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Current Trends in Daily Disposable Contact Lenses

Why has it taken so long for these lenses to catch on in the United States?

CARMEN F. CASTELLANO, O.D., F.A.A.O., ST. LOUIS, MO

When manufacturers introduced daily disposable contacts lenses a dozen years ago, some industry observers predicated they would quickly dominate the market, rendering other lens modalities all but obsolete. Instead, for a variety of reasons, their ascendancy in the United States has been less than meteoric, never rising above niche market status. In fact, the lenses' performance here has lagged dramatically behind other markets in the world where daily disposables enjoy greater popularity.

However, some industry analysts see signs this might be changing. Use of daily disposables in the United States has spiked significantly in recent years, and some predict their growth will outpace that of the "non-daily" soft lens market in the near future.

Recent statistics

Before we look at the recent surge in daily disposable popularity, let's review some past and recent statistics. Of the 53% of U.S. citizens who require vision correction, 13% wear contact lenses. Both in the United States and worldwide, the contact lens industry is viewed as healthy. Forecasters predict 7% to 8% annual growth is sustainable over the next few years.¹ Estimates put the global market at about $5 billion, with the United States accounting for 40% of that total.² Soft contacts make up 90% of new fits, with rigid lenses holding steady at 10%. Approximately two thirds of wearers are female, and about 16% are considered part time. The key growth drivers in the industry right now are silicone hydrogels and daily disposables.³

Historically, daily disposables as a percentage of new fits in the United States have hovered around 5%, but this figure is much higher elsewhere in the world. For example, dailies account from 40% to 60% of new soft lens fits in Japan, Scandinavia, Norway and Denmark.³ Overall, the U.S. daily disposable market share ranges from 7% to 10%, compared to about 33% worldwide.

Lens manufacturers and marketers have been scratching their heads for some time trying to figure out the cause of this discrepancy. Finally, they are beginning to see some encouraging trends.

This Strategic Skill Builders Continuing Education article is made possible by a grant from CIBA Vision. The content is independently produced by Optometric Management.

Today's market

The U.S. soft contact lens market grew by 6% in 2007, according to CIBA Vision marketing data. During that same time, the daily disposable market grew by 30%, beating even silicone hydrogels, which expanded at 20%. Meanwhile, daily disposable growth in Japan was reported at 10% and in Europe only 4%. Some industry analysts predict continued yearly growth of 20% or more in the United States over the next several years, which amounts to an increase in overall market share of 1% a year.⁴

To understand this recent trend, it is necessary to look back and explore the factors that limited daily disposable lenses in the past. Practitioners have long shied away from daily disposables due to design constraints and parameter constraints when compared to other contact lens options. Practitioners were also reluctant to embrace the lenses because of cost, which we will discuss. Frequently viewed as an excess, the modality was felt to offer little or no advantage to most patients. As a result, patients were often not even made aware of this modality, let alone offered it as an option.

Vistakon was the first to introduce daily disposables to the United States in the mid-1990s with its 1-Day Acuvue product. Shortly thereafter, CIBA Vision followed with Focus Dailies. Since then, a number of other companies have entered the market, and design refinements have occurred. Lenses are manufactured with remarkable consistency. Today there are over a dozen daily disposable designs listed on Tylers Quarterly Soft Contact Lens Parameter Guide. Spherical lenses offer power ranges from +5.50D to -12.00D, and limited options are now available in toric and multifocal designs. Newer materials have enhanced comfort by increasing moisture in the lens. Even cosmetic tinted daily disposables can now be had. (See Table 1 for a listing of available daily disposable lenses.) The first silicone hydrogel daily disposable will soon be available in the United Kingdom and Ireland, and shortly thereafter in the United States. Industry analysts anticipate the trend of improved materials and expanded parameters will continue in the coming years.

Sorting out the cost and compliance issues

Without doubt, the most prohibitive factor in the United States to the use of daily disposables has been the higher cost of the lens when compared to other soft contact lenses. But, we should ask ourselves, has this been a concern primarily of the practitioner or the patient? All too often, it seems, practitioners are the ones deciding the cost is prohibitive. However, if we factor in the convenience of daily disposables along with the drastically reduced cost of care products, many patients readily acknowledge the value of this modality. If we subtract the $150-a-year savings on cleaning and storage solutions, the overall cost difference between dailies and two-week replacements shrinks considerably.

In addition, recent scares involving Fusarium keratitis and Acanthamoeba keratitis, along with the highly publicized solution recalls, have created incentive for practitioners and patients alike to give daily disposables a second look. Investigators found poor lens hygiene to be a factor in 82% of the Fusarium cases reported in Singapore.⁵ Furthermore, in the Bausch & Lomb Renu with Moistureloc recall, it was not the preservative directly at fault, but rather a series of non-compliant behaviors such as patients allowing the solution to evaporate, keeping the lens bottle open between uses, and topping off lens cases. Such behaviors allowed the wetting agent to encapsulate the Fusarium spores, promoting their survival and germination. Given what is known about the deplorable state of patient compliance, we cannot ignore the clear benefits of removing from the equation solutions and lens care whenever possible.

To reinforce this point further, a recent survey by the Contact Lens Council found the following information regarding the habits of contact lens wearers:

► Fewer than 50% of patients said they clean their lens case once a week and nearly 30% of patients said they clean cases once a month or less.

► Only 65% report rubbing and rinsing lenses.

► Twenty-five percent always top off old solution and another 20% do so occasionally.

