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Medical Forum / General / Vision / April 2006Artificial Iris/Pupil Contact Lens
My mother has a damaged iris that is full (beyond full compared to the other eye) open at all times. (It is also somewhat off round since her cataract surgery.) This seems to be causing her extreme "glare" problems which she finds very disturbing. Prior to the cataract surgery everyone assumed that the cataract was the source of the glare, but while there was a general improvement in vision the glare remained after the surgery. It's hard to be sure what initially caused the glare since there may have been optic nerve damage from the same incident that damaged the iris. There does not seem to be an established way to determine whether the effect is optical or neurological. Another surgery to close up the iris is possible, but her opthamologist isn't pushing it. I had the thought that we should try a contact lens with a small clear central area set in an opaque ring to simulate a smaller pupil. It seemed to me that this could be helpful in and of itself plus it could provide a clue as to how effective surgery might be. The obvious test using a piece of paper with a small hole (but not a pinhole) held as close to the eye as safely possible appears to produce a dramatic improvement. No conventional corrective lenses significantly affect the glare. My mother's opthamologist does not fit contact lenses and didn't think that what I described existed. The local optometrist he suggested was rather emphatic that such things do not exist and claimed that they wouldn't work if they did. She went on to say that there would be no point in any case since she knew in advance that the surgery would help but that she did not recommend the surgery. I suggested that it might be nice to have a non-invasive way to evaluate the potential improvement, but I'm afraid at that point she really thought I was being a pest. :( Subsequent to talking to the optometrist I did some Googling and found quite a few references to artificial or prosthetic pupil/iris contact lenses--enough to convince me that even if not completely run-of-the-mill, what I was suggesting wasn't out of the ball park. I'd appreciate any thoughts about who we should talk to about trying something along these lines, if such contact lenses do indeed exist. Dan Lanciani ddl@danlan.*com Iris matching is done by very few optoms and apart from being expensive is very difficult to match precisely. You will need to find an optom who specialises in this field. You may need to ask around. Alternatively, sunglasses are a good way to beat glare and reduce cosmetic issues. dr grant If your mother isn't concerned about the appearance of the eye then she can certainly get a contact lens of the type you describe. A soft lens with a black 'iris' and a clear 'pupil' is what she needs. Iris matching is only needed if she wants it to look the same as her other eye but black will work better anyway. The question is, what diameter to make the clear pupil - maybe some trial and error required there. This is not technically difficult if she has an optometrist who is willing to spend just a little extra time with her. Of course it's a custom made lens which costs a little more but I'm sure it'd be worthwhile. Dom > My mother has a damaged iris that is full (beyond full compared to the > other eye) open at all times. (It is also somewhat off round since her [quoted text clipped - 35 lines] > Dan Lanciani > ddl@danlan.*com | If your mother isn't concerned about the appearance of the eye then she | can certainly get a contact lens of the type you describe. Indeed, she isn't concerned about cosmetics. I don't even know if she would be comfortable wearing a contact lens long term, but I thought it would at least tell us whether iris-closing surgery would be beneficial. | A soft lens | with a black 'iris' and a clear 'pupil' is what she needs. I'm glad I wasn't totally off base here. The optometrist really beat me down on the issue, ending by saying that if I really thought such a thing was possible I should go invent it. | The question is, what diameter to make the clear pupil - maybe some | trial and error required there. This is not technically difficult if she | has an optometrist who is willing to spend just a little extra time with | her. Clearly I need to find a different optometrist. I'm not sure how to screen them. I told the last one exactly what I was looking for when we came in, but she ignored me and did her usual vision exam. When I brought it up again after she finished she got kind of angry. | Of course it's a custom made lens which costs a little more but I'm | sure it'd be worthwhile. I'm willing to spend quite a bit if I can make my mother's vision a little more comfortable. I hate getting into arguments with medical folks, though. :( Dan Lancaini ddl@danlan.*com > | If your mother isn't concerned about the appearance of the eye then she > | can certainly get a contact lens of the type you describe. [quoted text clipped - 9 lines] > me down on the issue, ending by saying that if I really thought such a > thing was possible I should go invent it. You have to be careful with these types of people. (I don't really know what is wrong with them; there is no problem with saying "I don't know about such and such, I can do some looking into it for you..." wth? My own situation was using a workplace provided optometrist to fab up a new set of glasses and asking about any newer types of lens material other than the really thick plastic available at the time and all he said was "yea, it's called GLASS". It was real sarcastic and uncalled for. (I have a thick skin but you should be courteous if possible, right?) Long story but I wanted to point out you have every right and obligation to do your own fact finding and research, don't just take the 1st guy's word for it. TBerk If your mother isn't concerned about the appearance of the eye then she can certainly get a contact lens of the type you describe. A soft lens with a black 'iris' and a clear 'pupil' is what she needs. Iris matching is only needed if she wants it to look the same as her other eye but black will work better anyway. The question is, what diameter to make the clear pupil - maybe some trial and error required there. This is not technically difficult if she has an optometrist who is willing to spend just a little extra time with her. Of course it's a custom made lens which costs a little more but I'm sure it'd be worthwhile. Dom > My mother has a damaged iris that is full (beyond full compared to the > other eye) open at all times. (It is also somewhat off round since her [quoted text clipped - 35 lines] > Dan Lanciani > ddl@danlan.*com If your mother isn't concerned about the appearance of the eye then she can certainly get a contact lens of the type you describe. A soft lens with a black 'iris' and a clear 'pupil' is what she needs. Iris matching is only needed if she wants it to look the same as her other eye but black will work better anyway. The question is, what diameter to make the clear pupil - maybe some trial and error required there. This is not technically difficult if she has an optometrist who is willing to spend just a little extra time with her. Of course it's a custom made lens which costs a little more but I'm sure it'd be worthwhile. Dom > My mother has a damaged iris that is full (beyond full compared to the > other eye) open at all times. (It is also somewhat off round since her [quoted text clipped - 35 lines] > Dan Lanciani > ddl@danlan.*com It is hard to know if the glare is mostly the pupil or the optic nerve damage but even if the optic nerve is part of the problem, reducing pupil size should help reduce the glare even if it does not totally eliminate it. Custom opaque iris, clear pupil lenses are available. You will likely need to find a custom contact lens fitter, perhaps a local eye hospital or children's hospital has one. They are custom and can take several weeks to come in and will be priced well in excess of $200 per lens. If you are lucky, the fitter may have a trial set and let her wear a trial lens for a day to see if the glare improvement is worth the cost. CIBA Vision in Canada still has prosthetic contact lenses available, 6-12 week wait the last time I ordered one. Check out: http://www.cibavision.ca/lenses/specialty.shtml or refer her ophtho to the site. >My mother has a damaged iris that is full (beyond full compared to the >other eye) open at all times. (It is also somewhat off round since her [quoted text clipped - 32 lines] >I'd appreciate any thoughts about who we should talk to about trying >something along these lines, if such contact lenses do indeed exist. This sort of thing is done all the time probably by ocularists rather than anyone else. They are the same people who make ocular prostheses and shells. Ann | This sort of thing is done all the time probably by ocularists rather | than anyone else. They are the same people who make ocular prostheses | and shells. Ah, I wasn't aware of that term. I spoke to several optometrists today and they all understood what I wanted. One had even ordered a fitting information and literature kit from CIBA by the time he got back to me. We'll make an appointment with him next week after he looks over the literature. I feel much better now. :) Dan Lanciani ddl@danlan.*com
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