Prosthetic or soft colored contact lenses have cosmetic, therapeutic and psychological benefits for patients. The Miami Contact Lens Institute, specializing in both primary eye care and specialty contact lenses, provides custom-made soft lens designs for patients who seek prosthetic or cosmetic lenses or colored contact lenses with special effects.
One of the most rewarding opportunities in any practice is the ability to change a person’s life.
When the Institute was created, our doctors realized the need to help patients who have scarred or disfigured eyes resulting from traumatic injuries or congenital abnormalities. They quickly realized the emotional trauma and impact that these problems could have on self-esteem and decided to get involved.
In addition to improving cosmetic appearance, the lenses can also help block light and eliminate uncomfortable visual disturbances such as light sensitivity and double vision. Trauma or congenital defects can cause severe disfigurements to the eye. A soft prosthetic or cosmetic lens consists of a contact lens material that overlaps the eye to conceal the disfigurement. Various colored contact lenses designs can help mask the underlying problem and match the eye coloring to the normal eye.
In patients who still have vision in their eye, these lenses can improve their quality of life.
Options can range from a basic, standard set of prosthetic colored contact lenses to custom hand-painted lenses.
The following may cause disfigured corneas:
- Congenital defects
- Accident or injury (chemical burns, trauma etc.)
- Infections (river blindness, trachoma, herpetic keratoconjunctivitis)
- Surgical complications (glaucoma, retinal, corneal)
- Poor nutrition (vitamin A deficiency)
- Sjogren’s syndrome
- Retinal detachment
Several different kinds of lens options can be considered, depending on the therapeutic and cosmetic expectations:
Transparent Tinting: Enhanced tinting of lenses provides transparent coloring that overlaps the natural iris tones to slightly change iris coloring.
Standard Opaque Designs: Standard lenses are available in various base curves, pupil sizes with clear or black backing, iris diameters, and prescriptions.
Custom Hand-Painted: With hand-painted lens options, you can customize base curves, lens diameters, iris diameters, iris color detailing with flecks and limbal rings, pupils, and iris alignment for strabismus. Accurate digital photography of an iris is an essential part of the consultation to help provide custom contact lens laboratories with precise information for designing the most natural lens.
Therapeutic Benefits and Lens Types
Eliminating Double Vision/Occluder Lenses: Occluder lenses are often preferable to an eye patch for eliminating double vision or diplopia. It is important to design the lens so that the black pupil is large enough to totally block out light (typically 2-3 mm larger than the maximum pupil size). Our laboratory provides solid black pupil lenses (clear outer edge) with various pupil sizes.
Eliminating Photophobia: Our laboratory offers prosthetic iris lens designs with a clear pupil opening to recreate a normal pupil size, thereby eliminating uncomfortable light sensitivity. Trauma commonly causes complications to the iris and an irregular pupil opening.
Color Vision Benefits: Our laboratory can provide red lenses (for certain color deficiencies)
Patient Selection and Expectations
Patients must be able to wear a soft prosthetic contact lens comfortably. The decision to apply a contact lens to a newly disfigured eye is dependent on many factors, including the health of the front surface of the eye (the cornea and conjunctiva) and possible complications arising from prior surgical procedures (ex: sutures and blebs).
Decisions to be made prior to fitting a prosthetic contact lens include expectations for natural color tones (standard versus custom hand-painted), therapeutic benefits (a black pupil can eliminate light compared to clear openings), prescription options (if applicable), wearing schedules (extended versus daily wear), replacement schedule, contact lens care, and possible need for eye drops (e.g., for glaucoma).
In order to have an adequate prosthetic contact lens fit, additional measurements and assessments are needed.
Eye Health: Normal contraindications for contact lens wear should be considered, including dry eyes and ocular allergies.
Pupil Size: The pupil diameter will be measured in 0.5-mm increments in normal illumination to maximize cosmetic appearance. Black occluder pupils for diplopia must be measured in dim light to determine the maximum size needed to prevent light from entering.
Iris Diameter: The iris diameter will be measured in 0.5-mm increments; it needs to be large enough to ensure coverage of the natural disfigured eye. Matching the iris size of the healthy eye is important to ensure more natural results.
Base Curves: Because of disfigurement, corneal topography cannot always be obtained. Sometimes, trial lenses from various companies can help evaluate movement. The lens must permit some movement to prevent excessive tightening. Excessive movement detracts from a natural eye effect, however.
Lens Diameter: Using the largest diameter possible will ensure better centration and maximize cosmetic and therapeutic effects.
Prescription: If needed, the prescription will be measured in the office during the initial consultation.
Color Matching: As mentioned previously, digital photography is key to achieving an accurate iris color. Natural lighting conditions are used when photographing the iris color.
In general, darker iris colors (brown tones) are easier to match using the fitting sets for generic prosthetic lens options provided by various companies.
Lighter iris colors (lighter blues, greens) are more difficult to match, because the iris reflects light and its coloring changes in various lighting conditions, reflects off of clothing, etc. Hand-painted options may be recommended to ensure the best possible matching of lighter iris colors. Sometimes, using the same color lens on the healthy eye is another option to ensure exact color matching.
Patient Management After a Successful Fit
All prosthetic lens patients should wear glasses over their prosthetic lenses for two
- It is important to wearing glasses with polycarbonate, shatter-proof lenses that act as a shield to protect the eyes from injury.
- Glasses can help maximize appearance, camouflaging the prosthetic lens. He or she can select an interesting frame and perhaps a lens tint.
It is important to get regular eye exams to diagnose and treat serious eye conditions and assessing the overall health and how it affects the eyes. Often people wearing prosthetic lenses are relying on one healthy eye, which must be examined on a regular basis.
How Long Do Prosthetic Lenses Last?
Some standard and custom prosthetic color lenses can fade. The patient will be properly instructed about cleaning and disinfecting solutions to prevent this from occurring. Hand-painted soft lenses that have the coloring bonded within the matrix of the lens design do not fade when patients use proper lens care solutions.
Purchasing a spare lens to ensure continuity of lens wear is important in the event that a replacement lens is needed.
Patients who benefit from prosthetic lenses are usually enormously gratified and experience a major improvement in their quality of life.