Cosmetic shells and contact lenses
Contact lenses as ocular prostheses.
Contact lenses as ocular prostheses.
On this page we look at the history of contact lenses in their role as prosthetic objects, so we must look quickly at some definitions: A contact lens is a medical device worn over the front surface of the eye in order to correct a visual impairment, whereas a contact shell is merely a cover, worn directly over the eye, which may or not be transparent (depending upon whether or not the eye is sighted and needs to look through it). The function of a contact shell may be to protect the eye from external hazards or to conceal a disfigurement from the view of others. The distinction between some of these shells and the thinnest form of artificial eye can be a narrow one, but the technology of manufacture and the issues relating to comfort, length of wear, hygiene and cleansing regime are identical to those of contact lenses and it is mainly commercial contact lens companies, rather than hospital-based prosthetic technicians, who produce them. Therefore, for sheer convenience, we may use ‘contact lenses’ as an all-encompassing term.
When was the first of these ‘lenses’? To begin with we have an unsolved mystery to consider. In 1853 the London surgeon Smee wrote that he had known of a female patient presenting with differently coloured irises. She had requested an ‘artificial eye’ so that her eye colours would match. We don’t know if she envisaged this as something to be fitted over her existing eye or if the eye was to be removed first. We don’t know if she had sight in both eyes. If she did she might actually have been envisaging the first cosmetic shell, with a see-through aperture in the centre. Unfortunately there is no evidence that any procedure was performed on this patient or that any device was supplied.
In fact the first known contact shells date from 1887. They were afocal (without optical power) and intended to cover distortions of the cornea on the front surface of the eye. The condition is known as keratoconus. These shells had a protective, therapeutic function, rather than a cosmetic function and were made by Müller Söhne in Wiesbaden.
In 1888 an enquiry reached Adolf Eugen Fick in Zurich suggesting the use of a contact lens as a cosmetic device to improve the appearance of the eye. This was to feature a painted iris and pupil. This is the start of ‘cosmetic practice’ which in the original contact lens parlance was a phrase used when there was no perceived medical need for a lens i.e. when there was no keratoconus. The psychological benefit to the wearer in concealing the ravages of a diseased or injured eye was not yet viewed as a medical benefit. Indeed, in those days before antibiotics the general opinion was who in their right mind would want to risk wearing a glass lens beneath the eyelids? Nevertheless cosmetic shells were soon considered a viable alternative to the use of artificial eyes, with the advantage that an empty socket was not required.
Only subsequently was contact shell technology adapted in order to provide an optical correction and the consequence over time was that contact lenses became smaller in order to facilitate longer wearing times, but thereby lost most of their cosmetic function since they no longer covered such a large part of the eye surface. (By the late 1940s lenses were produced that covered only the cornea). As we will see, the exception was the use of tinted lenses designed to alter the colour of the wearer’s eyes.
Curators of museum collections should exercise caution, however since not all tinted lenses from the twentieth century are cosmetic. Light blue or grey tints are often just handling tints designed to help the patient see the lens and insert or clean it more easily. Other tinted lenses have a specialist medical purpose for instance in the alleviation of dyslexia.
In 1930 the Carl Zeiss company produced ‘Umbral’ tinted contact lenses. There has been some debate whether the tint was simply to reduce the amount of light entering the eye (almost as sunglasses) or whether it was to help reduce the glare which caused photophobia in patients with corneal oedema. The ‘Umbral’ contact lens was scleral. Scleral lenses cover the whole visible surface of the eye including the white part, or sclera, but this scleral lens could be supplied with tinted corneal zones of 25%, 50% or 75% absorption. Around the same time the researcher Streiff reported good results for the use of tinted lenses in treating albinos.
In 1936 the Hungarian Dr Josef Dallos (who would flee to Britain as a refugee a year later) made some tinted lenses for albinism and also some cosmetic scleral lenses. Dallos ground a depression onto the front surface of the lens in front of the optic portion. The iris was painted onto this and then a clear glass cap was cemented into place.
