Dr. Robert Berry, a corneal specialist at Baptist Eye Center, is fighting to save the eye of a 33-year-old woman who purchased green tinted, non-prescription contact lenses from a Hot Springs convenience store and contracted a severe corneal infection. If the infection spreads, her entire eye might have to be removed. In the best-case scenario, Berry will be able to clear up the infection with medication. But even then, the woman's cornea will be irreversibly scarred, and a corneal transplant will be necessary to restore her vision.
The patient, who doesn't want to be identified by name and declined through her lawyer to be interviewed, purchased the lenses in late March but didn't take them out of their packaging and try them out until May 5. It was her first time to wear cosmetic contacts, so she didn't know that she should take them out and clean them at night. Three days later, she went to the emergency room with excruciating light sensitivity in one eye.
She was sent to a Hot Springs ophthalmologist, who immediately got her an appointment with Berry. The woman had developed a rare but serious corneal infection so painful that at one point she begged a doctor just to take her eye out. She has missed three weeks of her job managing a fast-food restaurant, and she spends her days wearing sunglasses in dark rooms. If someone opens a door, letting in a crack of light, she groans and drapes a coat over her head. She's facing mounting medical bills and, according to Berry, a one- to six-month wait for a donor cornea. Her lawyer, James Street, is trying to trace the lenses to a manufacturer and distributor, to figure out if legal action is appropriate. This is the first time he's handled a case related to contact lenses.
Non-prescriptive over-the-counter lenses, some under the brand name Freshlook, are sold at gas stations, flea markets, convenience stores, nail salons, wig shops or costume suppliers and other retail outlets, to people wishing to change their eye color. But selling over-the-counter lenses is illegal, and a subject of growing concern to the medical community, said optometrist Dale Morris of Forrest City, the president of the Arkansas State Board of Optometry.
For several years, optometrists and ophthalmologists have been seeing patients with infections due to illegal contacts. "But recently, in the past six months or so, it's become a crisis situation," Morris said. "Lenses come in different shapes. We take measurements of the eye to determine the curvature, so the lens will sit on the eye comfortably. If the lens is too tight, it causes a decrease in oxygen to the cornea, which causes it to lose transparency."
OTC lenses may contain carcinogens or other toxins, and buyers may clean them improperly or even share them with friends. Arkansas eye doctors have treated corneal abrasions, ulcers, trauma and infection resulting from the lenses. In Morris' experience, the buyers are often young women or teen-agers who want to dress up for an event, such as Halloween or prom, or who simply want to change their eye color.
"All contacts are a risk," Berry said. "We see problems even with patients who are prescribed lenses. The doctor looks at you, talks to you and determines if you're a good candidate, but sometimes there are still complications. Of course, the risk is far greater if you just buy contacts from a gas station. No one knows whether those contacts were made by a reputable manufacturer, if the package was sterile, if they were worn, returned, repackaged and resold ..."
In 2005 Congress passed an amendment to the federal Food, Drug and Cosmetic Act regulating the sale of contact lenses as medical devices. Sen. John Boozman (then a U.S. representative), an optometrist, led a bipartisan charge to make illegal the purchase of any contact lenses without a prescription. Arkansas law further specifies that only optometrists and ophthalmologists are allowed to sell the lenses. At a recent meeting, the Arkansas Board of Optometry urged eye doctors to question their patients, in an attempt to compile a list of illegal contact vendors. There are no statistics to gauge the extent of the problem, but at his Forrest City practice, Morris has seen four cases involving these lenses so far in 2012.
"There are over 300 eye doctors in the state," he said. "So assuming they've all seen at least one case, that's a pretty big problem."
The Board of Optometry provides the names of illegal lens vendors to the state Department of Health's Pharmaceutical Services, which may send an investigator to the seller to attempt to purchase the lenses. Pharmaceutical Services reports any illegal sales to the Optometry Board, which can compel the vendors to come before it. Sellers may be fined at least $1,000 but more often in the neighborhood of $5,000, "depending on the extent of their involvement, the amount of lenses being sold," Morris said. In the past year, six vendors have been fined across the state, including two Citgo stations, in Malvern and Pine Bluff; a Shell station in Pine Bluff, a BP Food Mart in Benton, a sunglasses store in North Little Rock's McCain Mall and a clothing store in Hot Springs. "We're fining and stopping these people, but they don't communicate with each other or educate each other — there's no association to disseminate information, so we're not sure how effective our method is," Morris said. The Arkansas Optometric Association has started an awareness campaign, and the state board has discussed the problem with the attorney general, though, attorney general's office spokesman Aaron Sadler said, the office has not received any consumer complaints and has no plans to begin an awareness campaign.
Often vendors testify that they didn't realize selling the contacts is illegal. Thus far local suppliers have all been based out of state — some out of the country. The board has no jurisdiction to fine the suppliers and no way to keep the contacts from entering Arkansas. Ted Mitchell, the owner of Party City stores in Little Rock and North Little Rock, said one of his managers purchased several cases of the lenses at a buying market in Houston. "They're called theatrical lenses. All the temporary Halloween stores have them. We'd been getting a lot of requests," he said. The lenses made it to the Party City shelves by March, and a few weeks later, the store sold its third pair, to an undercover member of the Pharmaceutical Services investigation team. Party City didn't get fined. Instead, it threw out the lenses and turned over supplier details. Mitchell had no idea the lenses were illegal. "How would we know?" he asked. "They were everywhere at the buying show. We were told they're just theatrical, they don't have prescriptions."
A manager at No Clothes, a clothing and accessory boutique in Hot Springs that caters to teen-agers, wasn't so lucky. She was fined $3,000 for selling the lenses. "I had no idea they were illegal, obviously," she said. "If I did, I wouldn't have sold them. They're sold all over the place. Everyone's got them."
The lenses are easy to find. With no leads, it took the Arkansas Times only four stops in roughly two hours to locate a vendor. After trying a few stores in North Little Rock's McCain Mall, we stopped at a Citgo station, where the cashier directed us to a beauty shop at Broadway and Rogers streets in Rose City. The beauty shop didn't have them, but at the adjoining Hess station, right beside the register, we found a plastic display case full of Freshlook cosmetic contacts. They're like something out of a sci-fi film, dozens of violet and seafoam green orbs floating eerily in small packets of liquid. They sell for $19 and don't come with instructions. The cashier claimed that they're safe. He didn't know if they were legal, "but if they put a price on something, I'll sell it," he said.