Use of Single-Use Performance-Tinted Contact Lenses During Water Activities
Karl Citek, OD, PhD, FAAO, Dipl AAO
January 2024

Athletes and recreationists who participate in water activities will benefit from reduction of brightness
and glare and, if outside, protection from solar UV radiation. Many of these individuals also may need
vision correction in order to see clearly. Glare results from direct exposure to the sun and bright artificial
lighting, whether outside or indoors, and also from reflections of those light sources from the surface of
the water.1 The most common chronic eye health complaint associated with outdoor water activities is
an abnormal growth of the conjunctiva onto the cornea, known as pterygium, often referred to as
“surfer’s eye”.2 The condition is not limited to surfing, occurring in any environment to anyone who
experiences long-term exposure of the eyes to UV radiation, whether on water or land.
Tinted prescription and over-the-counter sunglass lenses with polarization and UV protection can be
effective for fishing and boating as well as driving. Unfortunately, spectacles are not effective when
swimming, surfing, water skiing, jet skiing, playing water polo, or even in a hot tub, since they can easily
fog, accumulate water, become dislodged, or, during sporting activities, harm or injure the wearer or
other participants during the course of play. Similar and other complications can occur with close-fitting
swim goggles.
3-5
Contact lenses can provide vision correction and UV protection. Importantly, tinted contact lenses can
reduce glare and increase visual comfort similar to or even better than sunglasses. In addition, while the
risk of ocular injury in sports is very low,6
the errant finger or elbow of an opponent or even teammate
can cause a corneal abrasion or laceration; contact lenses, while not traditional “impact-protective”
eyewear, could mitigate or even prevent damage to the wearer’s cornea in such situations.
7
Nonetheless, care must be taken with the use of contact lenses during water activities. In fact, the US
Food & Drug Administration (FDA) still advises that contact lenses should not be worn at all when
swimming or using a hot tub, but FDA does not consider or differentiate contact lens modalities or
hygiene.
8 Both the American Optometric Association9 and American Academy of Ophthalmology10 offer a
less strict guideline, suggesting that, if contact lenses must be worn when swimming, the user should also
wear tight-fitting swim goggles in order to avoid exposure of the contact lenses to water, whether it be
sea water, fresh water in a river or lake, or chlorinated water in a pool.
But for many professional and elite amateur water sports, even the best swim goggles may not be
appropriate, safe, or even allowed by the rules of the sport. For example, while surfers could benefit from
the use of swim goggles, there are several valid arguments against their use.11 Likewise, while the
American Academy of Pediatrics12 recommends that children who participate in water polo wear swim
goggles during practice and competition, National Collegiate Athletics Association (NCAA) water polo
rules13 require the athlete to obtain a prescription and written approval for the use of swim goggles and
other protective equipment that is not part of a standard uniform. Interestingly, international water polo
rules provided by FINA14 are silent on the use of swim goggles or other protective equipment, other than
to state that players “shall remove any articles likely to cause injury.” Consequently, many athletes who
surf, water ski, or play water polo do not wear swim goggles.
Contact lenses with UV protection and, especially, with tint seem to be the natural and automatic
alternative to spectacles and sunglasses, even without power for vision correction. However, the primary
significant risk of wearing contact lenses during water activities is eye infection due to adherence to the
lenses of microscopic organisms, contaminants, and irritants normally found in any water.15-16 A rare but
potentially very serious infection, which can cause pain and blindness if left untreated, is Acanthamoeba
keratitis (AK). In developing countries, AK can account for 2% of culture-positive corneal ulcers in noncontact lens wearers.17 The Centers for Disease Control and Prevention estimate that 85% of AK cases in
developed countries occur in contact lens wearers, with an incidence of up to 33 per million contact lens
wearers.18
Several recent studies have analyzed the incidence of AK in developed countries and the involvement of
contact lenses. A study from Australia, evaluating data over a 15-year period, demonstrated that the risk
of use of daily disposable contact lenses (4/52) is less than that due to corneal trauma or foreign body
(9/52).
19 A study from the UK, over a 1-year period, showed 3 out of 9 cases involved patients wearing
daily disposable contact lenses.20 It is unclear as to whether or not any of those patients used proper
hygiene techniques, such as not wearing the lenses longer than recommended and not storing and
wearing the lenses for multiple days. Another recent study in the UK demonstrated that, even though the
overall risk is low, wearers of reusable contact lenses (both daily-wear soft and rigid contact lenses) have
over a threefold increase in risk of developing AK compared to daily-disposable contact lens wearers.21
Thus, daily-disposable contact lenses, when worn and used as instructed, can significantly reduce the risk
of infection compared to other contact lens types and create no significantly greater risk than not wearing
contact lenses at all.
