection."

Even if you get the lenses from a doctor -- and the doctor helps you fit them -- "[d]aily-wear lenses should never be worn as extended-wear lenses. Misuse can lead to temporary and even permanent damage to the cornea. People who wear any type of lens overnight have a greater chance of developing infections of the cornea. These infections are often due to poor cleaning and lens care. Improper over wearing of contact lenses can result in intolerance, leading to the inability to wear contact lenses."

Having the prescription lenses not fit just right can be "potentially dangerous." Misuse of the contact lenses (even those you have had properly fit) "can lead to temporary and even permanent damage to the cornea."

With those risks associated with the contact lenses that are already regulated, ophthalmologists are even more concerned with the unregulated contact lenses that are being worn for cosmetic reasons and available everywhere from accessory shops to gas stations.

"The College of Optometrists urges wearers, and those contemplating buying Cosmetic Plano Contact Lenses (non-prescription contact lenses with colours and/or patterns on the surface), to take precautions before, during and after, wearing these lenses. Like all contact lenses, these novelty lenses sit directly on the front surface of the eye and, as such, should be firstly fitted properly by a qualified optometrist or dispensing optician. Wearers must also take note that contact lenses cut down the amount of required oxygen to the eye and if worn in smoky, hot and airless environments such as night-clubs, where cosmetic lenses are increasingly popular, there can be increased discomfort to the eye. The longer such lenses are worn, the higher the risk in causing damage to the eye. It is also important that wearers take proper care in cleaning and disinfecting these novelty lenses and their storage cases. The incorrect use of contact lenses can lead to serious optical complications, including Acanthamoeba keratitis, a potentially blinding condition caused by not cleaning contact lenses or their storage cases properly."

With "potentially blinding" consequences, there are those who are doing more than just urging wearers to be careful.

"Academy-backed legislation regulating cosmetic plano contact lenses was reintroduced in Congress on January 26 [2005]... The Academy [American Academy of Ophthalmology] initiated efforts to regulate cosmetic plano contact lenses following several reports of teenagers who developed serious eye problems after using nonprescription cosmetic lenses purchased from flea markets, beauty parlors, gas stations and other unauthorized vendors. ..."

So, what is meant by "serious eye problems"?

"Dr. [Thomas] Steinemann [a member of the American Academy of Ophthalmology] authored a case report of six patients treated for complications related to these lenses ... Two of his patients developed blinding complications, requiring lengthy hospital stays. One 14-year-old patient needed a corneal transplant after wearing cosmetic lenses without the supervision of an eye care professional; the other patient remains legally blind. Dr. Steinemann recently documented another 11 cases, and three of those patients developed blinding complications requiring hospitalization. Dr. Steinemann presented these findings earlier this month at a meeting of the Contact Lens Association of Ophthalmologists."

It is easy to understand why doctors with patients who develop "blinding complications requiring hospitalization" are concerned. Doctors want to help their patients.

If doctors are unaware that their patients are using an unregulated (yet, potentially harmful) product, what can they do? What if cosmetic contact lenses were regulated and available by prescription only? Would that solve the problem?

Corrective contact lenses are now available by prescription only, yet they can also be ordered over the Internet.

"Most consumers are unaware that contact lenses, even costume lenses not intended to correct vision problems, need to be fitted by an eye care professional and properly maintained. Most of the problems involve bacterial infections and scratches on the cornea. Without supervision, consumers -- particularly teenagers -- do not properly clean the lenses, fail to remove them before sleeping, (which cause a five-fold increase in the risk of bacterial infection) or share them with friends."

Not only do all contact lenses "need to be fitted by an eye care professional," they also need to be "properly maintained"?

Whether cosmetic or corrective, "[c]linical studies suggest that the extended use of contact lenses, particularly overnight, seriously increases the risk of developing corneal ulcers. This condition is called ulcerative keratitis. An ulcer can perforate or scar the cornea in a day or two, leading to permanent scarring of the cornea or even blindness. ... Smokers are eight times more likely to develop corneal ulcers than non-smokers, no matter which type of contact lenses they wear. Anything that causes dry eyes, including antihistamines, birth control pills, alcohol and air travel, can make contact lenses uncomfortable, and can increase the risk of an eye infection. In addition, environmental contaminants, such as dust, smoke, sprays and pollen, can irritate the eyes when you wear contacts."

Legislation is in the works to regulate cosmetic contact lenses. These unregulated products have damaged the eyes of users, and the doctors who have cared for these patients want to protect future users.

Questions of the Week:
Will legislation be enough to solve the problem? Do you think that most teens and young adults are aware that there is a health risk associated with the use cosmetic contact lenses (or even the improper use of corrective contact lenses)? How will legislation to regulate cosmetic contact lenses affect the choices of those who really want to use them? What additional risks can patients who choose to get contact lenses from an alternative source encounter?

Whether or not the legislation passes: How would you create an education campaign to reach your peers? What do they need to know about the risks involved with the use of unregulated contact lenses? What do they need to know about the proper use of both regulated and unregulated contact lenses? Why is "where" people get contact lenses important? How could you present this material in a way that would get your audience to understand the possible risks and consequences of improper use? Is there any other information potential users might need in order to make informed decisions?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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