cl update

2010 Annual Contact Lens Update

The contact lens market experienced slight overall growth regardless of the recession, our annual report reveals.

RICHARD MARK KIRKNER, PHOENIXVILLE, PA.

Overall, office visits for contact lens (CL) patients increased ever so slightly in 2009 — up 0.4% compared with 2008 — or approximately 120,000 patient visits total, according to data from Advance Insights (formerly known as Health Products Research), an inVentiv Health company. (See “Total CL Patient Visits 2007-2009,” below.)

“The contact lens industry is not what you would say recession proof, but it certainly has been recession resistant,” says James Gardner, CooperVision's senior director of marketing-Americas. “For us to be in an industry that demonstrated growth in a recession year is somewhat incredible. It shows just how strong this sector is.”

Advance Insights data were derived from a panel that included O.D.s, M.D.s, independent retailers and chains. The following are the key trends in CLs in 2009 that defied the economic odds, according to Advance Insights data:

SiHy momentum continues

The trend of more patients visiting practitioner offices for silicone hydrogel (SiHy) CLs continued through 2009, reaching an all-time high of 14.1 million patient visits overall. SiHy CLs as a percentage of all patient visits continued to grow in 2009, accounting for almost 50% of patient visits last year. (See “Silicone Hydrogel Use by Year,” below.)

The reason for this continued growth? New materials and designs, says Loretta Szczotka-Flynn O.D., Ph.D., of Case Western Reserve University in Cleveland.

Optometrist John Schachet, of Centennial, Colo. attributes this growth to marketing. “As you know, no lens type is without its problems, and SiHys are no different, but their success shows the power of good marketing,” he says.

Practice Pearl: Offer SiHy lenses to patients who have highpower prescriptions, says optometrist William Townsend of Canyon, Texas. “Their lenses are thicker, and these patients are going to have a greater problem with oxygen permeability because their lenses are thick,” he says. “Those are always the last people to get the new materials.”

An age shift?

Two other data points that reached a peak in 2009 were patient visits for those 40 and older and for multifocal CLs, both posting strong growth in 2009. (See “Lens Type by Year” and “Patient Visits by Age Group,” below, respectively.) At the same time, visits by patients age 17 and younger declined 4.8% in 2009 from 2008, and visits for spherical CLs dropped about 1.6%, Advance Insights data show.

Practitioners cite a plethora of new multifocal CL designs in both soft and gas permeable materials as the reason for the increase in patient visits for this modality.

“Fitting has never been easier, and designs have never been so effective,” says optometrist Milton Hom, of Azusa, Calif. “The manufacturers are going to great extremes to support their multifocals.”

Dr. Townsend says he's seen emerging presbyopic patients marching into his Canyon, Texas, office. “…Emerging presbyopes are a patient group with unmet needs who have, for the most part, gone unnoticed,” he says. “It takes a lot of time and expertise to do a good job with them, but we have better multifocal and toric lenses and lens designs than we ever had before. That not only decreases the time we spend, but also increases patient satisfaction.”

Practice Pearl: Spread the word about multifocals, says Christine Sindt, O.D. and contact lens service director at the University of Iowa. “Many people don't know multifocal lenses are available or that they work well,” she says. As a result, Dr. Sindt says she embraces word-of-mouth opportunities, such as talking to local media and age-appropriate groups about multi-focal CLs.

The decline in patient visits in the 17-and-younger group last year comes as no surprise to Robin Chalmers, O.D., co-chair of the soon-to-be-published Contact Lenses and Youth (CLAY) trial, which involves 1,100 contact lens patients ages eight to 17. “Families have been hit pretty hard in this last [economic] downturn,” she says. “That's one thing that might cause children's visits to be underrepresented. Another thing is when people lose good jobs — the jobs most likely to have vision insurance — that insurance is probably responsible for a lot of the precisely annual visits that practitioners get.”

This shift may also be a reflection of the overall population, Dr. Schachet says. “I wonder as well as we look at the older-than-40 group whether that's just the demographic in the U.S. actually increasing,” he says. “And the other aspect [to consider regarding this data] is we really do have much better presbyopic CL options than we did 10 years ago.”

