Types of Contact Lenses

Reasons to consider contact lenses

• Contact lenses move with your eye, allow a natural field of view, have no frames to obstruct your vision and greatly reduce distortions.
• Unlike glasses, they do not fog up or get splattered by mud or rain.
• Contact lenses are excellent for sports and other physical activities.
• Many people feel they look better in contact lenses.
• Compared to eyeglasses, they may offer better, more natural sight.

Some things to remember about contact lenses

• Compared with glasses, contact lenses require a longer initial examination and more follow-up visits to maintain eye health. Lens care also requires more time.
• If you are going to wear your lenses successfully, you will have to clean and store them properly, adhere to lens-wearing schedules and make appointments for follow-up care.
• If you are wearing disposable or planned replacement lenses, you will have to carefully follow the schedule for throwing away used lenses.

Purchasing contact lenses

1. Why can’t decorative contact lenses be purchased on the Internet or in drug stores without a current prescription?

   The United States Food and Drug Administration (US FDA) classifies all contact lenses as medical devices, whether they correct vision or are simply used for cosmetic purposes such as to change one’s eye color. ¹ In the United States, contact lenses cannot be obtained legally without a prescription. The prescription shows that the contact lenses were fit by a qualified eye care professional. There is no such thing as an “over-the-counter” contact lens. There are several problems potentially associated with wearing decorative (i.e., cosmetic tints, theatrical, "Halloween,” or "circle”) contact lenses if purchased on the Internet or in drug stores. If they are obtained without a prescription and without appropriate lens care instructions, fitting, and follow-up care, their use can result in complications including eye infections and permanent loss of vision. ^2,3,4,5,6,7

   There are numerous reports detailing infections resulting in significant vision loss in individuals using cosmetic contact lenses obtained from improper sources without medical supervision. ^3,4,5,8,9 These infections include not only common infections and complications but also more rare sight-threatening conditions such as Acanthamoeba keratitis or rare bacterial infections. ^10,11,12 There are many prescription cosmetic contact lenses available through your doctor of optometry that have been shown to be safe when properly prescribed and monitored by an eye care professional. ¹³ Consult your eye care provider to discuss healthy cosmetic contact lens options and to review the best strategies for care and handling of these lenses.

   1. United States Food and Drug Administration–Consumer Health Information. “Improper Use of Decorative Contact Lenses May Haunt You.” PDF. October 2009. Available: https://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/ucm048904.pdf
   2. Mathe BE. Ordering Lenses Without An Rx: The Dangers Revealed. Contact Lens Spectrum. 2003: 18(30).
   3. Steinemann, Thomas L., et al. "Over-the-counter decorative contact lenses: cosmetic or medical devices? A case series." Eye & contact lens 31.5 (2005): 194-200.
   4. Snyder, Robert W., et al. "Microbial Keratitis Associated with Piano Tinted Contact Lenses." Eye & Contact Lens 17.4 (1991): 252-255.
   5. Fogel, Joshua, and Chaya Zidile. "Contact lenses purchased over the Internet place individuals potentially at risk for harmful eye care practices." Optometry-Journal of the American Optometric Association 79.1 (2008): 23-35.
   6. Stapleton, Fiona, et al. "The incidence of contact lens–related microbial keratitis in Australia." Ophthalmology 115.10 (2008): 1655-1662.
   7. Young G, Coleman S. Poorly fitting soft lenses affect ocular integrity. CLAO J 2001; 27(2):68-74.
   8. Singh S, Satani D, Patel A, Vhankade R. Colored cosmetic contact lenses: an unsafe trend in the younger generation. Cornea 2012; 31(7):777-9.
   9. Young G, Young AGH, Lakkis C. Review of complications associated with contact lenses from unregulated sources of supply. Eye Contact Lens 2014; 40(1):58-64.
   10. Gagnon MR, Walter KA. A case of acanthamoeba keratitis as a result of a cosmetic contact lens. Eye Contact Lens 2006; 32(1):37-8.
   11. Lee JS, Hahn TW, Choi SH, Yu HS, Lee JE. Acanthamoeba keratitis related to cosmetic contact lenses. Clin Experiment Ophthalmol 2007; 35(8):775-7.
   12. Ray M, Lim DK. A rare polymicrobial keratitis involving chryseobacterium meningosepticum and delftia acidovorans in a cosmetic contact lens wearer. Eye Contact Lens 2013; 39(2):192-3.
   13. Rah, MJ, Schafer J, Zhang L, Chan O, Roy L, Barr JT. A meta-analysis of studies on cosmetically tinted soft contact lenses. Clin Ophthalmol 2013; 7:2037-42.

