Regulatory measures for ensuring safe use of contact lenses

MOH's Reply

The Sunday Times, 18 January 2015

Regulatory measures for ensuring safe use of contact lenses

We are encouraged by letters highlighting the important role that consumers play in safeguarding their eye health when using contact lenses ("Safe to wear contact lenses, if proper care is taken" by Singapore Optometric Association president Koh Liang Hwee and "Best to go for regular eye checks" by Mr Yap Tiong Peng; last Sunday).

Consumers should undergo proper eye examination and contact lens fitting by registered optometrists or contact lens practice opticians. They should not buy contact lenses from unlicensed vendors over the Internet or from other dubious sources, as they are often counterfeit or substandard.

Using such illegal products may have adverse consequences like conjunctivitis, and corneal abrasions and ulcers that may lead to visual impairment or blindness.

Contact lenses for vision correction and therapy in vision disorders, such as myopia or astigmatism, are classified as medical devices and have to be registered with the Health Sciences Authority (HSA) before sale. This ensures conformity to the required standards of safety, performance and quality.

All importers and wholesalers dealing with such devices must obtain the relevant certifications and licence(s) from HSA. Anyone caught importing these contact lenses for sale without an import licence, or supplying unregistered or counterfeit contact lenses, can be fined up to $100,000 and/or jailed for up to three years.

From 2012 to last year, two persons were fined $4,000 and $12,000, and one was sentenced to community service, for these offences.

Since September 2011, HSA has rolled out initiatives to raise public awareness of the dangers of buying contact lenses from dubious sources. HSA has also reached out to online marketing sites to educate them on the regulatory requirements.

In Singapore, companies cannot sell contact lenses directly to consumers, including online. Companies can supply contact lenses only to qualified persons.

Under the Optometrists and Opticians Act, only registered optometrists and contact lens practice opticians can prescribe, supply and dispense contact lenses. Unqualified persons who prescribe, supply or dispense contact lenses may face up to a $25,000 fine, six months' imprisonment or both for a first offence, and up to a $50,000 fine, 12 months' imprisonment or both for a second or subsequent offence.

From 2012 to last year, six persons were prosecuted for such offences. Five persons were fined between $1,500 and $5,000. The case against the sixth person is still before the courts.

We will continue to maintain our close surveillance efforts and take the relevant enforcement and public health action to ensure the safe use of contact lenses in Singapore.

Lim Bee Khim (Ms)
Director, Corporate Communications
Ministry of Health

Raymond Chua (Assistant Professor)
Group Director, Health Products Regulation Group
Health Sciences Authority

Harold Tan (Dr)
Registrar
Optometrists & Opticians Board

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Forum Letters

The Sunday Times, 11 January 2015

Best to go for regular eye checks

Last Sunday's article ("Coloured, corrective contact lenses a concern") serves as a good reminder to consumers.

Users must get their eyes checked regularly to ensure that their eye health is not compromised by contact lens use. This service is provided routinely by optometrists. Unfortunately, the same level of care may be less accessible to users who buy contact lenses over the Internet. They also risk getting poor-quality, non-sterile or counterfeit products.

The article implied that coloured contact lenses are cosmetic and not medical devices. In fact, the Health Sciences Authority (HSA) considers all types of contact lenses to be medical devices.

The sale of contact lenses online is illegal here, and the HSA has often warned the public against buying them over the Internet. Blogshops and overseas sources are the main culprits.

The article also highlighted the risks faced by those using Ortho-K "hard" contact lenses. Patients should weigh the risks against the benefits before undergoing any treatment. Consumers can minimise the risks when they are under the regular care of an optometrist.

Yap Tiong Peng

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The Sunday Times, 11 January 2015

Safe to wear contact lenses, if proper care is taken

Contact lenses per se do not cause eye infections ("Coloured, corrective contact lenses a concern"; last Sunday).

Infections may be due to improper hygiene, non-compliance with the cleaning regimen, or lack of follow-up care. Infective organisms such as acanthamoeba are typically found in contaminated water.

If coloured contact lenses from non-reliable sources are a major cause of contact lens-related eye infections, then it would be prudent for the authorities such as the Health Sciences Authority to prohibit their sales on the Internet, or from any sources that bypass the opportunity for eye exams by an optometrist.

Contact lens industry sources estimate that there are 600,000 contact lens wearers in Singapore, and not 200,000 as previously stated.

This puts the incidence of contact lens-related infections at 0.06 per cent. This shows that, with appropriate measures in place, wearing contact lenses is safe and can be made safer.

The process of corneal reshaping with orthokeratology (Ortho-K) lenses is not a simplistic "squashing" of the cornea or "causing little breaks on the surface", but rather a gradual reshaping process due to the forces of the tear film under the lens. A properly fitted orthokeratology lens does not contact the cornea but sits on the tear film. At no time is the corneal surface meant to be broken.

Studies show that orthokeratology lenses are no riskier than other types of contact lenses worn overnight. However, one has to consider the merits of orthokeratology, that is, control of myopic progression.

High myopia is a potentially blinding condition. While there are other options, there is none that is risk-free. With orthokeratology, the benefits outweigh the risks.

I hope that with the involvement of the optometric community in this dialogue, the public will have a balanced view of the issue of contact lens use, and be mindful of the need for compliance.

Koh Liang Hwee (Dr)
President
Singapore Optometric Association