By Courtney Dryer, OD and Jennifer Palombi OD, FAAO
Innovation in contact lens materials, modalities and designs has driven the U.S. contact lens market in the last several years. Material enhancements for improved comfort combined with unique lens designs now allow providers to fit more patients in contact lenses than ever before. Adults with presbyopia, children with myopia, and digital device users of all ages are expected to expand the demographics of the contact lens market. The U.S. contact lens industry is expected to grow at a compound annual rate of 5.6% over the next 10 years.1
Of the projected 164 million current spectacle wearers in the U.S.,2 only 45 million wear contact lenses.3 Two-thirds of contact lens wearers are female and contact lens wearers are, on average, 31 years of age.3 These estimates indicate enormous potential to convert more spectacle wearers to contact lens wearers and broaden the base.
This potential for market growth presents tremendous opportunity for both eye care professionals (ECPs) and their patients. Contact lens evaluations and lens sales are vital to practice growth and profit; contact lenses improve the lives of those who wear them.
Patients Benefit from Contact Lens Wear
Contact lens wearers of all ages report improved vision satisfaction, self-perception, and quality of life when compared to spectacle wearers.4,5 Studies in children4 and teenagers7 highlight improved physical appearance, athletic competence, and social acceptance with contact lens wear. Americans who wear correction prefer contact lenses for sports when compared to spectacles or refractive surgery.6
With the onset of the pandemic and new occupational safety and mask guidelines, many American workers report an increase in spectacle fogging and intermittent blur. Many healthcare workers have sought out contacts to eliminate spectacles from under layers of PPE. Research conducted in 20218 showed that contact lenses are the preferred visual correction with masks. Patients also report the contacts/mask combo is superior for day-to-day activities such as walking and exercising.8
Practices Benefit from Lens Wearers
When compared to spectacle wearers alone, contact lens wearers are more valuable to practice profitability over the lifetime of the practice.9 About 50% of Americans have vision insurance,10 and those who wear contact lenses have more frequent eye examinations (18 months vs 24 months), pay higher fees per exam and make more frequent purchases.11 They often purchase spectacles along with an annual supply of contact lenses and are likely to use their vision benefits yearly.
Retaining current lens wearers and adding new wearers is important to practice growth and profitability. In fact, lens fits and lens sales account for 17% of all practice revenue.12 Retail sales from contact lenses have grown at a faster rate than eyewear sales.13 When compared to other lens modalities, disposable lenses can be more profitable for the practice.13 Disposable lens wearers are more compliant and return on a more frequent basis13.
Best Practices for Growth
ECPs can identify new contact lens wearers and grow their practices by utilizing screening techniques, educating on technological advancements, and targeting specific patient subsets. Existing contact lens wearers can also benefit from upgrades in technology and modality and are more likely to see the value in yearly examinations when their visual needs are proactively addressed.14
Utilize Screening Techniques
Lifestyle questionnaires are an effective way to identify new wearers. Many electronic health records (EHRs) provide an opportunity for the patient to complete a questionnaire prior to arrival so staff can allocate time for new fittings. Staff should be trained to ask a new patient upon scheduling if they currently wear correction and if they may be interested in contact lens wear. Proper screening techniques can help identify those who unsuccessfully tried lenses in the past but are willing to try again. Asking patients lifestyle questions regarding hobbies, occupation, and sports can initiate conversations that lead to new fittings. Many patients remain unaware of the many market options for lenses now available but would prefer contact lenses assuming good vision and comfort can be achieved.15
Many lens wearers have experienced issues with dryness or poor vision in the past and expect that to be the standard.16 An ECP’ should consider annual education on lens technologies and benefits for ocular health and to help eliminate barriers to lens wear.
Educate on Technological Advancements
Contact lens dropout has can negatively impact practice profitability. Across developed countries, the rate of dropout ranges from 12.0% to 27.4%.16 In fact, 25% of new wearers discontinue contact lens wear within the year following their first fitting.17 Contact lens dropout can be minimized with education, switching lens brand or modality and/or early treatment of ocular surface disease. In new contact wearers, specifically astigmats and presbyopes, dropout was due to poor visual performance.18
Many patients who have worn lenses in the past cite dryness16, inconvenience19, or becoming presbyopic20 as reasons for lens discontinuation. With education on new materials, optical designs, and/or ease of cleaning, many are willing to try contacts again.18
Both existing contact lens wearers and potential new wearers should be annually updated on the latest advancements and availabilities in contact lens wear.14 The rise of disposable lens use has helped improved the contact lens wearing experience for many patients and makes for an ideal introduction point to contact lens wear. Disposable silicone hydrogel (SiHy) contact lenses have become the most preferred lens by ECPs. It has been reported that 90% of ECPs agree that daily SiHy lenses are the healthiest option for patients and provide a better wearing experience.21 When compared to Europe and Japan, the U.S. fits substantially fewer disposable lenses.13 ECPs should ask why more patients are not fit in silicone hydrogels, given that they agree that they are the best solution for patients. ECPs assume their patients may be unwilling to pay for disposable SiHy lenses.21
By asking leading questions of existing wearers, ECPs can address current and past problems and provide appropriate solutions. Proactive ECPs can prevent dropout by addressing patient satisfaction with current comfort and vision.
- How is your vision throughout the day?
- Are your contact lenses comfortable throughout the day?
- If there was anything you could improve about your contact lenses, what would it be?
- Is there anything you dislike about your current contact lenses?
- Are lenses as comfortable after weeks of daily wear vs. a new pair?
An ECP should recommend the best solution for a patient’s vision and ocular health.
