Contacts in the Eye

With contact lenses just about 21 years old, boosters were claiming last week that they had "come of age" and that no fewer than 6,000,000 Americans are wearing them. In fact, the business of supplying contact lenses to patients is suffering collective growing pains, and some elements in it are still behaving like juvenile delinquents. While it is true that about 6,000,000 pairs of contact lenses have been sold in the U.S., many of these are not in the buyers' eyes but in bureau drawers or medicine chests--how many, nobody can estimate with any accuracy.

At the root of many of these difficulties is the multitude of professions engaged in correcting visual defects. There are the ophthalmologists, M.D. physicians who prescribe corrective lenses as a minor part of their specialty of treating eye disorders. Then optometrists,* who may not apply medicine or perform surgery, but measure visual defects, prescribe for them and fit lenses. Then there are the opticians. The ophthalmologists generally regard the other groups as journeymen technicians. But most ophthalmologists have been slow to see the potential demand for contact lenses, or their possible advantages; so the optometrists have filled the vacuum.

The Boom. Foreshadowed by Leonardo da Vinci in 1508, contact lenses were first made in Europe in the 1880s. They were big, covering most of the sclera (the white of the eye), heavy (made of glass), hard to fit and forbiddingly expensive. Early plastic lenses were also of the big scleral type, had to float on a bath of special wetting fluid, and could be worn only four to five hours at a stretch. Then came the methyl-methacrylate plastics (of the Plexiglas family), the discovery that fluid was unnecessary if lenses had a hole to permit tears to pass beneath, and development of the tiny corneal lens, which covers only the eye's iris. The boom was on.

Get-rich-quick operators swarmed into the field, advertising directly to eyeglass wearers through the lay press and classified telephone directories. Appealing to feminine vanity and masculine athletic aspirations, they claimed that famous actresses and sports champions were wearing them. In an uphill fight to crack down on these fringe operators, the Federal Trade Commission found most of these claims untrue. Also untrue: claims of "continual comfortable wear," "wear them up to six months without removing," "never irritating," "unbreakable," "cannot damage the eye," "provide better vision than other eyeglasses," "protect the eyes in all active sports." The FTC has forced several makers of such claims to tone down their copy, but the peddlers involved often simply cross a state line and set up shop under a new name.

Equally anxious to clear up the business is the American Optometric Association, which last week had sent out to members 50,000 copies of a frank, sensible booklet, "What Everyone Asks About Contact Lenses." Key points: no matter how well fitted, the contact lens is a "foreign body" in the eye, so the wearer must "learn to tolerate this intruder just as one must learn to wear false teeth." This may mean a week or two of varying discomfort, for some patients a month or more. Rare indeed are the happy individuals who can pop lenses into their eyes, feel comfortable right away, and keep the lenses in all day.* At least five or six office visits are needed for proper fitting, says the association, and as many as 20 visits may be required. Finally, the association admits frankly, "In some cases, satisfaction and comfort just never come." This is a far cry from the operators' advertising lenses at $29.95 (after one fitting), "satisfaction guaranteed."

Vanity & Sport. Grinding the tiny, feather-light plastic lenses is technically so difficult that eye practitioners do not attempt it themselves, leave it to specially equipped laboratories. These labs do not sell directly to the public, so they remain unknown, though Chicago's Plastic Contact Lens Co., the giant in the field, has made more than 4,000,000 pairs in ten years. Average price to ophthalmologists and optometrists: $50 to $60 a pair. After fair charges for examinations, fittings and corrections, the practitioner may collect $150 to $300 from an average patient. Those with special problems must expect to pay more.

At least two-thirds of all contact-lens wearers are women, and most of these (in the 15-40 age range) take to them for vanity. A few, such as models and actresses, need them for professional reasons. Among them: Metropolitan Opera Soprano Patrice Munsel (TIME cover, Dec. 3, 1951), Hollywood's Deborah Kerr, Ann Sothern, Debra Paget. Since the lenses can be tinted, they came in handy for turning grey-eyed Nina Foch (a regular wearer anyway) into a brown-eyed Egyptian in The Ten Commandments.

Esther Williams, who is myopic, wears them out of the water but does not bother with them when immersed. Swimmers who need correction for reasons other than myopia usually wear the bigger scleral lens because it is harder to dislodge under water. Skindivers who use scuba favor contacts because spectacles, however ingeniously installed, are cumbersome inside a watertight face mask.

Some ophthalmologists still insist that the small corneal lenses should not be worn in active sports because of the risk of dislodgement. But several members of the Chicago Bears (hardly a sedentary group) wear them, notably Dr. William McColl, 29, All-America (Stanford University '52), with the Bears since 1952 and now in his second year as a resident in surgery at the University of Illinois. In his first season with the Bears, McColl's contacts fell out a few times, but he has no trouble now that they have been refitted. And Dr. McColl wears them into surgery, where his eyeglasses used to steam up.

Special types of contact lenses are being devised for a variety of visual defects. There are two main types of bifocals, one squared off so that it will not rotate, the other made of concentric circles, with the reading prescription on the outside (this type can rotate freely). When the eye has lost its own lens because of a cataract operation, a contact can help in many cases to supply the tremendous correction needed. Another type is being tried in the early stages of glaucoma. There is evidence that contacts may slow down the progression of myopia, and hope that they may actually reverse it in the young.

Though the American Academy of Ophthalmology and Oto-Laryngology still sniffily refuses to take any position on the desirability of contacts, its members are coming around to using them. At least half of the nation's 4,500 ophthalmologists have now prescribed them. With more cooperation between these specialists, the optometrists and the 125-odd reputable laboratories that make the majority of contacts, they should eventually get only into the eyes that need them and can safely wear them.

* Most laymen are understandably confused by the terms. Until about 1920, eye-specialist physicians were generally known as oculists; status seeking led them to style themselves ophthalmologists (which few patients can spell or pronounce). The man who made corrective lenses was an optician. An intermediate group developed, called doctors of optometry, who often did the eye measurement (refraction) on which the prescription was based. Opticians can still grind lenses but are forbidden to do the refraction.

* No responsible eye practitioner recommends wearing them all night (it is best to give the cornea a rest), though some wearers occasionally forget to take them out at night, awake without discomfort.

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