Non-Prescription Contact Lenses (Hansard, 28 October 2003)

§ John Robertson (Glasgow, Anniesland)

I beg to move, That leave be given to bring in a Bill to reclassify non-prescription contact lenses as medical devices; and to restrict their sale so that they can only be sold by, or under the supervision of, a registered doctor or optician.

The fad for coloured or patterned contact lenses, which alter the colour of the wearer's eyes, is a relatively new one, especially among young people, and that may be why we have yet to introduce legislation that adequately regulates their sale. As Plano—or cosmetic—lenses retail for about £25, they are a relatively affordable fashion accessory, and it is estimated that 90,000 people in the UK have used them. Such lenses have been popularised by sports stars who have worn Union jack lenses while representing their country, and by rock stars such as Marilyn Manson, whose scary white eye has become a popular style to emulate. In addition to patterned lenses, there are coloured lenses that intensify the natural colour of the eye or change it entirely.

The law as it stands allows people of all ages to buy fashion or cosmetic lenses over the internet, by mail order or in fashion accessory stores, without any consultation to establish whether the wearer is suitable for contact lens use. There is no requirement for regular check-ups and ongoing after-care, nor is there practical advice or proper guidance on inserting, removing, cleaning, storing and caring for the lenses.

The risks of infection for all wearers of contact lenses, both corrective and cosmetic, are high because lenses stop the cornea getting enough oxygen, thereby allowing the water layer on top to stagnate. That can lead to deposits of bacteria and dirt on the lens surface. Of course, there are guidelines for the use and care of lenses that, if followed accurately, can minimise the chances of infection. That is very important.

Failure to adhere to the guidelines can result in a range of infections and conditions such as microbial keratitis, a condition in which the cornea becomes inflamed after infection by bacteria, fungi or amoebae; interference with colour perception and binocular vision; and acanthamoeba, which can lead to ulceration of the cornea, and ultimately to blindness. Contact lens wearers who do not follow the care instructions are up to 80 times more likely to develop eye disease.

I am not for a moment suggesting that we stop young people wearing such lenses, but rather that they should have to buy them face to face with someone who knows what they are talking about. We need to emphasise the fact that although cosmetic lenses are fashion accessories, they are still intended for personal use, in the same way as corrective lenses. Ultimately, we need to stress that the overwhelming risks of non-adherence to hygiene instructions are very real for all types of lenses.

Although care instructions are issued with cosmetic lenses, they are no substitute for a qualified eye-care professional conducting a proper fitting and explaining how to use and care for lenses. Research suggests that many people pay little attention to written instructions and may give them only a cursory glance in their haste 177 to try the new lenses. I do not believe that men have a special gene or something in their biological make-up that gives them an aversion to following instructions, but I cannot think of many people whose first instinct, when faced with a new and exciting purchase, is to dive straight for instruction booklet before they have a go at figuring out how their new purchase works, particularly when small pictures are shown on the instruction leaflet.

Pre-sale assessment needs to be made a requirement for the initial supply of fashion lenses, and regular check-ups should take place before additional lenses can be supplied, in the same way as is required for corrective lenses. Why? First, a wearer needs to be assessed to ensure that they are suitable for contact lens use, and that the lenses that they seek to buy fit properly. According to the Royal National Institute of the Blind, more than 17 million people in the UK do not have regular eye tests, and the problem of irreparable damage is exacerbated if people harm their eyes by using lenses incorrectly without supervision and assessment.

If people buy lenses over the counter from a shop or through mail order, their suitability for wearing them will not be assessed. If the lenses do not fit properly, they can damage the surface of the cornea. If they are not inserted or removed properly, the risk of transfer of infection is greatly increased. Inserting and removing lenses for the first time is tricky and takes practice to get right. It needs a specialist to show new wearers how to do it, to encourage them when, at first, they get it wrong, and to answer any questions they may have.

There are different techniques for removing contact lenses. The traditional way of removing the lens between one's thumb and forefinger is hopeless if one has long fingernails, but there are alternatives to get around the problem, and these can easily be demonstrated. Having an eye-care professional instructing and supervising makes the world of difference.

If lenses are not cleaned and stored properly, the risk of infection is increased. I have heard of cases where people washed their lenses with water, or kept them in while swimming, which is not quite as grotesque as some of the risks that I have described. However, lenses are affected by the differences in water hardness throughout the country, which can lead to AK—acanthamoeba keratitis—a rare condition that initially causes irritation, but can lead to loss of sight in serious cases. The General Optical Council cited instances where lenses were stored in cases that were full of mould. If people are not required to attend a check-up before more lenses can be issued, infection may not be detected until permanent damage has been done.

More worryingly, I uncovered disturbing incidents of teenagers swapping lenses with friends—often at parties, among a group of friends—which obviously 178 greatly increases the risk of cross-infection. The dangers need to be stressed and stressed again at the point of sale. Worse still, I have received reports of untrained shop assistants demonstrating how to wear the lenses on themselves, before selling them on.

It is unsurprising that the call to regulate the sale of cosmetic lenses has been backed by professional bodies such as the General Optical Council, the RNIB, the Eyecare Trust, the Association of British Dispensing Opticians, the Association of Optometrists, the Federation of Ophthalmic and Dispensing Opticians, the College of Optometrists, and the Royal College of Ophthalmologists, as well as by a number of opticians who have treated people with infections caused by using novelty lenses, and by individuals who contacted me after being adversely affected.

I realise that it is rare for ten-minute Bills to advance much further than First Reading, but there is a real need for legislation on the issue. I understand that the Department of Health is planning to start a consultation this year and I hope that it will act soon. If my Bill fails to complete its passage, amendment of the Opticians Act 1989 would be a good place for the Department to start. Section 4 of the 1989 Act, which deals with sale of lenses, is wholly inadequate and is ripe for amendment. Under the terms of the Act, the sale and supply of contact lenses must be undertaken by, or under the supervision of, registered medical practitioners or registered optometrists". The key issue is how the courts define the word "supervision". My Bill or any other that is introduced to amend legislation on these matters would apply throughout the United Kingdom. The Bill would cover Scotland, as health professionals are a reserved matter.

Is it not time to introduce legislation to protect those who, through no fault of their own, do not know any better?