The story now moves for the first time to Hollywood. Reuben Greenspoon, a Beverly Hills optometrist ‘to the stars’, was the first to perform cosmetic work in the US in 1939. He used semi opaque solutions on scleral lenses to change the eye colour. His son, Morton joined him in practice in 1951 having previously had aspirations to work as an actor. Morton instead went on to win an Emmy for his contact lens work on the Star Trek television series and an Academy award nomination for his technical work in Dracula starring Gary Oldman.
Also in the United States, with the introduction of PMMA (Perspex) around 1940 the process of producing lenses had radically changed. The Obrig lens was 60% lighter than an identical glass lens. It could have a coloured optic portion or a coloured scleral portion… or both.
Literary villain in disguise
Perhaps it was this sort of lens that the author Ian Fleming had in mind when he wrote the James Bond novel On Her Majesty’s Secret Service in 1963. In the novel Blofeld the villain, wears dark green tinted contact lenses to protect his eyes from the sun and to maintain a disguise as the Comte de Bleuville.
The first soft contact lenses were produced in Czechoslovakia at the Institute for Macromolecular Chemistry in Prague in the early 1960s. They were all made transparent although Professor Otto Wichterle took out patents for coloured versions that seem never to have made it to production.
A company called Titmus Eurocon also gained an early patent for colour tinting of soft lenses in 1972 and they actually went on to produce both tinted soft lenses and soft lenses with a hand painted iris. This German company, later acquired by the giant CIBA Vision, was the leader in developing new cosmetic technologies for the rest of the century.
Sub-laminated cosmetic soft lenses
In 1974 the Weicon Iris Print lens was introduced. (Click on the image of the patent to enlarge it). The iris colour was laminated under the surface of the lens, resulting in an opaque appearance that masked unsightly eyes. Four years later, in 1978, the company began using a photographic process to print the iris. They followed this up in 1981 with a manufacturing process to apply an opaque tint to soft lenses. Their market was widened significantly when the US Food and Drug Administration (FDA) approved the commercial tinting of soft lenses in 1983.
Developments in coloured lenses were for a while driven by the television and film industries, sometimes when their use was actually featured in the plot of the book being filmed. For instance corneal cosmetic lenses featured as a means of disguise in Frederick Forsyth’s Day of the Jackal (1971, filmed in 1973 but with the action set in 1963). In 1984 the optician John de Carle made a cosmetic lens for a 20th Century Fox film being shot in Munich called Enemy Mine in which the aliens had to have cats’ eyes. Scleral lenses could have been used but the actors weren’t keen. He therefore used corneal-size rigid gas permeable (RGP) lenses, with the colour laminated in the middle, but these tended to move too much on the eye and also to rotate. As the pupils had to be vertical they initially used a girl to manually rotate the lens back in place during the shooting! Eventually the actors wore a ‘sandwich’ of three lenses including a soft lens on top. This reduced the movement but you see how these lenses would have been quite impractical for all but momentary wear.
British firms lead the way
Two British firms have been leaders in this field. Cantor & Nissel Ltd whose special eye laboratory is in Hemel Hempstead make hand painted soft lenses for television productions and advertising campaigns such as the Churchill Insurance dog.
SCL Contact lenses, founded by Steve Lennox in the 1980s, manufacture both printed and hand painted lenses. They have many orders from the movie, advertising and music industries, but the bulk of their work comes from medical orders, for example lenses to mask strabismus (squint).
With the development of soft lenses a new range of cosmetic possibilities was opened. Whilst cosmetic shells continued to be used to medically ‘remodel’ the eye, the opportunity to alter the appearance of one’s eyes for social reasons would eventually prove particularly popular with young night-clubbers.
This means that cosmetic contact lenses now enjoy an unusual position in being both a prosthetic medical device, obtainable through clinical practitioners, and a fashion item of choice, available commercially over the Internet. In recent years ranges of so-called 'Fun' lenses have been devised with designs such as cats’ eyes, smiley faces, flowers, stars, spider’s webs etc. The use of non-powered coloured contact lenses for fun has raised concerns regarding their supply and the hygiene (or lack of it), which is associated with an increase of contact lens related eye infections such as microbial keratitis. Perhaps uniquely they are a form of semi-internal prosthesis that different users have shared or exchanged, with potentially serious risks to health. Two studies from Australia and the US have also suggested increased risks associated with purchasing contact lenses online. The risk of serious infection was found to be nearly five times higher. That is why in the UK the supply of lenses over the Internet is strictly regulated and the supply of so-called zero-powered lenses (that change the colour or appearance of the eye rather than correct eyesight) can only be sold under supervision of a registered optometrist, dispensing optician or medical practitioner.
