April 8, 20256 min readAn Experimental Eye-Color-Changing Surgery Is Gaining Popularity—Here’s What We Know about ItA new surgical procedure to permanently change eye color is gaining traction in the U.S. But many ophthalmologists fear long-term unknownsBy Saima S. Iqbal edited by Lauren J. YoungSome people who have always wanted a different eye color, like this vibrant green shade above, are considering a new surgery called cosmetic keratopigmentation to permanently change them. Sergey Pristyazhnyuk/Alamy Stock PhotoCarol Miranda paid a surgeon in Los Angeles thousands of dollars last year to permanently change her eye color from dark brown to hazel.Miranda, a now 49-year-old sales associate, had dreamed since childhood of having hazel or green eyes. For decades she’d worn colored contacts and admired how the lenses “softened” her facial features. She sometimes wore them to bed or the beach despite doctors’ warnings. Then, in 2022, she learned of an experimental procedure called cosmetic keratopigmentation—which claimed to offer the effect of colored contacts sans the fuss.For the procedure, Miranda lay flat on an operating table opposite a large, machine-guided laser. Speculums bared her eyes wide as numbing drops desensitized the tissues. Her surgeon directed the laser to dig donut-shaped channels into each of her corneas, the clear outer coverings of the eyes. Using various handheld tools, the doctor then adjusted the edges of these channels and filled them with dye. In under 20 minutes and with minimal discomfort, the transformation was complete: Miranda’s honey-colored eyes looked “surprisingly natural,” she says.On supporting science journalismIf you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.Developed in small clinics in Spain and France in the 2010s, cosmetic keratopigmentation quietly entered the U.S. in 2019. Today just a handful of ophthalmologists in the country offer the procedure, and it is performed “off-label,” or at their professional discretion, without the U.S. Food and Drug Administration’s explicit approval or supervision. Yet public demand has recently surged, in part because of viral social media videos. Miranda’s surgeon and corneal specialist, Brian Boxer Wachler, has performed hundreds ofcosmetic keratopigmentation procedures since adding it to his practice in early 2024. Another well-established practitioner, Alexander Movshovich, told the Wall Street Journal last November that he was on track to perform more than 400 surgeries in 2024. The rise of cosmetic keratopigmentation has alarmed some ophthalmologists, who argue that the procedure is too risky to be readily available.Clients’ motivations range as widely as custom eye color options, which span the natural spectrum from icy blue to hazel. Some, like Miranda, believe different colors better suit their appearance. Others, Boxer Wachler says, find solace in having an eye color that resembles a family member’s, living or deceased. After receiving their new eye color, “I’ve had patients be giddy with laughter or cry of happiness,” Boxer Wachler says.In September 2024 surgeon Boxer Wachler transformed this client’s eye color from brown to a “medium-intensity evergreen.”Boxer Wachler Vision InstituteIn the early 2000s, people interested in similar cosmetic transformations often turned to iris implantation, an invasive and dangerous off-label operation then available in a few countries outside of the U.S. But iris implantation routinely causes chronic inflammation, glaucoma, cataracts and vision loss. By contrast, proponents of cosmetic keratopigmentation liken the newer procedure to LASIK (laser-assisted in situ keratomileusis), a widely approved procedure for correcting visual problems. Both LASIK and keratopigmentation procedures are generally quick, painless and easy to recover from. (At around $6,000 per eye, however, cosmetic keratopigmentation costs more than twice that of LASIK.)In December 2024 Boxer Wachler transformed another client’s eye color from brown to a “medium-intensity emerald green.”Boxer Wachler Vision InstituteEarly studies indeed suggest that serious adverse effects of cosmetic keratopigmentation are rare, and practitioners market the surgery as safe. But many ophthalmologists emphasize that research on the procedure features small sample sizes and short follow-ups, leaving crucial questions about long-term effects. And they fear that people may not be able to make an adequately informed decision because they lack a full understanding of risks. For example, Miranda says she had assumed the operation was approved by the FDA. In fact, it is not standardized or regulated by any American medical organization.