During extensive research of the several tinted contact lenses on the market, a lack of information was noted as to whether or not tinted contact lenses can effect visual acuity under conditions of varying contrast. With this in mind we conducted a study to determine the effect of tinted contact lenses on visual performance under high and low contrast conditions. Using twenty-four research subjects, high and low contrast visual acuities were documented in order to compare performance with tinted to clear contact lenses. Two tints were chosen, royal blue and evergreen, with each person serving as their own control by wearing a pair of clear lenses. Subjects accepted for the study were required to have small refractive errors, + 1.00 to -4.00 diopters with astigmatism less than 0.75 diopters. Acuities were measured using Bailey-Lovie LogMAR contrast acuity charts, and the data analyzed with paired t-tests. The data showed that visual acuity decreased by approximately 1/2 a Snellen line under high and low contrast conditions compared to the clear lens performance. These data suggest that visual performance deficits can occur when tinted lenses are prescribed for cosmetic purposes, particularly under conditions of varying contrast. This may have impact in situations ranging from safety in the workplace to performance in sports or fine visual motor tasks, and it is suggested that patients be informed of possible difficulties when wearing deeply tinted cosmetic lenses

Borgholthaus, Jay L

Demeerleer, Jennifer R

Heller, Joan L

Shreck, William R

English

CommonKnowledge

Pacific University 
CommonKnowledge 
College of Optometry Theses, Dissertations and Capstone Projects 
5-1991 
Visual performance with tinted contact lenses 
Jay L. Borgholthaus 
Pacific University 
Jennifer R. Demeerleer 
Pacific University 
Joan L. Heller 
Pacific University 
William R. Shreck 
Pacific University 
Recommended Citation 
Borgholthaus, Jay L.; Demeerleer, Jennifer R.; Heller, Joan L.; and Shreck, William R., "Visual performance 
with tinted contact lenses" (1991). College of Optometry. 921. 
https://commons.pacificu.edu/opt/921 
This Thesis is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at 
CommonKnowledge. It has been accepted for inclusion in College of Optometry by an authorized administrator of 
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Visual performance with tinted contact lenses 
Abstract 
During extensive research of the several tinted contact lenses on the market, a lack of information was 
noted as to whether or not tinted contact lenses can effect visual acuity under conditions of varying 
contrast. With this in mind we conducted a study to determine the effect of tinted contact lenses on 
visual performance under high and low contrast conditions. Using twenty-four research subjects, high and 
low contrast visual acuities were documented in order to compare performance with tinted to clear 
contact lenses. Two tints were chosen, royal blue and evergreen, with each person serving as their own 
control by wearing a pair of clear lenses. Subjects accepted for the study were required to have small 
refractive errors, + 1.00 to -4.00 diopters with astigmatism less than 0.75 diopters. Acuities were 
measured using Bailey-Lovie LogMAR contrast acuity charts, and the data analyzed with paired t-tests. 
The data showed that visual acuity decreased by approximately 1/2 a Snellen line under high and low 
contrast conditions compared to the clear lens performance. These data suggest that visual performance 
deficits can occur when tinted lenses are prescribed for cosmetic purposes, particularly under conditions 
of varying contrast. This may have impact in situations ranging from safety in the workplace to 
performance in sports or fine visual motor tasks, and it is suggested that patients be informed of possible 
difficulties when wearing deeply tinted cosmetic lenses. 
Degree Type 
Thesis 
Degree Name 
Master of Science in Vision Science 
Committee Chair 
Cristina Schnider, O.D. 
Keywords 
Visual performance, contrast sensitivity, tinted contact lenses, low contrast, high contrast, logMAR units 
Subject Categories 
Optometry 
This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/921 
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VISUAL PERFORMANCE 
WITH 
TINTED CONTACT LENSES 
BY 
JAY L. BORGHOLTHAUS 
JENNIFER R. DEMEERLEER 
JOAN L. HELLER 
WILLIAM R. SHRECK 
A thesis submitted to the faculty of the 
College of Optometry 
Pacific University 
Forest Grove, Oregon 
for the degree of 
Doctor of Optometry 
May 1991 
Advisor: 
Cristina Schnider, O.D. 
r: ~-'", ,~, 
'' 
VISUAL PERFORMANCE 
WITH 
TINTED CONTACT LENSES 
By -
