contact lens overview
The State of Contact Lenses: 2003 In Review
The past year's industry figures show growth for disposable lens categories, but quarterly and traditional replacement soft lenses are losing popularity. But there's more.
BY KAREN RODEMICH, Managing Editor

Last year, the number of optometrist locations that dispensed contact lenses grew by 8.5%, according to Health Products Research, Inc. (HPR). With the number of total patient visits where contact lenses were dispensed growing by only 2.6%, some may conclude that the slices of the contact lens pie are shrinking for optometrists. But that's not so, says Rebekkah Carney, HPR manager of client services. The slice allocated to optometric practices have grown.

Ms. Carney explains, "If O.D.s were competing more with each other, then the number of patient visits per location would drop rather than increase, as it has (from 599 in 2002 to 645 in 2003)."

How have optometrists made their segment of the pie bigger? According to Ms. Carney, patients are migrating over from other segments (i.e., M.D.s, chains and independent retail locations).

Narrowing our focus

Let's take a closer look at the numbers as they apply to each category (soft contact lenses and hard contact lenses). Doctors as a whole dispensed more soft contact lenses than any other lens at patient visits. And so we begin with soft lenses.

Soft lenses. HPR identified 37,332 U.S. locations where soft contact lenses are dispensed, up from 36,235 in 2002. Of these 37,332, O.D.s operate roughly 18,658; M.D.s operate about 7,137; independent retailers operate approximately 5,193 and chains operate somewhere around 6,344. When we compare these numbers to those of last year, we see an interesting fluctuation. O.D. locations took a big jump of about 1,502, while M.D. locations only increased by two. Independent locations actually decreased (from 6,269 in 2002 to 5,193 in 2003) and chains also saw a healthy increase of 669 locations. The chart, "Soft Lenses by Modality" (on page 34) breaks down the soft lens category even further, as does "A Closer Look at the Soft Lens Category" on page 32."

► For a sense of how the soft lens category breaks down by the subcategories bifocal, toric and spherical, refer to the pie chart "Soft Lens Break Down" (at right). Interestingly, in 2003, the number of patients dispensed soft bifocal, toric and spherical lenses was relatively even between the four segments of the contact lens market. Says Lou Applebaum, Bausch & Lomb Senior Product Manager ­ Lenses, "The future growth of toric lenses will be driven by the continual upgrading of spherically masked astigmatic patients to better vision."

M.D.s saw big increases between 2002 and 2003 in dispensing bifocals and torics, and a slight decrease in dispensing spherical lenses. As for O.D.s, this segment's numbers remained consistent between the two years (see "Dispensing Specialty Lenses" on page 34).

A representative from CooperVision predicts that with the current trends, by the end of 2004, new brand dispenses will represent 70% of all multifocal lenses, which will demonstrate a 50% increase in volume. That source commented that, "The presbyopic population and the aging eye are sensitive to wearing contact lenses. Therefore, lens materials that do not dehydrate easily and are better for 'dry eye' will be the key for seeing further growth in this segment."

Mr. Applebaum adds, "What's most important to note is the true expansion of the industry in presbyopic correction that has helped limit the number of dropouts and increased the new wearer base of those older than age 40."

► As for cosmetic soft lenses, the number of patient visits in 2003 where soft contact lenses were dispensed looks like this:

• cosmetic tint (which encompasses opaque, shimmer and enhancing) = 10%
• no tint = 23%
• handling tint = 67%.

HPR didn't track Internet and e-mail company dispenses. However, according to Ms. Carney, "They are estimated at about 10% to 14% of the market, given the discrepancy between shipments and patient dispense estimates."

Hard lenses. The number of patient visits where the practitioner dispensed hard (GP + PMMA) contact lenses in 2003 was 1,371 (1,347 GPs + 23 PMMAs). Comments Edward S. Bennett, O.D., M.S.Ed., "Practitioners and patients alike value oxygen permeability. The tremendous impact of the Focus Night & Day lens is confirmation of this. Newer hyper-Dk GP lens materials such as Boston XO are increasing in popularity at the expense of lower-permeable GP lens materials." Looking at the data from HPR, the share of patient visits where contact lenses were dispensed for GPs was 5.4% -- down from 5.6% in 2002.