Previous studies and surveys have thrown light on similar behaviors:

► Most healthcare providers say one-third of patients follow instructions exactly, one-third follow instructions partially, and one-third of patients do not follow instructions at all.⁶

► Forty-seven percent of contact lens patients exhibit at least one aspect of non-compliant behavior regarding wear or cleaning regimens.⁶

► Somewhere between 40% and 91% of patients who wear contact lenses are non-compliant in their recommended care and maintenance regimen.⁶

► Up to 80% of contact lens complications trace back to poor patient compliance.⁶

► Twenty percent of patients replace their contact lens cases yearly; 23% never do.⁶

Most eyecare practitioners agree a vast amount of non-compliant behavior occurs. A recent Contact Lens Spectrum reader survey found practitioners believe only 8.5% of patients who require lens care systems are compliant. In fact, despite our best efforts to recommend specific care products, consumer research tells us that in 2007 private label products led the market among multipurpose solutions, accounting for 25.3% of sales.⁷

There is a persistent concern that those fitted with daily disposable contacts will wear them longer than prescribed. But consumer data provided by CIBA Vision indicates that 85% of Focus Dailies wearers are compliant with wearing schedules, while that figure is only 35% in soft lens wearers overall. This seems to suggest that contact lens patients generally avoid daily disposables if they do not intend to use them as prescribed.

Staining, health benefits and other factors

Much has been written in the professional literature regarding corneal staining and solution compatibility. Some research concludes that certain care products are problematic when applied to certain lens materials. Also, keep in mind that though today's solution preservatives possess higher molecular weights designed to preclude penetration into the lens matrix, sensitive patients may still develop allergic or toxic reactions.

A daily disposable lens modality is an easy way to obviate such concerns. Patients may occasionally require a saline or multi-purpose solution for rinsing but, with no need for soaking, preservative absorption and corneal toxicity cease to be worries.

As we begin to recognize the health benefits of daily disposables, we can also begin to see the positive effect they can have on profitability. Even in the face of competition from alternate source suppliers, dailies offer practitioners an opportunity to improve profitability via incremental box sales. When we factor in that dailies patients tend to replace lenses as prescribed, the profit margin increases further. Finally, dailies wearers tend to be successful and satisfied patients, which often translates into loyal patients and increased new patient referrals.

Most patients would benefit from the convenience and safety of daily disposables, but a few groups stand out as particularly good candidates. Those who work in dusty or dirty environments, such as construction sites, where reusable lenses tend to get unusually soiled, are prime candidates. Frequent travelers may also enjoy the convenience of not lugging solutions and other paraphernalia on trips, as well as freedom from cleaning lenses after a long business day. Airlines have also posed restrictions on fluids, which include drops and cleaning solutions. Those who wear lenses for intermittent sporting or social activities are also ideal, because daily disposables will not be left to soak in solutions for days or weeks at a time. And of course younger patients, who may be less likely to comply with lens care instructions, will find daily disposables a safe and convenient way to wear contacts, while providing their parents, and practitioner, with peace of mind.

Daily disposables may allow patients with chronic or seasonal allergies to tolerate contact lens wear. Once or twice daily use of prescription anti-allergic eye drops is conducive with daily disposables. And, by using a cleaner lens and a system free of preservatives, many such patients can return to and maintain successful contact lens wear. Dailies are also an excellent alternative for patients suffering from giant papillary conjunctivitis.

Finally, there is the matter of contact lens dropouts. How many times have patients told us they previously wore contact lenses but discontinued due to the hassles of lens care? These patients are prime candidates for dailies, especially as they have already experienced the visual benefits of contact lenses. Often they are thrilled to be offered an option that involves little or no care.

Trends in contact lenses as we move forward

Whether daily disposable penetration in the United States approaches 50% or more, as in other countries, remains to be seen. However, the upward trend appears obvious. Patients are looking for convenience and practitioners are looking for safety, and the daily disposable modality certainly blends the two. As more and more practitioners offer this modality, and as more and more patients enjoy its benefits, market share should follow. Moreover, as technological improvements continue, such as the availability of daily disposables in silicone hydrogel materials, the benefits, to both the patients and the practice, will continue to accrue.

Some industry analysts suggest that one day the contact lens market will consist of patients who can safely wear lenses for extended periods and those who dispose of their lenses on a daily basis. As we continue to see refinements and improvements in both these areas, that day may be here sooner than we realize. OM

1. Mack, C.J. Contact Lenses 2007. Contact Lens Spectrum; January 2008.

2. Kirby J. 2008 Annual Contact Lens Update. Optometric Management; April 2008.

3. Morgan P.B., Woods C.A., et. al. International Contact Lens Prescribing in 2007. Contact Lens Spectrum; January 2008.

4. Johnson J. A Wall-Street Perspective. Optometric Management; April 2008.

5. Levy B., Orsborn G. Clinical Risks: Myths and Truths. Contact Lens Spectrum; January 2008.

6. Castellano, C.F. 10 Steps to Improving Contact Lens Compliance. Contact Lens Spectrum; March 2004.

7. Gromacki S. Hydrogel and Silicone Hydrogel Lens care. Contact Lens Spectrum; ry 2008.

Dr. Castellano practices at The Koetting Associates, specializing in contact lenses. He also currently serves as adjunct assistant professor at the University of Missouri-St. Louis School of Optometry, Pacific University College of Optometry and Department of Ophthalmology and Visual Science at the Washington University School of Medicine. Dr. Castellano has provided advisory services to CIBA Vision (1992-1994) and Vistakon (2004-2006) and has no financial interest in any of the products mentioned in this continuing education article.