JAY L. BORGHOLTHAUS ____ =;-L--/2~.oc..l~------
JENNIFER R. DEMEERLEER_9-f"--2~-d2Jll~~----
JOAN L. HELLER ___ ..:::::... t.~';;.:~-:;;;L_'JJ._(_..1_J.. _________________ _ 
WILLIAM R. SHRECK_m~£?------------
ADVISOR: (! 
CRISTINA SCHNIDER, O.D. ___ [_IJJ:AB.t!J.J.l _1__~--
AUTOBIOGRAPHY 
CF 
JAY L. BORGHOLTIIAUS 
Originally from Payette, Idaho, Jay grew up with examples of the 
medical profession, his father being a dentist and his uncle, an 
optometrist. These influences in his life helped him to lead a course 
toward optometry school via undergraduate studies at Brigham 
Young University. He was accepted to Pacific University College of 
Optometry in 1987 and furthered his studies by obtaining a Visual 
Science degree in 1989 which will enable him to achieve the 
Doctorate degree in Optometry. 
After graduation, Jay plans to remain in the Pacific Northwest with 
his wife and son to pursue a career in a full-scope private practice. 
AUTOBIOGRAPHY 
CF 
JENNIFER R. DEMEERLEER 
Jennifer DeMeerleer was born and raised in the Pacific Northwest, 
and is currently residing in Forest Grove, Oregon where she has 
attended Pacific University College of Optometry since 1987. While 
working part-time in the private practice of an Optometrist during 
her high school and undergraduate years, Miss DeMeerleer 
developed a strong interest in the eye care field. She attended 
Pacific University for two years of undergraduate studies before 
being accepted into their optometric graduate program the fall of 
1987. She received her Bachelor's degree in Visual Science, Magnum 
Cum Laude, in the spring of 1989. 
Jennifer DeMeerleer would like to further her education in full-scope 
optometry and her special interests of contact lenses and geriatric 
optometry by pursuing a residency program following graduation in 
May of 1991. 
AUTOBIOGRAPHY 
(F 
JOANL. HELLER 
Joan Heller is originally from Denver, Colorado. A career in the 
health sciences had been of interest to Joan since early childhood. As 
a student at the University of Colorado, Joan narrowed her goals m 
the health field to Optometry. After completion of her 
undergraduate degree, Joan was accepted to Pacific University 
College of Optometry. She began her studies in the fall of 1987. 
During her four year optometry program Joan became interested m 
many areas of study. Her chief interests lie in the areas of v1s10n 
therapy, contact lenses and a special interest in low vision. 
Upon graduation, Joan hopes to enter into a full scope practice with 
an established practitioner. This will enable her to further her areas 
of interest while continuing to educate herself in primary care. 
AUTOBIOGRAPHY 
CF 
WILLIAM R. SHRECK 
William is originally from Broomfield, Colorado. He began his 
undergraduate studies in the fall of 1984 at Colorado State 
University. While at Colorado State University, William gained an 
interest in the optometric profession. He was accepted to Pacific 
University College of Optometry in 1987 and furthered his studies by 
receiving a Bachelor's degree in Visual Science in the spring of 1989. 
Upon graduation from Pacific University College of Optometry in the 
spring of 1991, William will return to Colorado to set up a full-scope 
optometric practice with special emphasis on contact lenses, ocular 
pathology, and pediatric orthoptics. 
ABSTRACT 
During extensive research of the several tinted contact 
lenses on the market, a lack of information was noted as to 
whether or not tinted contact lenses can effect visual acuity 
under conditions of varying contrast. With this in mind we 
conducted a study to determine the effect of tinted contact 
lenses on visual performance under high and low contrast 
conditions. Using twenty-four research subjects, high and 
low contrast visual acuities were documented in order to 
compare performance with tinted to clear contact lenses. 
Two tints were chosen, royal blue and evergreen, with each 
person serving as their own control by wearing a pair of 
clear lenses. Subjects accepted for the study were required 
to have small refractive errors, + 1.00 to -4.00 diopters 
with astigmatism less than 0.75 diopters. Acuities were 
measured using Bailey-Lovie LogMAR contrast acuity 
charts, and the data analyzed with paired t-tests. The data 
showed that visual acuity decreased by approximately l/2 
a Snellen line under high and low contrast conditions 
compared to the clear lens performance. These data suggest 
that visual performance deficits can occur when tinted 
lenses are prescribed for cosmetic purposes, particularly 
under conditions of varying contrast. This may have 
impact in situations ranging from safety in the workplace to 