“I tell my students, ‘You want to be on the cutting edge, not the bleeding edge,’” says Roberto Pineda, a corneal specialist at Massachusetts Eye and Ear. “Cosmetic keratopigmentation currently lacks scientific rigor.”In January 2024 the American Academy of Ophthalmology (AAO), the world’s largest association of eye doctors, warned consumers that both iris implantation and cosmetic keratopigmentation “carry serious risks for vision loss and complications.” The latter surgery could inflame or damage the cornea, the association said. Scarring of the cornea may also occur from potential infection. The dye might also leach out of its channels, potentially affecting other structures of the eye.Boxer Wachler, Movshovich and two doctors who pioneered cosmetic keratopigmentation promptly wrote to the academy, urging it to withdraw its warning and citing research they felt demonstrated the procedure’s safety. The academy has stood by its statement, says AAO spokesperson Thomas Steinemann, an ophthalmologist at MetroHealth.Boxer Wachler says few lasting adverse effects have been reported in the procedure’s medical literature. The largest study of outcomes to date, published in 2018, surveyed 204 people who’d undergone keratopigmentation in the past four months to 12-plus years. Of the 29 people who developed complications, 49 percent suffered light sensitivity that tended to resolve after six months; 19 percent saw their new eye color fade or change; and 4 and 2 percent, respectively, experienced slight visual field limitations or pain in magnetic resonance imaging (MRI) machines. A 2021 study conducted by some of the same co-authors, who surveyed 40 cosmetic keratopigmentation clients two and a half years after their operation, reported similar but less frequent complications. The authors of that study wrote in their paper that this shift reflected advancements in technique. More recent research documented five cosmetic keratopigmentation recipients who later developed ectasia, a corneal bulge that can distort vision without treatment.Visual field changes may arise because the procedure can flatten the dome of the cornea, Boxer Wachler explains. And if a person later has an MRI, swelling and burning of the eye can occur if the machine’s powerful magnetic field interacts with trace colorant metals in the new pigment. The FDA does not regulate such pigments, raising the risk of contamination by bacteria or damaging materials, including certain colorant metals.Boxer Wachler clarified he does not use pigments containing metals, though he declined to specify his dyes’ ingredients or sources. He and Movshovich say they’ve pioneered techniques to remove some of a client’s dye if needed, but the pigment generally persists in eyes. The removal techniques are mostly used to modify the intensity of a client’s new color or to swap it out for another hue.To better assess the long-term health risks and safety of a new procedure, ophthalmologists generally prefer to follow people over a minimum of 30 years, says Diane Hilal-Campo, a private-practice ophthalmologist and member of the AAO. Some serious complications build gradually, as with iris implantation, she notes.Cosmetic keratopigmentation surgeons may be able to extrapolate from the 25-year history of the procedure’s therapeutic counterpart: medical keratopigmentation. This treatment, also performed off-label, is an option for people born without irises or missing parts of them, which causes serious visual glare that can make daytime activities such as driving difficult or painful; in medical keratopigmentation, surgeons inject dye over missing regions of the iris to help block excessive light. Pineda, who began performing the therapeutic procedure in the late 1990s, notes that reports of side effects are limited but can include pigment fading and, in rare circumstances, spreading.A decades-long randomized controlled trial with hundreds or thousands of people who have received cosmetic keratopigmentation could best help doctors understand the procedure’s long-term implications. But the logistics would likely be too expensive or burdensome for test subjects, says ophthalmologist Kevin Miller of UCLA Health. Doctors who perform the surgery can voluntarily document people’s reports of severe complications or conduct limited survey-based studies—but they are not required to. Under current law, the recipient is ultimately liable for any benefits or burdens the procedure brings.Boxer Wachler says he declines to operate on people with a history of LASIK, eye inflammation, present or prior autoimmune conditions or other conditions that might raise the risk of complications. He treats clients at risk for glaucoma on a case-by-case basis. Steinemann advises anyone with a strong family history of eye disease to steer clear of the procedure, noting that it might obstruct surgeries needed to treat any future conditions. Boxer Wachler encourages prospective cosmetic keratopigmentation receivers to seek out experienced providers for the safest and most natural-looking results.Many ophthalmologists recommend that people interested in changing their eye color stick to colored contacts—a cheaper option they say poses minimal risk when used appropriately. Wearing poorly fitted or dirty contacts or regularly sleeping, showering or swimming with them can cause serious complications, such as corneal ulcers or potentially blinding infections. The AAO urges consumers to get their cosmetic contact fittings, prescriptions and use instructions from eye care professionals.“I’d ask people to remember,” Steinemann says, “that with your eyes, you don’t get a second chance.”