in their choice of vision correction
It is estimated that around one in four people (27%) in the US who require vision correction use both spectacles and contact lenses.1
In theory, these ‘dual wearers’ have choice in how they correct their vision from day to day, but is this actually the case?
Do dual wearers gain beneﬁts from having ﬂexibility in how they see the world, and what does the option of contact lenses add for them? The vast majority of people with refractive error are spectacle only users. Do they feel happy wearing spectacles, or would they also beneﬁt from having choice in their vision correction?
A recent survey, commissioned by CooperVision and conducted by YouGov, was designed to investigate these questions. The experience of more than 4,000 dual wearers and 4,000 spectacle only wearers was analyzed. The results of the survey are shared in this report, along with suggestions of how to make use of the new insights in practice.
The online survey was conducted in October 2020 in eight countries (Figure 1). The total sample size was 8,203 adults aged 18 or over, split equally into spectacle only wearers (n=4,139) and dual users of both spectacles and contact lenses (n=4,064). (Table 1).
Just over one thousand responses were received from each country, evenly split between spectacle only and dual wearers (circa 500 in each group in each country). Of the dual wearers, 50% wore reusable and 48% daily disposable contact lenses, with just over half wearing them between 4-7 days a week (56%).
Reusable lenses were worn every day of the week by 43% of wearers, compared to daily disposables where a more even split in frequency of use was reported: 22% everyday, 22% 4-6 days and 23% 2-3 days.
(spectacle and contact lenses)
4,480 Female; 3,723 Male
Average age 48 (SD 8)
Spectacles 4-7 days a week 85%
Contact lenses 4-7 days a week 56%; (all CL types),
43% (Daily disposables), 68% (Reusables)
Daily disposable (1,936) 48%;
Reusable (2,047) 50%;
Other (81) 2%
KEY INSIGHT 1
The ﬂexibility dual wearers experience
As expected, the vast majority of spectacles wearers use them every day (87%). The key insight found in this survey relates to how dual wearers approach their visual correction. Most of them (62%) also wear their spectacles daily (Figure 1) and nearly half (48%) do so for 8 hours or more. Layering on their contact lens use, it starts to paint a picture of true dual wear, with frequency of contact lens use ranging from one day a week (7%) through to everyday (33%), with just over a third (36%) wearing their lenses for between 4-8 hours, and half (51%) for over 8 hours. The relatively even split of contact lens wear frequency across the week, combined with continued spectacle use, is further reﬂected in dual wearers choice of visual correction when going out in public (Figure 2).
These results illustrate the ﬂexibility dual wearers have available, with daily spectacle use in full time contact lens wearers still likely morning and evening, through to the other end of the spectrum of part time contact lens wearers choosing between lenses and spectacles based on the activities they may be doing each day.
- Dual wearers regularly use both spectacles and contact lenses
- Dual wearers gain ﬂexibility in their choice of vision correction, and use a combination of spectacles, contact lenses or both every day, as required
- When going out in public, half of dual wearers prefer contact lenses, just over a quarter prefer to wear their spectacles and one-ﬁfth are equally happy with both
KEY INSIGHT 2
The beneﬁts dual wearers receive compared to spectacle only wearers
Just under a third (32%) of spectacle only wearers said they enjoyed the fact that their spectacles feel comfortable, and that they formed part of their personality, making them ‘look more like themselves.’
However, the most common response to the question about what this group liked about their spectacles was that nearly four out of ten (38%) said they ‘did not enjoy anything about spectacles’ (Figure 3).
In contrast, dual wearers responded in greater numbers in each category for the reasons they enjoy their contact lenses. High on the list were that fact that contact lenses are more convenient (46%) and they ‘like the way they look in their contact lenses’ (52%). Perhaps due to the events of 2020 and the increasingly common need to wear a facemask out of the house, the fact that contact lenses do not fog up or get dirty was particularly appreciated by contact lens wearers (58%).
Previous work has highlighted the impact on quality of life that living with refractive can have with concerns centered around cosmetic appearance, ocular health, and difficulty performing day-to-day activities.2-5 For many patients, contact lenses can provide an option to help with these feelings, creating deeper emotional beneﬁts beyond vision correction. A survey of spectacle and dual wearers in the UK found more than two-thirds of contact lens wearers (68.5%)6 experienced increased self-conﬁdence, compared to just over one-third of spectacle wearers (35.4%).6 Feeling conﬁdent and experiencing improved quality of life was recently reported by more than 8 out of 10 in a survey of over 5,000 contact lens wearers in ﬁve countries.7
- A number of patients do not like anything about wearing spectacles and may beneﬁt from being recommended an alternative form of vision correction
- Dual wearers report practical and emotional beneﬁts when wearing their contact lenses
- More than 8 out of 10 (81.1%) dual wearers feel that having the option of both forms of vision correction gives them the ‘best of both worlds’ 6
KEY INSIGHT 3
Motivation to wear contact lenses, and barriers to starting
The two most common reasons that prompted dual wearers to try contact lenses agree with the beneﬁts reported above. Over half of lens wearers (54%) started because they found spectacles inconvenient for certain activities (such as exercise), and more than a third (37%) started because they did not like the way they looked in spectacles. Recommendation from their eye care professional (ECP) was reported as a reason to start lens wear by one-ﬁfth (21%) only (Figure 4).
