Nice Ink.

Blue eyes (and red hair) arose, it is now believed, around the Black Sea as a mutation in a single individual approximately 8000 years ago. This mutation and resulting trait provide few, if any, apparent evolutionary advantages, but it persisted and eventually radiated primarily into Northern and Western Europe. Perhaps there, the advantage of better production of Vitamin D stood its pale-faced owners in better stead, but there just does not seem to be any other advantage to survival. Evolution has no motive except survival. This brings us to the question of why blue eyes would persist and thrive without an obvious survival advantage. Paleoanthropologists believe that the persistence of blue eyes may simply be a sexual selection, much like a peacock’s tail, a sexual novelty. There are other possible explanations, of course, but this one seems to be the most logical. Now, 8000 years later, we are still finding eye color to be novel, and we are trying to find new ways to change it. Alio et al, in this month’s issue of Cornea, brought a new technique to the concept of changing eye color, although the technique was suggested in the early 1950s. Keratopigmentation: Alio is well known in corneal tattooing circles and probably has the most experience in this arcane discipline. But, I wonder about the patient’s motivation and especially the physician’s willingness to perform such procedures on healthy eyes. Tattooing is certainly gaining “cred” in our modern world, and the new lexicon of “nice tats” or “awesome ink” is often more in vogue among the young than other more customary greetings. But, these corneal tattoos are not meant to be the spectacle, the pseudogarment, or the message as would be the cutaneous tattoos, but rather, they are meant to blend in so well as to create the illusion of another eye color. There must be an undercurrent of strong desire for ocular cosmetic procedures because these authors are not the first who have attempted to change eye color. Recently, there has been a laser procedure promoted to create blue eyes from brown ones by pigment dispersion. Unsubstantiated reports of success without significant complications are not hard to find on the Internet. One has to wonder if these patients will show up in later articles with the tragedy of intractable pigmentary glaucoma or, worse, sympathetic ophthalmia. The urge to change eye color is strong as there are other methods that have been attempted including intraocular implants (BrightOcular), oral tablets (hydroquinone), and drops, although it is difficult to verify the success and safety of these agents. Certain diseases and treatment can change the color of the iris too. For example, prostaglandins, when used topically in and around the eye, can cause darkening of the periocular hair and iris, and moxifloxacin can cause an acute depigmentation of the iris with color change with an associated uveitis. The reports of spontaneous iris depigmentation are probably from moxifloxacin. But, these changes are usually not desired nor do they occur because of the desire to change iris color. The novelty of changing eye color by keratopigmentation, however, is a creative technique for this purely cosmetic desire. In the 7 reported cases, 3 female patients chose blue eyes, and 4 male patients chose brown eyes. It seems that blue eyes may not be the only attractive color as our predecessors of 8000 years ago believed. There should be concerns for such procedures. There are few animal studies to document safety or long-term potential problems, although previous human work suggests that there are relatively few safety issues. More commonly, though, such tattoos are placed in partially sighted or blind eyes—at least in previously published accounts. Altering eye color in an otherwise healthy eye, though, is a different matter, and other questions come to mind. For instance, how is contrast sensitivity affected? Dark adaptation? Visual fields? Visual optics? Driving abilities? This article states that visual function is not affected, although no documentation of that was presented.