Operation to change eye color: risks of this fashion

Many people are not happy with the color of their eyes and believe that their appearance would improve if they had a different shade. Colored contact lenses are an option that not only serves to dress up for Halloween or carnival, but can also be used daily as another makeup accessory. However, their use is limited to a few hours and they require some care, and perhaps that is why other alternatives that allow you to change eye color permanently and irreversibly have become fashionable, such as cosmetic keratopigmentation.

Numerous influencers have promoted this specific technique on social networks, which has also featured in KOLOR 2024, a recent monographic international conference held in Alicante and in which the latest innovations in the field of eye color change have been discussed. . We explain what this intervention consists of, what its possible risks are, and what other alternative options exist.

What factors influence eye color

First of all, you will surely wonder what it depends on whether we have one eye color or another. Well, eye color is determined by a combination of genetic and biological factors, and the amount of melanin present in the iris, which is greater in brown eyes than in blue eyes and which is a hereditary trait, is decisive.

The factors that most influence eye color are:

• Genetics: There are numerous genes involved in this trait, and in fact, a study by scientists at King’s College London and Erasmus University Medical Center Rotterdam published in Science Advances identified 50 new genes for eye color.
• Inheritance: Inheritance patterns can be complex. For example, two parents with brown eyes can have a child with blue eyes if they both carry recessive alleles for the color blue.
• Melanin: Melanin is the pigment that gives color to our eyes, skin and hair. Brown eyes have a high concentration of melanin in the iris, while blue eyes have very little.
• Distribution of melanin: Not only the amount, but also the distribution of melanin in the different layers of the iris influences the color of the eyes.
• Age: Eye color can change with age. For example, babies are usually born with blue or gray eyes, but these can darken as they grow and melanin production increases.
• Medical conditions: Certain conditions can influence eye color. For example, Waardenburg syndrome, which is characterized by changes in the pigmentation of the skin, hair and eyes, which can be deep blue or different colors (heterochromia).

Surgical options to change eye color

There are various surgical techniques to change eye color permanently in healthy people who wish to undergo these interventions for aesthetic reasons:

• Place colored iris implants: this intervention was intended to correct vision problems in patients with iris defects or diseases such as congenital aniridia, in which their aesthetic appearance was also improved.
• Depigment the iris with a laser: a low-energy laser is applied that depigments the iris and lightens its color, but it does not help to achieve a specific shade in the eyes.
• Femtosecond Laser-Assisted Annular Keratopigmentation (FLAAK): consists of “introducing a pigment into the cornea, which is previously pocketed with a laser to achieve the shade desired by the patient,” explains the Spanish Society of Ophthalmology ( SEO).

Complications associated with surgeries to change eye color

Dr. Jorge Alió, professor of Ophthalmology at the Miguel Hernández University (UMH) of Elche and pioneer in the femtosecond laser keratopigmentation technique, affirms that it is supported by science and by research spanning more than a decade. Specifically, this prestigious specialist refers to a study in which he himself participated: ‘Cosmetic Change of the Apparent Color of the Eye: A Review on Surgical Alternatives, Outcomes and Complications’.

This work reviews the different alternatives available to change eye color and exposes the possible risks associated with them:

• Cosmetic iris implants: They are not CE marked or approved by the United States Food and Drug Administration (FDA) and serious complications can occur from their placement, such as uveitis, hyphema (or bleeding in the anterior chamber of the eye ), glaucoma, cataracts, corneal endothelial damage and vision loss. Research has shown that people with healthy, functional irises who undergo this surgery are at increased risk of complications that can seriously damage the eyes and vision, and even lead to blindness.
• Laser iris depigmentation: It can be performed on an outpatient basis using neodymium Nd:YAG (neodymium yttrium aluminum garnet) lasers, but it is not officially approved or licensed and there is still little scientific data on the treatment.
• Cosmetic keratopigmentation: It is the most studied technique and the available evidence suggests that it is the best surgical option for people who want a permanent cosmetic change in eye color. However, it is necessary to continue research to “optimize results, minimize postoperative complications and continue developing this and other new surgical alternatives, such as laser procedures.”

Possible risks of laser annular keratopigmentation

The potential long-term consequences of laser annular keratopigmentation are not well known and, therefore, experts from the Spanish Society of Ophthalmology (SEO) do not recommend this technique to permanently change eye color in people with healthy eyes and have issued a statement in which they warn that “patients have already been seen undergoing this intervention with serious corneal decompensations that have led to the irreversible loss of their transparency, leading the patients to a corneal transplant, which demonstrates “It cannot be considered a safe technique exclusively for aesthetic purposes.”

SEO also highlights other problems associated with this intervention:

• Peripheral loss of visual field.
• Difficulties in carrying out a complete examination of the fundus, the anterior chamber or the chamber angle.
• Difficulties in performing cataract surgery, retinal surgery, or any intraocular intervention by preventing the correct visualization of the ocular structures, which significantly increases the risks of these interventions and their intraoperative complications, in addition to negatively influencing the prognosis of the surgery.

In the opinion of these experts, at the moment there is not enough scientific evidence to support the safety and effectiveness of this intervention, which does not provide natural results either, since the appearance of the eyes is similar to what would be achieved with contact lenses. colors, they conclude.