performance in sports or fine visual motor tasks, and it is 
suggested that patients be informed of possible difficulties 
when wearing deeply tinted cosmetic lenses. 
Key Words: Visual performance, contrast sensitivity, tinted 
contact lenses, low contrast, high contrast, logMAR units. 
Acknowledgements 
The authors of this project wish to thank Dr. Cristina 
Schnider for her advise and expertise in dealing with contact 
lenses and statistical analysis. 
We also wish to thank the Ciba and Bausch and Lomb 
Companies for their support with materials supplied for this 
project. 
Visual Performance 
with 
Tinted Contact Lenses 
by 
Jay L. Borgholthaus 
Jennifer R. DeMeerleer 
Joan L. Heller 
William R. Shreck 
INTRODUCTION 
"Five foot two, Eyes of blue, Oh what those five feet can 
do, Has anybody seen my gal" . Songs like this have sparked 
an interest in appearance of eye color. With current 
technology an individual can now, by choice, choose their 
own eye color. Whether the lens color is tinted blue, green, 
or even purple, any variation from a clear lens may cause a 
person to wonder, "how much of my vision is being 
affected?" Today's eye care practitioners must also concern 
themselves with the possible visual hindrances associated 
with tinted lenses. One method of examining these 
disturbances is by testing visual acuity under varying 
conditions, rather than just under optimal conditions (high 
contrast, moderate to high illumination) as suggested by 
Josephson, et al.(5) Contrast levels can vary significantly in 
a person's normal daily activities. These variations occur 
not only during normal daylight vision; but also in night 
vision, sporting activities, restaurant dining and any area of 
life where variation of lighting and contours occur. Since 
vision becomes increasingly important for interpersonal 
and behavioral communication an optometrist should not 
solely be concerned with a person's vision under standard 
optometric testing conditions (i.e., high contrast Snellen 
acuity). 
Accordingly, we chose to investigate the area of tinted 
contact lens use under both high and low contrast 
conditions. Specifically we selected CIBA STD royal blue and 
evergreen lenses. Royal blue and evergreen lenses were 
selected due to the fact that they have the highest density 
of color of commonly available tinted lenses and therefore 
are likely to cause the greatest deficit in contrast sensitivity. 
The Ciba lenses were chosen because their tint is applied 
across the entire central portion of the lens. The Bailey-
Lovie chart was chosen due to its sensitivity 1n detecting 
subtle changes in visual function. ( 1 ,2) 
METIIODS 
Previous contact lens wearers were solicited for 
screening for participation in the study. Of those screened, 
24 people were selected on the basis of refractive error and 
biomicroscopic examination. The subjects selected were 
between the ages of 18 and 30, with refractive errors of 
+ 1.00 to -4.00 D with astigmatism less than 0. 75D. All 
patients with anterior ocular health contraindications to 
soft contact lens were excluded from the research. These 
conditions included giant papillary conjunctivitis, pterygia, 
tear film dysfunction, corneal/conjunctival abnormalities, 
etc. 
Each patient was fitted with a pair of clear and a pair of 
tinted lenses at an initial fitting visit. Lenses were fitted to 
achieve full corneal coverage and good centration and 
movement characteristics. At the dispensing visit, each 
patient was given the same standard regimen of care for 
their lenses (AOSEPT) as provided by CIBA. An adaptation 
period of one week was given, where subjects were asked to 
wear their lenses at least 4 to 6 hours per day. The subjects 
were then recalled for a single experimental session. 
Prior to testing, all subjects underwent a second 
biomicroscopic examination on both clear and tinted lenses. 
This was done to ensure both a proper fit and clean lenses. 
Subjects were tested on logarithmic scaled Bailey-
Lovie high and low contrast visual acuity charts provided 
by Bausch and Lomb. The actual chart contrast between 
the background and letters was approximately 85% high 
contrast and 7% low contrast. All testing was performed at 
the prescribed test distance of four meters. The advantage 
of using these charts was that they offered alternate letter 
sequences from the standard projected Snellen chart and 
hence prevention of patient memorization of the letters. 
Room illumination during testing was standardized and 
monitored at the testing site using a photometer at 15 
footcandles. 
The study used only routine procedures performed in 
clinical practice. This involved an overrefraction performed 
