In Los Angeles, marketing has appeared for a surgery described as “Eye Color Surgery.” The promotional materials promise a safe, simple procedure to permanently change your eye color with results that are “instant and amazing.” You have brown eyes and have dreamed of having blue eyes; hazel eyes but you want to have green eyes: this could be your ticket. But wait a minute, is this too good to be true? How safe can it be if you have fly to Panama to have the surgery?
First, the procedure requires an intraocular surgery. Technically, the surgery is very straightforward. A small incision, under topical anesthesia drops, is made into the front of the eye at the edge of the cornea, which is the clear window of the eye, and in front of the iris, the colored part of the eye. A small thin, sterile, colored disc of silicone is folded and inserted into the eye where it is unscrolled in front of the iris. The disc is colored and is chosen based on the desired eye color. The disc has a central hole for the pupil but otherwise covers the iris so the eye color is now the color of the implanted disc. The incision is small enough that it self-seals and does not need a stitch: a few days of eye drops, and you’re good to go. So what could possibly go wrong?
Let’s consider what has been reported regarding the clinical experience of this device. The device was invented by a Panamanian ophthalmologist named Delary Kahn, M.D. and is covered by a US patent issued in 2004. According to his promotional materials, he invented the implant to help the Kuna Indians of Panama who suffer a high incidence of ocular albinism rendering them light sensitive. However, the implant is now promoted as a cosmetic treatment to permanently change eye color.
Dr. Kahn has not formally published any results in peer-reviewed journals, which is the accepted standard for meaningful scientific communication. However, Dr. Kahn has had several abstracts accepted which briefly describe his studies and are published in association with a presentation at a meeting. The standards for publication of abstracts are much lower than those for the publication of an article in a scientific journal because abstracts are considered preliminary scientific reports—a preview, if you will, of a current line of investigation.
The iris implant surgery is being advertised in the United States but it is not available in the United States. The device lacks FDA approval and the inventor makes no mention of current efforts, if any, to obtain FDA approval for cosmetic use. Potential patients have to travel to Panama for the surgery. The presentations to date by Dr. Kahn and his colleagues only include 12 patients. In terms of complications, these authors have reported that a 2.6% loss of the cells that line the back surface of the cornea at 8 months after the procedure. These cells called endothelial cells are responsible for keeping the cornea clear. If enough of the endothelial cells disappear, the corneal becomes filled with fluid and vision is degraded, possibly necessitating a corneal transplant. One patient also needed their color iris implant removed due to intraocular inflammation and the development of elevated eye pressure.
Only one report concerning these implants appears in the peer-reviewed literature: a paper by Thiagalingam et al (Thiagaligam, et al. Complications of cosmetic iris implants. J Cataract Refract Surg 2008; 34:1222-1224). These authors report the case of a 19-year old man who presented 2 weeks after implantation of colored iris implants with reduced vision, inflammation inside the eye, and glaucoma. Both color iris implant were ultimately removed to treat the inflammation. The authors of this report found that this man had lost a larger percentage of endothelial cells and had early cataract changes thought to be directly related to the placement of the colored iris implants.
With such limited information about this particular implant, is there any other body of information that might give us some insight on the likely effects of this particular surgery? There is a long history of anterior chamber implants to correct vision after cataract surgery and more recently so-called phakic intraocular lenses have been introduced to correct vision for individuals who are not candidates for refractive surgery on the cornea, like LASIK. Unlike the colored iris implant, a number of these intraocular implants are FDA approved. Further, clinical experience with these phakic intraocular lenses is well described in peer-reviewed papers. Even these FDA approved devices are, well, controversial. The key issue is related to the balance between risk and benefits. When the benefits are outweighed by the risks, responsible surgeons will strongly discourage the treatment. Unfortunately, these generally well-tolerated lens seem to damage the corneal endothelium over time.
With so little information about eye color surgery, can we say if it is safe or unsafe? The simple answer is yes. Even without the reports of eye inflammation following this procedure necessitating the remove of the implant, the risk/benefit ratio of this procedure is not good. The primary purpose of the surgery is permanently changing eye color. If you are not albino and missing iris pigment or have part of the iris missing either from a birth defect or from trauma, then there is no compelling medical reason for this surgery. Therefore, any risk of harm makes it very difficult to justify permanent eye color surgery just because you desire a different eye color.
The colored disk that is put in the eye has been shown to cause harm and this is completely foreseeable based on a long history of intraocular implants that have been used to correct vision either following cataract surgery or with so-called phakic intraocular lenses. When the natural lens is removed, the change in refraction is so profound, there is a very reasonable need to replace the natural lens with a man made implant. When this is done with an implant that sits in front of the iris, there is a much higher rate of complications then when the implant is placed behind the iris, which is the preferred method. Also, the colored iris implant has a fixed pupil size so it will interfere with adapting to dark lighting conditions and may interfere with examination of the back of the eye when necessary.
Don’t like your eye color? Well, contact lenses may be an option. However, trying to change your eye color with a surgical implant seems like a really bad idea. Having this type of eye color surgery is likely to result in long-term damage to the eyes and the real risk of additional surgery to remove the implant. AskMen.com called it right in reviewing the technology: “Normal people don’t permanently change their eye color. Crazy people permanently change their eye color.” If you still feel compelled to have eye color surgery, see you personal general ophthalmologist, and ask them what they think of the idea. After all, this is the person who will be responsible for saving your vision when things go awry after your eye color surgery.
Dr. Steinsapir is a renown Cosmetic, Facial and Eye surgeon in the Los Angeles / Beverly Hills area. Those interested in cosmetic surgery have traveled the world to be treated by a professional of his caliber and training. If you are interested in any of his available cosmetic treatments, please contact us today for a consultation.