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Prosthetic Contact Lenses

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What are prosthetic contact lenses?

A prosthetic contact lens is a soft cosmetic contact lens that consists of an opaque material that is used to conceal the eye once it is placed on its surface. This can be useful in patient populations where there are disfigurements to the eye that may cause cosmetic or functional daily disability. The contact lens is created in various designs and colors in order to properly mask the underlying ocular defects. These lenses work to help eliminate excessive light into the eye and reduce visual discomfort as well as double vision. The lenses are made to replicate the details and color of a real eye in order to most closely match the other.

Who is a good candidate for prosthetic contact lenses?

Prosthetic contact lenses benefit disfigured eyes, irises (colored part of the eye) or corneas (the front surface of the eye). This can occur in cases of infections, congenital defects, accidents/ injuries, glaucoma, surgical complications, and post retinal detachment. A patient with iris irregularities can have overwhelming feelings of glare and light sensitivity. A special contact lens can be made to limit the amount of light that enters the eye and simultaneously provide a cosmetic balance to the two eyes. A patient who suffers from cosmetically disfigured eyes can mask the insecurity with the use of a prosthetic contact lens, ultimately providing a sense of relief for the wearer. If any of the listed cases is you, your eye doctor can evaluate your eye to determine if this lens is the best fit for you. An ideal candidate would be a patient who is capable of wearing a soft prosthetic contact lens comfortably and must be able to properly insert and remove the lens. The front surface of the eye or the cornea must be in proper health. Realistic patient expectations must be established.

Some examples of patients who may benefit from prosthetic contact lenses are:

  • Albino
  • Aniridia
  • Colobomas
  • Phthisis bulbi
  • Micropthalmia
  • Strabismus
  • Iris transillumination defects
  • Irregular pupils
  • Irregular corneas

  • Leukoma
  • Band keratopathy
  • Vitamin A deficiency
  • Trauma
  • Heterochromia
  • Diplopia
  • Glare
  • Photophobia
  • Sjogrens syndrome

  • Keratoconus patient with Intacs


    What kind of prosthetic lenses are available?

    Each patient’s situation is entirely unique and so there are many different lens options available, all of which should be considered when fitting a patient with this type of lens. These lenses can be made in different materials, available as a soft contact lens or rigid lens. The lenses can be made as a corneal contact lens which is the typical contact lens type. However, in some cases the lenses can be made as a scleral lens in which the contact lens rests on the white surface of the eye. These lenses are larger in diameter and can benefit some patients with surface irregularities or dry eye conditions. Some examples of the types of prosthetic lens types available are:

    • Standard opaque designs
    • Custom hand painted designs
    • Transparent tinting designs

    Computer generated or standard prosthetic lenses have pre-determined iris colors and diameters, limiting the degree of personalized changes that the patient can make. This type of contact lens is reliable and reproducible. The patient can count on what type of product they will receive. These lenses tend to be on the less expensive side. On the other hand, a hand painted lens are completely customizable and can be produced exactly to the patient’s specifications. The lens can be produced in any variation of iris color and pupil diameter. This customization typically results in a higher overall cost. In addition to the standard and custom contact lens designs, transparent tint designs are available as well. This is ideal for patients with color deficiencies or patients with a desire for contrast enhancement for sports or other recreational activities. Red lenses can be used for certain color deficiencies in order to provide a broader visible spectrum for patients. This is true in cases of albinism. Patients who participate in sports or outdoor recreation may benefit from tinted contact lenses as well due to enhanced contrast. This can provide optimum visibility, improve accuracy and increase comfort in sports. Tint colors are available in colors such as gray, green, and amber. The colors can be trialed by patients to determine which tint would benefit the patient the most. However, a tinted lens is not opaque enough to conceal any disfigurements.

    What are the benefits of wearing a prosthetic contact lens?

    A prosthetic contact lens can eliminate symptoms of double vision, light sensitivity, and even work to improve color vision and contrast. Prosthetic contact lenses can help improve vision by decreasing pupil size, creating a pinhole effect where light focuses better in the eye. A prosthetic may provide emotional relief for patients who experience insecurities over their ocular abnormalities. Tinted contact lenses can provide a soothing effect on patients who experience migraines. These tints can also enhance visibility in sporting or recreational situations.

    How do you fit prosthetic contact lenses?

    A prosthetic contact lens fit requires careful evaluation of the patient’s natural iris color and ocular details. Color matching is important in order to provide natural results. Your eye doctor will evaluate and document your natural iris color to order a lens that most closely resembles your natural eye. Close up photographs may be taken in order to send to the contact lens manufacturer to help in the color matching process. If a patient has a refractive error that requires correction then a new contact lens prescription must be determined. The lenses can be used to correct astigmatism, near-sightedness, and far-sightedness. A pupil diameter must be determined based on the patient’s activities of daily living. Your eye doctor will ensure the soft prosthetic lens will be comfortable and have an acceptable fit on your eye. A patient with irregular ocular surfaces will require more customized measurements in order to ensure the lens will fit. In some instances, a clear contact lens with the proposed measurements will be created just to try in the office before putting on any colors or details in order to ensure the lens is fitting as it should.

    Keratoconus patient with Intacs

    How do you clean and manage prosthetic contact lenses?

    After successful fitting with a prosthetic contact lens, it is still important to wear protective eyewear in order to prevent further harm to the eye. Polycarbonate and uv protectant lenses are recommended. It is important to adhere to the recommended cleaning regime that your eye doctor goes over with for you. Each brand of prosthetic contact lenses may suggest different cleaning supplies. Consult your eye doctor to determine the appropriate lens cleaner for your specific lenses.

    How long do prosthetic lenses last?

    Prosthetic contact lenses are prescribed on an annual replacement schedule. Patients must keep in mind that their hand painted or tinted lenses may gradually fade over time. The computer generated lenses are printed and therefore tend to fade less frequently than the other types. However, annual replacement is recommended in order to maintain proper hygiene and provide optimum cosmetic results.

    What are possible contraindications for prosthetic lens wear?

    In general, there are no contraindications specifically for prosthetic lens wear. If a patient is successful in wearing traditional soft contact lenses then they can adapt to a prosthetic soft lens. A patient must be able to follow the cleaning regime, replacement schedule, and wear time properly in order to avoid risk of infection or permanent vision loss. Patients with blebs, sutures, dry eye, or ocular allergies can experience difficulty with contact lens wear and therefore should consider carefully if prosthetic lenses are the right fit for them. Corneal neovascularization and hyperemia may occur in certain contact lens materials that are not as breathable.Patients who are on medicated eye drops such as glaucoma patients may not enjoythe inconvenience of taking off contacts in order to instill the drops. Consult withyour eye doctor to determine if this is the right option for you.