Contact lenses can provide vision correction to individuals in situations where they cannot or should not
wear spectacles or swim goggles. When participating in water activities, the best defense to exposure to
excessive brightness, glare, and UV radiation is provided by a tinted contact lens with UV protection.
Proper selection of contact lens type and subsequent hygiene and care are essential to allowing the lenses
to function as intended to improve the wearer’s vision and, more importantly, to keep wearer’s eyes safe.
Daily-disposable single-use contact lenses with UV absorbance and tint, when worn and used correctly,
are protective and do not increase the risk of infectious eye conditions more than not wearing contact
lenses. Specifically, ALTIUS® single-use performance tinted contact lenses block 100% of UV and over 99%
of total blue light (up to 500 nm) in either available tint, Amber and Grey-Green.22 The risks and benefits
for any individual should be fully discussed with an eyecare practitioner, to determine if contact lenses
will be safe and effective for that individual.

References
1. UCLA Health. Ophthalmology: Glare Sensitivity. https://www.uclahealth.org/medicalservices/ophthalmology/eye-signs-and-symptoms/glare-sensitivity. Accessed 11/10/2023.
2. WebMD. What is surfer’s eye? https://www.webmd.com/eye-health/pterygium-surfers-eye.
Reviewed 9/16/2022, accessed 11/10/2023.
3. Jonasson F. Swimming goggles causing severe eye injuries. Br Med J, April 2, 1977;1(6065):881.
4. Lamb RJ. Swimming goggles causing severe eye injuries. Br Med J, May 14, 1977;1(6071):1281.
5. Wakely LA, Reeves G, Ashraff N, et al. Swimming goggles suck. Br J Ophthalmol 2004;88:1600-1601.
6. Youn J, Sallis RE, Smith G, et al. Ocular injury rates in college sports. Med Sci Sports Exerc
2008;40(3):428-432.
7. Hou A, Jin ML. Goldman D. The protective effects of soft contact lenses for contact sports: a novel
porcine model for corneal abrasion biomechanics. Eye Contact Lens 2022;48:228-230.
8. US Food & Drug Administration. Everyday Eye Care: 7 Tips for Using Contact Lenses Safely.
https://www.fda.gov/medical-devices/contact-lenses/everyday-eye-care. Updated 10/28/2019,
accessed 11/10/2023.
9. American Optometric Association. Contact Lens Care. https://www.aoa.org/healthy-eyes/vision-andvision-correction/contact-lens-care?sso=y. Accessed 11/10/2023.
10. American Academy of Ophthalmology. What You Should Know About Swimming and Your Eyes.
https://www.aao.org/eye-health/tips-prevention/swimming-contacts-your-eyes. Updated 8/16/2016,
accessed 11/10/2023.
11. Elgar R. Do Surfers Wear Goggles? Why Most Don’t (+5 Pros & 8 Cons).
https://www.watersportgeek.com/surfers-goggles/. Accessed 11/10/2023.
12. Care of the Young Athlete Patient Education Handouts: Water Polo. American Academy of Pediatrics,
2011.
13. 2022-23 and 2023-24 NCAA Water Polo Rules and Interpretations. National Collegiate Athletic
Association, July 2022.
14. FINA Water Polo Rules 2019-2021. Fédération Internationale de Natation, 10 February 2019.
15. Choo J, Vuu K, Bergenske P, et al. Bacterial populations on silicone hydrogel and hydrogel contact
lenses after swimming in a chlorinated pool. Optom Vis Sci 2005;82:134-137.
16. Wu YT, Tran J, Truong M, et al. Do swimming goggles limit microbial contamination of contact
lenses? Optom Vis Sci 2011;88:456-460.
17. Garg P, Kalra P, Joseph J. Non-contact lens related Acanthamoeba keratitis. Indian J Ophthalmol
2017;65:1079-86.
18. Centers for Disease Control and Protection. Sources of Infection and Risk Factors.
https://www.cdc.gov/parasites/acanthamoeba/infection-sources.html. Updated 12/29/2021, accessed
11/10/2023.
19. Höllhumer R, Keay L, Watson SL. Acanthamoeba keratitis in Australia: demographics, associated
factors, presentation and outcomes: a 15-year case review. Eye 2020;34:725-732.
20. Hassan F, Bhatti A, Desai R, Barua A. Analysis from a year of increased cases of Acanthamoeba
Keratitis in a large teaching hospital in the UK. Contact Lens Anterior Eye 2019;42(5):506-511.
21. Carnt N, Minassian DC, Dart JKG. Acanthamoeba keratitis risk factors for daily wear contact lens
users: A case-control study. Ophthalmology 2023;130:48-55.
22. ALTIUS. Visible Light Transmission – VLT. https://altiusvision.com/visible-light-transmission-vlt/.
Accessed 11/17/2023.