Allow patients to trial daily disposable lens options before making decisions on cost. Contact lens wearers agreed they would be willing to pay more for new or improved features and believed their doctors would recommend the most healthy option.22 Placing lenses on a patient for them to wear during the frame selection process can be one tool to convert patients to new wearers.23
Target Patient Subsets
Contact lenses should be recommended for specific subsets of patients including digital device users, presbyopes, and age-appropriate childhood myopes. Patients in these groups are likely to be unaware of the potential improvements in quality of life and visual performance.
Digital Device Users
Americans spend 60 hours each week on digital devices24 and 50 to 90% of users report symptoms of digital eye strain.25 Contact lenses can be a preferred alternative to blue-blocking glasses. Innovation in aspheric contact lens designs can improve digital eye strain symptoms by easing stress on the ciliary muscle and reducing the burden of accommodation on the eye.26
The increase in myopia prevalence in children corresponds with increased near work and a lack in time outdoors.27 Genetics are also a contributing factor.27 By 2050, it is estimated the worldwide population of myopes will reach 4.8 million.28 Though the prevalence of myopia is highest in Asian countries, studies on non-cycloplegic refractions show myopic prevalence in the US as high as 42%.29
Contact lenses are an ideal solution for myopia control in age-appropriate children. Children gain increased self-perception,4 experience few complications with contact lens wear30 and demonstrate lifelong ocular health benefits from myopia control.31 Children can be as simple to fit as adults and are successful at wearing disposable contact lenses.32 As the myopic population continues to grow, the improvements in quality of life and the ocular health benefits of controlling myopia in age-appropriate children with contact lenses should be discussed with each family.33 In late 2019, the FDA approved* MiSightÒ 1 day, the first contact lens approved to slow the progression of myopia in children aged 8-12 at initiation of treatment.34,35**
Patients new to presbyopia are eager to know their options for vision correction and rely on their ECPs to provide the best solution. There are an estimated 40 million people approaching presbyopia (age 35-44) and another 142 million already aged 45 or older in the U.S.36 An estimated 32.6 million Americans wear OTC readers.2 Presbyopia is associated with a reduction in quality of life as reported by patients.37 Most patients are aware of the aging process, but unfamiliar with the term presbyopia. This lack of understanding may account for the 34% of presbyopia remaining uncorrected in developed countries.37 Amongst ECPs, a survey found that .50% recommend contact lenses for presbyopes38 though less than 10% of patient report their ECPs mentioning multifocal contact lenses. Those who already wear contact lenses for distance correction report an interest in near vision correction.37 A discussion of vision solutions should always include contact lenses, including those with newly onset presbyopia.
Historically, comfort and vision have been reported as primary reasons for contact lens discontinuation in patients with presbyopia.39 With many multifocal contact lens options on the market today, attaining acceptable comfort and vision is possible. Many fitting guides exist to help reduce chair time and increase patient satisfaction. Today, multifocal contact lenses are available with new designs in daily disposables, toric options, and in silicone hydrogel materials, providing both enhanced visual performance and health outcomes for presbyopic patients. With proper education and appropriate expectations, presbyopes can be successful new contact lens wearers and a significant source of profit for the practice.
Contact Lens Capture
With the rise in online contact lens sales and low market prices, it can be difficult for ECPs to capture and retain contact lens sales. Annual patient education is necessary. The ECP and staff must convey to patients ways to maximize their insurance benefits and utilize manufacturer rebates, and the office should invest in a direct-to-patient lens delivery service to capture contact lens sales. Doctors may compete with online distributors by offering convenient delivery methods to their patients.
Utilize Manufacturer Rebates
Product rebates allow ECPs to bring value to their patients and compete with other sellers. Equip your front desk with resources to promote and educate patients on rebates. By providing your patients with all the rebate information, it becomes easy for patients to do business with your office.
Invest in a Direct-to-Patient Contact Lens Service
Many direct to patient contact lens ordering systems exist and several of the major contact lens manufacturers offer these services to practices. In many cases, these e-commerce solutions will make patients aware when their current contact lens supply will run out and they will be offered the chance to make an additional purchase through your office. A simple text or email to the patient can prompt them to purchase from their ECP instead of online. By utilizing manufacturer rebates and services, the practice can make buying contact lenses easier for their patients and capitalize on contact lens sales. ECPs can grow their capture rate of soft lens sales over the current industry standard of 76%.13
Successful screening methods, patient education on new technologies, and broadening patient targeting can result in greater satisfaction, loyalty to the practice, and enhanced quality of life for patients. In turn, optometry practices experience increased growth and profitability when ECPs actively pursue new contact lens wearers from within their practices and update existing wearers on new lens materials and designs.
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2. Organizational Overview. 2018. Accessed January 14, 2022. https://www.thevisioncouncil.org/sites/default/files/TVC_OrgOverview_sheet_0419.pdf
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5. Coates ZA. Contact Lens, Academics, and Self-Perception (CLASP) Study: Study Design and Initial Results. The Ohio State University; 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1554753474788361
6. Zeri F, Pitzalis S, Di Vizio A, et al. Refractive error and vision correction in a general sports-playing population. Clin Exp Optom. Mar 2018;101(2):225-236. doi:10.1111/cxo.12626
7. Plowright AJ, Maldonado-Codina C, Howarth GF, Kern J, Morgan PB. Daily disposable contact lenses versus spectacles in teenagers. Optom Vis Sci. Jan 2015;92(1):44-52. doi:10.1097/opx.0000000000000454
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34. FDA approves first contact lens indicated to slow the progression of nearsightedness in children. 2019. https://www.fda.gov/news-events/press-announcements/fda-approves-first-contact-lens-indicated-slow-progression-nearsightedness-children
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**Indications for use: MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal.
**Compared to a single vision 1 day lens over a 3-year period.