Within the spectacle only group, nearly one-quarter (24%) said they did not want to try contact lenses. Among other barriers were fear of touching their eye (23%), being unaware contact lenses were available for their prescription (23%) and lack of recommendation from their ECP (15%) (Table 2).
- Dual wearers conﬁrm the main reasons for commencing contact lens wear relate to activities or wishing to change how they look
- Common barriers to contact lens wear are modiﬁable and can be addressed by ECPs, including advising on lens availability and providing tips on how to overcome concerns about touching eyes
- Lack of ECP recommendation rates as one of the reasons to not start contact lens wear, a barrier that could be overcome by taking a proactive approach in mentioning the option routinely8
KEY INSIGHT 4
Experience is key
Perhaps the most striking insight from the survey is the comparison between the responses of dual wearers and spectacle only wearers to the advantages of contact lenses. Both groups were asked to choose activities and occasions where contact lenses are preferred or perceived to be beneficial (Figure 5). Most popular were exercising and sport, special and social events, and vacations. The broad spread of responses from most to least popular was similar between the groups, however, the proportion of contact lens wearers able to recognize the benefit was significantly higher, by 2-4 x in every case (p<0.001). Further, half of all spectacle wearers felt that contact lenses would not be beneficial in any circumstance. While the difference in response is understandable from the point of view of ‘experiencing’ compared to ‘imagining’ something, this is also the key point to focus on. No different from test driving a new car, or trying on new clothes, it is simply not possible for a patient to appreciate the benefits and know if they will like contact lenses until they have experienced it.
- The benefits of contact lenses may be hard for a patient to imagine
- It is important to move from proactive recommendation of contact lenses to a lens on eye experience to help make those benefits tangible for the patient
- Applying contact lenses to help with new spectacle frame selection is one way to achieve this, reinforcing the dual wearer position of a choice of vision correction, and resulting in increased patient satisfaction, spectacle dispensing value and number of contact lens trials9,10
Using this in practice
Dual wearers gain from having a choice in their vision correction, and when contact lenses are worn, experience both practical and emotional benefits. Significant numbers of spectacle wearers do not enjoy wearing spectacles, may be misinformed about contact lenses, and may be waiting for their ECP to recommend them. A key insight is the dierence that exists between dual wearers and spectacle only patients in appreciating situations where contact lenses may be beneficial. The tips below may help to address some of the barriers and gaps highlighted in these results, helping to create more dual wearers in practice.
Make it personal
Illustrate the benefits of lens wear by giving examples based on the patients own activities and lifestyle.
Proactive recommendation of contact lenses by ECPs is crucial. Help patients understand their eyes are suitable for lens wear and that contact lenses are available in their prescription
Get lenses on eyes
On-eye lens experiences, for example when choosing new spectacle frames, are incredibly helpful for patients to understand the potential benefits of lens wear. They overcome initial concerns about what lenses feel like on the eye, and start creating moments where patients can appreciate the benefits of lens wear.
- CVI data on ﬁle 2019. Industry and Market data, US consumer CL market in 2018.
- Kandel H, Khadka J, Goggin M, et al. Impact of refractive error on quality of life: a qualitative study. Clinical & experimental ophthalmology 2017;45:677-88.
- Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optometry and vision science 2009;86:222-32.
- Walline JJ, Jones LA, Rah MJ, et al. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optometry and vision science 2007;84:896-902.
- Smith S, Morgan P, Orsborn G, et al. Subjective Acceptance and Quality of Life with users of Comﬁlcon A Silicone Hydrogel Soft Contact Lenses in a Multiple Aspheric Curve Lens Design. Optometry and vision science 2020;97:xxxx.
- Draper M, Patel K, Russell N. Mixed-methods study of behaviours and attitudes to vision correction of spectacle and contact lens wearers. Contact Lens and Anterior Eye 2019;42:e23.
- Jones L, Jones D, Langley C, et al. Reactive or proactive contact lens ﬁtting - does it make a difference? J Brit Contact Lens Assoc 1996;19:41-3.
- Atkins NP, Morgan SL, Morgan PB. Enhancing the approach to selecting eyewear (EASE): a multi-centre, practice-based study into the effect of applying contact lenses prior to spectacle dispensing. Contact lens & anterior eye 2009;32:103-7.
- Mayers M, Jansen Bishop M, Walerius D, et al. Improving your spectacle patients' in-practice experience with contact lenses during frame selection. Contact lens & anterior eye 2019;42:406-10.