Ophthalmology Times flags cosmetic lens risk

Ophthalmology Times Europe published an article on October 8, 2025 that challenged a common assumption in eye care: that decorative contact lenses are plainly the safer way to change eye color. The piece, by Francis Ferrari, MD, and Brian Boxer Wachler, MD, compared microbial keratitis risk reported for cosmetic contact lenses with outcomes from femtosecond laser-assisted annular keratopigmentation, or FLAAK. The authors said the comparison should change how clinicians counsel patients and how they take histories in red-eye and corneal-infection workups. ### Why did this comparison draw attention? Francis Ferrari and Brian Boxer Wachler wrote that many ophthalmologists regard colored cosmetic contact lenses as the safest eye-color option, compared with cosmetic iris implants, laser iris depigmentation and keratopigmentation. Their article said microbial keratitis is a known contact-lens complication and set out to compare published cosmetic-contact-lens infection rates with outcomes from their FLAAK surgical cohort. (europe.ophthalmologytimes.com) The Ophthalmology Times Europe article said 1,953 patients underwent FLAAK at the authors’ center between December 2013 and the end of 2023. It reported that none showed signs of microbial keratitis at day 1 and day 14 follow-up, which the authors described as the maximum incubation period they used for assessment. ### Does that mean decorative lenses are broadly unsafe? (europe.ophthalmologytimes.com) The American Academy of Ophthalmology said in an October 2025 clinical statement that cosmetic contact lenses can lead to serious infections and vision loss, especially when obtained without a prescription or professional supervision. The statement said all contact lenses, including decorative and costume lenses, are medical devices that require an eye doctor’s prescription and supervision. (europe.ophthalmologytimes.com) The U.S. Food and Drug Administration says decorative lenses are not cosmetics or over-the-counter merchandise and that sellers offering them without a prescription are breaking the law. The agency said poor fit can cause corneal scratches, infection, decreased vision and blindness, and warned that bacterial infections can progress rapidly if not treated promptly. ### Which habits and purchase patterns raise the risk most? (aao.org) The Centers for Disease Control and Prevention said on May 27, 2025 that decorative lenses carry infection risk when they are bought without a prescription, fit poorly, or are worn and stored improperly. CDC guidance says users should not share lenses, should never store them in water, and should disinfect and store infrequently worn lenses in fresh solution at least every seven days. (fda.gov) The AAO statement said patients who obtain cosmetic lenses from unauthorized vendors are less likely to receive education on proper use and care. It also cited FDA testing that found microbial contamination in 60% of counterfeit cosmetic lenses and 27% of unapproved lenses evaluated by the agency. CDC guidance also says users should avoid sleeping in lenses unless directed by an eye care provider, keep lenses away from water, rub and rinse them with disinfecting solution, and replace the storage case at least every three months. (cdc.gov) Those are the same day-to-day behaviors Ferrari and Wachler highlighted as relevant when assessing risk around decorative lens wear. ### Why does the article focus so much on patient history? Ophthalmology Times Europe said decorative lenses are often treated by patients as beauty accessories rather than medical devices. (aao.org) That gap matters in clinic because unexplained red eye, recurrent keratitis or atypical corneal infiltrates may not be linked to cosmetic lens use unless the clinician asks directly about it. (cdc.gov) The FDA and CDC both frame decorative lenses as prescription medical devices that require fitting, supervision and hygiene. That makes purchase source, overnight wear, cleaning routine and replacement practices directly relevant parts of the history when a corneal infection is suspected. ### What should clinicians and patients watch next? The October 2025 Ophthalmology Times Europe article remains the cited source for the FLAAK-versus-cosmetic-lens comparison, and the AAO’s 2025 clinical statement and CDC’s May 27, 2025 guidance provide the current U.S. safety framework. (europe.ophthalmologytimes.com) Those documents name the next practical step: ask about decorative lens wear, verify where lenses were bought, and review overnight-use and cleaning habits when evaluating corneal infection symptoms. (fda.gov)