The Optometrist's Guide to Color and Costume Contacts

“I shouldn’t have put in that contact.” Many eyecare providers are familiar with the phrase coming from patients who have purchased color contact lenses illegally sold online and have suffered from complications. Only now it’s too late! Your patient is crying in your chair as you assess, hoping that there is no serious damage or infection.

Color and costume contact lenses have been a longstanding pain point for eyecare professionals due to lack of sales regulation and public misinformation. Here is what you need to know about these contacts as an eyecare provider.

There are several types of color and costume contact lenses that can be made with or without a prescription. Different categories include:

The goal of this lens is to enhance the eye color. This lens is usually tinted at the edge of the iris to give an enhanced but natural look. Some examples of color enhancing contacts are Freshlook One-Day and Acuvue Define 1-day lenses; both are reportedly discontinued by the manufacturer, but they can still be found online and in various stores. Another option in the category is Bausch and Lomb’s Naturelle Pureblack.

When most of us think of colored contacts, this is probably the category that comes to mind. These lenses have a larger tinted area to help give the appearance of eye color change. You can find these in various shades of brown, hazel, green, blue, gray, and, sometimes, purple or amethyst.

Each manufacturer offers their own variety of colors and powers. For instance, Lacelle, the color contacts from Bausch and Lomb, come in plano, -0.50 to -6.00 in -0.25 diopter steps and -6:50 to -10.00 in -0.50 diopter steps. Alcon offers both daily and monthly options with Dailies Colors and Air Optix Colors.

TORIColors offer astigmatism correction with -0.65 cyl and -1.25 cyl with some limited axis and power options. Misaki color lenses rank well online, so they will probably be found easily by consumers, and they offer a wonderful variety of power and axis options, but these lenses have a lower Dk value compared to modern soft lenses.

This category of contacts is most popular around Halloween, but you may also find patients who are involved in creative productions asking about these year-round. These lenses make the eyes look unnatural to help complete a costume or for special effects. A great example of these is the Gothika line from Orion Group, which also offers custom made lenses. Consumers can now find glow-in-the-dark costume contacts for raves online as well.

No, not the scleral lenses of which you are probably thinking. These are costume lenses that cover the sclera. They are in their own separate category because they are a larger lens and may limit oxygen permeability. Consumers can find scleral lenses online and at various stores. Sclera-lenses.com even offers 12.5mm diameter scleral lenses in powers ranging from -1.00 to -5.00.

Note that some companies will also refer to costume scleral and costume lenses as “theatrical” lenses. Some companies will make custom-made contacts in various shapes and colors. However, these are often significantly more expensive than the lenses found online.

Color and costume contact lenses are safe when they are made by a trusted manufacturer, fitted under the supervision of an eye doctor, and when they are properly cared for by the patient. Unfortunately, many online manufacturers sell their contact lenses without a prescription and without FDA approval.

The AOA has had some success in combating the issue. In 2020, a company called The Third Eye recalled its contacts because they had not been cleared by the FDA. However, the existence of many other websites that target young adults presents a continuous safety risk for patients.

Color contact lenses should be worn according to the manufacturer's recommendations. Some manufacturers allow their lenses to be worn for up to one year, while others have a more restrictive wearing schedule. Patients should know to stop wearing a contact lens if the eye becomes red or irritated, if the lens is torn, or if the lens is no longer comfortable.

Contact lenses that are manufactured according to the FDA guidelines and sold with a prescription requirement are likely to be safer compared to contacts sold at a grocery store or an online store that does not require a prescription.

It is important to educate patients to seek FDA- compliant websites and websites that ask for a prescription and to ensure proper fit of both color and costume lenses. Some brands that are recommended by other eyecare professionals include Orion, Acuvue Color, and Alden. Custom color lenses are also an option, though they are more expensive.

Here are just a few tips on addressing color and costume contact lenses with your patients.

The battle over online contact lens sales has been going on for decades with very few consequences for the shady practices of online retailers. Considering color and costume contacts on top of clear contacts can feel a bit overwhelming. However, ignoring the problem is not going to help our patients. If we don’t talk to them, who will?

Many patients still don’t know that color and costume contacts are medical devices that require a prescription. And why should they? Stores, both brick-and- mortar and online, are happy to sell a pair of whatever brand color lenses to whoever will pay. While we have a long way to go towards educating the public, we can always educate our patients.

Post about it on your social media, your website, and even put a sign in your office. If a patient asks about color contacts, don’t be afraid to tell them about illegal contact lens sales and the risks of buying poor-quality lenses. You can even add a question about color or costume contacts to your patient intake form.

Many color and costume contact brands are geared towards myopes and don’t offer astigmatic correction. If you have an individual with a high degree of astigmatism, explain their options and try to find a compromise. This can be glasses over contacts, a 20-happy visual acuity, or a more expensive lens.

If a patient asks you about buying color or costume contacts online, don’t dismiss them and don’t force them to buy the brand you like. Instead, teach the patient what to look for in an online store and explain the risks. If the patient still wants to shop online, bring that patient back for follow-up once they’ve purchased those online contacts to assess fit and vision.

There are many online contact lens websites and some are FDA compliant. Check out the popular websites and look at the materials, colors, and stats. You might find a website that you feel comfortable recommending to your patients. For instance, Moody contact lenses list an FDA compliance certificate, require a prescription, and list their lens materials. These are all good indications that the vendor is a trusted and quality source.

Color and costume contacts are popular among young adults and are often purchased online or in-stores. Unfortunately, the regulations for costume and color contact lens sales fall short and allow for unsafe, illegal contact lens sales to the general population. By educating patients on contact lens safety and teaching them how to make more intelligent purchasing decisions, eyecare providers can make color and costume contacts safer for their patients.