by the same examiner for all subjects in order to maintain 
consistent results. With best corrected sphere-cylindrical 
overrefraction in the phoropter, visual acuities were taken 
using first the low contrast chart followed by the high 
contrast chart. To standardize testing procedures, acuities 
were taken with the tinted lenses first, followed by the clear 
lenses. 
The data for each subject's right eye were then 
statistically analyzed via a computerized paired t-test. The 
log MAR value for visual acuity was utilized in the analyses. 
RESULTS 
Vision results are expressed as LogMAR or Log of the 
minimum angle of resolution, where 20/20 is expressed as 
0 (Log 1). Therefore, acuities better than 20/20 are 
expressed as negative values, and acuities worse than 
20/20 are positive. The Bailey-Lovie charts contain 5 
letters to a line, and each line equals 0.1 unit on the LogMAR 
scale. 
Table 1 summarizes visual acuity data gathered under 
the various test conditions. Note that both green and blue 
lenses caused a mean reduction in visual acuity for high 
and low contrast conditions. However, there was no 
difference between green and blue lens findings, so they will 
be treated as a single group for discussion purposes. 
(Insert Table 1) 
Table 2 presents the statistical analysis of this data. 
Statistically significant decreases were found for visual 
acuity under both high and low contrast conditions for 
colored lenses compared to clear lenses on the same 
individuals. These decreases correspond to a mean loss of 
about 3 letters for high and low contrast conditions when 
compared to the performance with clear lenses under the 
same testing conditions. 
(Insert Table 2) 
DISCUSSION 
The results clearly demonstrate a loss in visual 
performance with the deeply tinted hydrogel lenses used in 
this study compared to their clear counterparts. While not 
every patient demonstrated such losses, it is obvious that 
some may experience increased difficulties with fine acuity 
tasks when wearing tinted lenses, especially during 
conditions involving low contrast targets or low light levels. 
These data suggest that acuities should be carefully tested 
when tinted hydrogels are prescribed, and that results 
with clear lenses alone not be relied upon. Other data in the 
literature shows that contrast sensitivity losses can occur 
during soft lens wear. (3,4,5) Others report that since the 
mechanism of contrast sensitivity loss is unknown, it is 
apparent that the loss is often refractive because the 
degradation of vision is generally not correctable by 
altering the refractive power of the contact lens.(6) In this 
case, an alteration in the retinal luminance levels may be a 
factor, verses a shift in sensitivity due to the "band pass" 
filter placed on the cornea. 
REFERENCES 
1. Brown B, Levie-Kitchin JE. High and Low Contrast Acuity 
and Clinical Contrast Sensitivity Tested in a Normal 
Population. Optometry and Vision Science1989; 66:467-
470. 
2. Grey CP. Changes in Contrast Sensitivity during the First 
Six Months of Soft Lens Wear. Am J Optom and Physiol 
Optics 1987; 64: 768-774. 
3. Applegate RA, Massof RW. Changes in the Contrast 
Sensitivity Function Induced by Contact Lens Wear. Am J 
Optom Physiol Opt 1975; 52: 840-846. 
4. Kirkpatrick DL, Roggenkamp JR. Effects of Soft Contact 
Lenses on Contrast Sensitivity. Am J Optom Physiol Opt 
1985; 62:407-412. 
5. Josephson JE, Caffery BE, Pope CA. Clinical Experiences 
with Tinted Hydrogel Lenses. Contact Lens Forum, 
January1985; 43-47. 
6. Ho A, Bilton SM. Low Contrast Charts Effectively 
Differentiate between Types of Blur. American Journal of 
Optometry and Physiological Optics 1986, Vol. 63, No. 3; 
202 - 209. 
TABLE 1 -VISUAL ACUITY RESULTS 
X1: HCVA CLEAR 
Mean: Std. Dev.: Std. Error: Variance: Coef. Var.: Count: 
,.01 ,.076 1.016 j.oos 1757.816 122 
Minimum: Maximum: Sum: 
-. 1 4 .14 .22 
X2: HCVA COLOR 
Mean: Std. Dev.: Std. Error: Variance: Coef. Var.: Count: 
,.066 1.087 ,.019 l.oo8 1131.327 122 
Minimum: Maximum: Sum: 
-. 06 .24 1.46 
xa: LCVA CLEAR 
Mean: Std. Dev.: Std. Error: Variance: Coet. Var.: Count: 
,.334 1.119 ,.025 1.014 135.747 122 
Minimum: Maximum: Sum: 
.1 4 .56 7.34 
X4: LCVA COLOR 
Mean: Std. Dev.: Std. Error: Variance: Coef. Var.: Count: 
1.391 1. 11 1.023 1.012 
Minimum: 
.18 .62 8.6 
TABLE 2 STATISTICAL ANALYSIS, ALPHA= 0.05 
Paired t-Test X1: HCVA CLEAR Y1: HCVA COLOR 
OF: Mean X- Y: Paired t value: Prob. (2-tail): 
1-.056 1-3.852 1.0009 
Paired t-Test X2: LCVA CLEAR Y2: LCVA COLOR 
OF: Paired t value: 
21 -.057 -2.546 


Visual performance with tinted contact lenses

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