Observers noted that the GP category could be strengthened by orthokeratology (ortho-k), GP lenses that reshape the cornea. The FDA approved Paragon's corneal refractive therapy lens for overnight wear in 2002. Euclid Systems's ortho-k lens is pending FDA approval for overnight wear. Industry sources say the new ortho-k lens designs are effective and safe. In addition, they're highly profitable for optometrists to fit and dispense.

Last but not least

Here's how two new lenses factor into HPR's data:

Acuvue Advance with Hydraclear (Vistakon). This lens is a two-week lens, and was therefore classified in HPR data as "other disposable." It became available in January 2004. According to a Vistakon spokesperson, the company is currently on pace to meet/surpass the sales achieved by Acuvue 2 in its first year. "Part of the reason is that eyecare practitioners are realizing that Acuvue Advance Brand Contact Lenses with Hydraclear is a lens for all patients and that there is a much greater need for end-of-day comfort than they originally thought," commented the spokesperson.

Also, the breakdown of sales by distribution channel is similar to that of other Acuvue lenses, says the company. The spokespersons also states that all channels have a greater willingness to maintain inventory of lenses because Acuvue Advance with Hydraclear performs for all patients.

Focus Night & Day (CIBA Vision) lenses. HPR classified this 30-day extended wear lens as "planned replacement monthly." Patients wear them for 24 hours each day for up to 30 nights and days. These lenses were first made available in the United States in October 2001. According to the company, approximately 1.25 million individuals in more than 40 countries wear the lenses today.

A spokesperson for the company provided the following information:

• Demand for Night & Day lenses has continued to grow
• For the year ending September, 2003, new fits of Night & Day increased 224% from the year before
• Market research shows that the lens is becoming one of the most widely accepted and fastest growing categories in the U.S. eyecare industry with eyecare professionals and with patients

CIBA Vision predicts that in 2004, the silicone hydrogel category is likely to exceed 9% of U.S. industry sales and will surpass $100 million in U.S. manufacturer sales.

Experts weigh in

After reviewing HPR's data, some of our contributing editors gave their input. Says Brian Chou, O.D., F.A.A.O., "As expected, the proportion of disposable soft contact lens wear continues to increase, especially the monthly disposable category, but at the expense of conventional soft contact lens wear."

Dr. Bennett says, "It's evident that the current trend is away from traditional lens replacement and even quarterly replacement and moving toward daily to monthly replacement. Obviously, this increases patient comfort, vision and eye health."

He adds, "The contact lens bifocal market is increasing, although it's still the most underused lens application today. Most practitioners fear the complexity of GP and soft multifocal lens designs and instead prescribe monovision or single-vision lenses plus reading glasses. Patients are often being deprived of the quality of vision, cosmesis and visual freedom provided by bifocal lenses, which actually aren't that challenging to fit."

Reading the crystal ball

We've just reviewed the facts from the past year, but who knows what 2004 -- or even further in the future -- holds for the state of contact lenses. Dr. Chou says there's reason for excitement and possibly concern.

"Perhaps the most exciting stuff in contact lenses is still on the horizon," says Dr. Chou. "Such as wavefront-designed contact lens platforms, which are generating a buzz."

Dr. Chou adds, "Aside from lens technology, I expect the other newsworthy development this year will be the fallout of the Fairness to Contact Lens Consumers Act (FCLCA). The silver lining in FCLCA is that it will catalyze practitioners to cost-shift from contact lens materials into professional services. I expect fees for contact lens services will go up in response to decreasing material revenue, but the real question is, how quickly?"

Leverage your CL practice

Optometrists have nothing to fear -- but everything to gain -- from capitalizing on the contact lens segment of their practices. Manufacturers continue to produce newer, safer, and better lens designs and materials. Patients appear to be turning to optometrists for their lenses more and more. There are those practitioners who specialize in contact lenses -- might they be on to something?