2. Are contact lenses that dispense medication readily available?

   
   Not at this time; however, prototype contact lenses for sustained drug release are being investigated and may be available in the near future. ^{1,2,3,4,5,6,7,8,9} The advantages of having drops reach the eye in a slower fashion, like that which would occur though a contact lens delivery method, could include more drug reaching the eye and improved patient compliance. ^1,10,11 When drops are instilled into the eye, most of the medication is washed away by the tears so that only between 1-7% of the eye drop is actually absorbed by the eye.10 In addition, a drug-eluting contact lens may reduce the current 24-59% noncompliance that exists with patients taking topical medications for glaucoma, a potentially sight-threatening condition. ^11,12 Disadvantages to this technology includes its high cost, processing and storage issues and difficulty with control over the rate and concentration of the drug delivered to the eye. ⁷

   1. Ciolino, Joseph B., et al. "A drug-eluting contact lens." Investigative Ophthalmology & Visual Science 50.7 (2009): 3346-3352.
   2. White, C. J., A. Tieppo, and M. E. Byrne. "Controlled drug release from contact lenses: a comprehensive review from 1965-present." Journal of Drug Delivery Science and Technology 21.5 (2011): 369-384.
   3. Tieppo, A., et al. "Sustained in vivo release from imprinted therapeutic contact lenses." Journal of Controlled Release 157.3 (2012): 391-397.
   4. Guzman-Aranguez, Ana, Basilio Colligris, and Jesús Pintor. "Contact lenses: promising devices for ocular drug delivery." Journal of Ocular Pharmacology and Therapeutics 29.2 (2013): 189-199.
   5. Bengani, Lokendrakumar C., et al. "Contact lenses as a platform for ocular drug delivery." Expert opinion on drug delivery 10.11 (2013): 1483-1496.
   6. Tieppo, Arianna, et al. "Analysis of release kinetics of ocular therapeutics from drug releasing contact lenses: Best methods and practices to advance the field." Contact Lens and Anterior Eye 37.4 (2014): 305-313.
   7. Hsu, K-H., S. Gause, and A. Chauhan. "Review of ophthalmic drug delivery by contact lenses." Journal of Drug Delivery Science and Technology 24.2 (2014): 123-135.
   8. Hui, Alex, Mark Willcox, and Lyndon Jones. "In Vitro and In Vivo Evaluation of Novel Ciprofloxacin-Releasing Silicone Hydrogel Contact Lenses." Investigative ophthalmology & visual science 55.8 (2014): 4896-4904.
   9. Xu, Jinku, Xinsong Li, and Fuqian Sun. "In vitro and in vivo evaluation of ketotifen fumarate-loaded silicone hydrogel contact lenses for ocular drug delivery." Drug delivery 18.2 (2011): 150-158.
   10. Ghate, Deepta, and Henry F. Edelhauser. "Barriers to glaucoma drug delivery." Journal of Glaucoma 17.2 (2008): 147-156.
   11. Gurwitz, Jerry H., et al. "Treatment for glaucoma: adherence by the elderly." American Journal of Public Health 83.5 (1993): 711-716.
   12. Rotchford, Alan P., and Karen M. Murphy. "Compliance with timolol treatment in glaucoma." Eye 12.2 (1998): 234-236.

3. Does it matter where (or from whom) I purchase my contact lenses?
   
   Contact lenses are medical devices, the fitting of which requires the expertise of an eye care professional. ¹ Contact lenses should be prescribed by a licensed practitioner. Hygiene and proper care of the lenses is very important to avoid infections and other problems. ² Studies have shown that patients who purchase their lenses on the internet have a higher risk of contact lens-related complications. ^2,3 Additionally, contact lenses ordered online or from another third party generally cannot be returned to the prescribing doctor unless purchased through the prescribing doctor's office.

1. Steinemann, Thomas L., et al. "Over-the-counter decorative contact lenses: cosmetic or medical devices? A case series." Eye & Contact Lens 31.5 (2005): 194-200.
2. Stapleton, Fiona, et al. "The incidence of contact lens–related microbial keratitis in Australia." Ophthalmology 115.10 (2008): 1655-1662.
3. Fogel, Joshua, and Chaya Zidile. "Contact lenses purchased over the Internet place individuals potentially at risk for harmful eye care practices." Optometry-Journal of the American Optometric Association 79.1 (2008): 23-35.

Cost of contact lenses

Every doctor of optometry individually determines his or her fees for services. There are a number of factors that may go into determining the initial cost of contact lenses, and these may include the professional services necessary to provide the best lens selection and a good start toward safe, successful wear. If you are considering contacts, be aware that some of the services and materials that might be included in the initial cost are:

• A thorough diagnostic examination.
• A lens care kit.
• Lens wear and care training.
• Follow-up office visits over a specified period of time.

If you already wear lenses and need replacements, or if you want a spare pair, the total cost might include the actual cost of the lenses plus the fee the doctor might charge for his or her professional time. Again, every doctor of optometry individually determines his or her fees, and there is no formula or standard fee for contacts or professional services.

It is certainly important to check out costs when considering contacts, but cost is just one factor in making your decision. All types of lenses are not the same. It is important for you to get the lenses that are healthiest for you and the professional services and follow-up care to help you wear your lenses successfully.