Practice Pearl: Despite this decline in visits, don't ignore the age 17-and-younger patient, says Dr. Chalmers. “If the practitioner is prepared to discuss the option with the child and his parents with the backing of the number of research findings recently published, the family will be able to make an informed decision,” she says.

Football fits

As is the case with presbyopic patients, astigmatic patient visits also grew in 2009. Specifically, patient visits for toric CLs accounted for 21.5% of all CL visits last year, compared with 20.6% in 2008, according to Advance Insights data. Aside from improvements in CL materials, CL fitters and industry sources alike also cite a wider selection of parameters than ever before as a reason for these visits.

“I think most people are starting to consider torics not specialty lenses anymore because they work so well,” Dr. Sindt says.

Practice Pearl: Offer today's torics to patients who just a few years ago weren't candidates, such as dry eye patients, says Dr. Townsend. “ … The lenses have much higher Dk values, and I'm encouraged by the results we're seeing with toric silicone hydrogels lenses,” he says.

Daily wear/daily disposables

Although patient visits for extended-wear modality CLs increased about 6.4% in 2009, based on Advance Insights data, this same data show that the proportion of patient visits compared with daily wear remained “relatively unchanged” from 2008. (See “Wear Schedule by Year,” below.) Specifically, the proportion of daily wear remained around 93% of patient visits through 2009.

Dwight H. Akerman, O.D., director, professional programs, North America, for CIBA Vision Corp., credits one-day disposable CLs and monthly planned replacement CLs for the continued shift to daily wear. “[This shift] is partially driven by better [patient] compliance that you find with [the one-day disposable CLs and monthly replacement lenses], which results in a better patient wearing experience,” he says. “The patients aren't stretching their CLs as much, and it's also financially better for the practitioner.”

The proportion of CL visits that are for monthly replacement lenses (as marketed), meanwhile, continues to grow (26.3% in 2009, compared with 24.4% in 2008). Actual patient visit volume for monthly lenses rose as well, increasing about 8% compared with 2008. These data fall in line with Bausch + Lomb's own observation of the practitioner market, says Carla Mack, O.D., M.B.A., and director of global medical affairs for Bausch + Lomb Vision Care.

“Monthly replacement CLs along with one-day disposable CLs could be considered more natural modalities,” she says, “because B + L data show that patients are more compliant with daily disposable and monthly replacement CLs vs. two-week disposable CLs.”

Based on the Advance Insights data, one-day disposable CLs continued to register double-digit growth in terms of patient visits, increasing 11% in 2009. The proportion of all patient visits for one-day disposable CLs grew to 6.4%, up from 5.8% in 2008. (See “Modality (As Marketed) by Year,” below.)

Other industry observers are not counting out two-week disposable CLs, as other data suggest that non-compliant patients stretch CL wear for longer periods of time with those lenses that have longer recommended wear schedules.

Colleen Riley, O.D., M.S. and Vistakon's vice president of professional development, says that the single-use CL modality has a lot of upside potential. “If you look around the world, single-use lens wear has been adopted by patients and practitioners more heavily than it has in the U.S.,” she says. “With innovative products, such as one-day silicone hydrogel CLs, on the way, we think the U.S. will begin to match the rest of the world.”

Direct-to-consumer advertising probably factors in this trend, adds Dr. Schachet, as manufacturers have “done a good job in marketing, and there are more options out there, more lenses.”

He adds that he believes daily disposable CLs are still getting a bump from the 2005 to 2006 Fusarium keratitis outbreak.

Practice Pearl: Offer one-day disposable CLs to patients who have questionable compliance to lens wear and care, says Dr. Sindt. “For existing wearers, I review cleaning and care, as well as do a comprehensive slit lamp exam,” she explains. “If I find anything that concerns me, I explain it to the patient and then offer one-day lenses as an alternative to what they are currently wearing.”

Although 2009 saw several market sectors continue to struggle because of the recession, the contact lens market showed resilience, according to Advance Insights data. That could be good news for you and your patients who can benefit from the innovations and trends in CLs. OM

If you are an eyecare practitioner and would like to participate in Advance Insights' quarterly panel, please visit www.rxsurvey.com/Enroll.