Dyes used have included vegetable dyes, laundry inks, oxidised epinephrine compounds (adenochrome) and biological stains such as Sudan fat. None of these proved particularly stable or permanent so nowadays vat dyes, acid-reactive or diazo dyes are used.
The Softcolours range (1984) was one of the first soft lenses offered to the general market to enhance the natural eye colour. The logical development from this was to offer ‘made to order’ colours so the user could choose what eye colour to present to the world. The Durasoft 3 Colours range (1986) was the first coloured soft lens with dot matrix pattern to change the colour of even the darkest eyes. The opaque coating was applied as a series of dots to break up the colour on the lens allowing some of the eye’s natural colour to show through, thus giving a more natural appearance. In this and with other products Wesley-Jessen became one of the market leaders in the manufacturing and distribution of coloured contact lenses both in prescription and non- prescription forms. The lenses were promoted direct to the public with adverts featuring film star Brooke Shields.
To give an example of how popular the idea had become, in 1989 Singapore, Malaysian and Japan Airlines actually banned the use of coloured contact lenses for flight crew on grounds of their appearance and also concerns regarding hygiene.
The first disposable tinted lens was the Freshlook Lite Tint (1993) followed soon after by the Freshlook Colours range (1994) – The claim was that dot matrix pattern lenses were thus affordable enough for occasional wear. By 1999 the Colourblends range was employing dual colour to try to mimic the natural colour distribution of the eye and give a more natural appearance, but a look at advertising ephemera in our museum’s collection confirms that the emphasis was clearly on fantastical designs designed to make the wearer ‘stand out’ or ‘unleash your wild side’.
Many cosmetic lenses were intended for evening wear, at night clubs, on romantic dates etc. but the next generation of coloured lenses was more functional, featuring ultraviolet filters and an emphasis on outdoor activity. For example in 2000 ProSoft (2000) was launched for tennis players and Nike Maxsight (2005) claimed it could enhance sporting performance, but some might suggest it was really as much about looking your best on the sports field.
In 2001 the pharmaceuticals giant Johnson & Johnson, a major sponsor of successive Olympic Games, launched the Acuvue 2 Colours range. A highly popular existing range of prescription lenses was thereby given a set of coloured options. The makers emphasised the wearability of their product, referring to it as being ‘wrapped in comfort’. In Germany you did not even need to be professionally fitted. You could buy these lenses from vending machines at Berlin Airport. In 2004 they also launched a 1-Day version, the world’s first daily disposable coloured lens. Success was limited however due to dissatisfaction with the range of colours and it was discontinued in 2006.
Research in the noughties showed just how great a proportion of the population was potentially interested in using lenses to change their eye colour though the research tended to be sponsored by the manufacturers and was quoted in order to promote greater sales. For instance in 2004 CIBA Vision UK Ltd reported that ‘44% of current contact lens wearers are interested in enhancing or changing their natural eye colour’.
Today disposable cosmetic lenses are produced for special events such as football tournaments. They are a lifestyle product that forms part of the young person’s fashion ‘look’. The Eclipse RGP lens was developed by Vista Optics of the UK in 2000 as the first photochromic contact lens material that changed colour on exposure to light, much like ‘Reactolite’ spectacle lenses. In 2009 Ultravison Ltd launched the first cosmetic coloured lenses made from state-of-the-art silicone hydrogel materials (SiH). It seems that no technological developments are introduced without cosmetic options following close behind.
So in conclusion, cosmetic contact lenses have moved from medical device to lifestyle consumable. They are not alone in this; think of how hairpieces and wigs have come into greater use amongst those who have no medical need of them, but as a semi-internal prosthesis with a strict hygiene regime to observe and legislative restrictions on their supply we must still consider them as part of medical history with around 130 years of evidence to consider.