Article Date: 4/1/2010

2010 Annual Contact Lens Update
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.

Specialty CL fits increased

Specialty CLs brought more patients back into practitioners' offices in 2009 than in 2008, according to Advance Insights data. Patient visits for toric and multifocal CLs last year increased 4.5% and 10.3%, respectively, while visits for GP CLs increased 4.3% in 2009 (although the proportion of CL visits for GP lenses remained fairly flat, at 3.5%). (See “Lens Material By Year, ” below.) Decision-makers in the specialty CL field anticipate 2010 to build on these positive trends.

“We saw actual growth in what we consider to be a down year,” says Steve Brauner, president of the custom-order soft-CL company SpecialEyes. Because practitioners don't stock SpecialEyes CLs, Mr. Brauner says his company is “kind of like a canary in a coal mine” on the economy.

At Blanchard Contact Lenses Inc., Lee M. Buffalo, national sales director, attributes 2009 growth to three new CLs the company offers: the RSS Refractive Surgery Specific CL; Biexpert multifocal (also licensed by Art Optical); and Reclaim HD Bi-Aspheric multifocal. “We believe 2010 will be just a phenomenal year,” he says.

Menicon's acquisition of the RoseK CL for keratoconus in late 2008 led to an “upper single-digit” growth in that business in 2009, says Jonathan Jacobson, general manager of global strategy and operations. “We're seeing more interest in [CLs for] irregular cornea fittings,” he says. Mr. Jacobson adds he anticipates that growth in multifocal CL designs will drive demand by labs for Menicon Z GP material.

As is the case with many CL labs, Art Optical added soft CLs to its product mix to become a one-stop shop. “We're experiencing growth in soft lenses, but it's nowhere near the volume we're doing in gas perm contact lenses,” says Mike Johnson, director of consultation services. Orders for Art Optical's menu of toric and multifocal CLs have grown in the past year, he says, thanks in part to licensing the Biexpert bifocal technology. “It's given us just that little added push again from the practitioner seeing something new and asking about it,” he says.

Kevin Lippert, president/chief executive officer of Lensco, is anticipating a new soft CL multifocal this year, following up on 2009 when multifocal CLs accounted for most of the company's growth. “This year, a lot of the push is going to be on daily disposable lenses,” he says. “The majority of doctors that our field reps are talking to feel that the contact lens business will grow overall this year.”

Paragon Vision Sciences' CRT CL has made a strong impact in the age eight-to-18 age group and among former soft CL wearers experiencing discomfort, according to Pam Scoggins, director of sales and marketing development for the company. “These people are struggling with daytime discomfort, but are making every attempt not to return to wearing glasses,” she says. In 2009, Paragon introduced its SureFit system, aimed at increasing first-fit success.

While Unilens Vision Inc. reports slight decreases in disposable and custom lenses, it also reports an 18% increase in earnings for the quarter ended December 31, 2009. Licensing of multifocal technologies has contributed to the bottom line, says chief executive officer Michael Pecora.

“Sales of our C-Vue brand of lenses, sold exclusively to independent practitioners, combined with a 13% growth in royalty revenue derived from Bausch + Lomb's sales of multifocal lenses that use our key technologies, was responsible for our record second-quarter performance,” he says.

Talk about improved CL technology often centers on improved lathing techniques by CL labs. Chris Pantle, president of the Contact Lens Manufacturers Association and DAC International Inc., a lathe manufacturer, credits the labs for catching up.

“Our technology hasn't changed that much over the past five years,” he says. “but I think the laboratories are utilizing it better.” That's helping labs make larger-diameter lenses, “which spells more comfort in GPs,” he says.

What can all this mean to your practice?

“What I'm hoping that we see in 2010 and beyond is that doctors really start emphasizing their ability to fit these specialty lenses,” says Dr. Sindt. “What it comes down to is their expertise and not the material or the lens itself.” (See “Ten Trends to Guide You in 2010, below.)


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.

Ten Trends to Guide You in 2010

1. The unserved market is still huge. Only about 26% of Americans with vision correction wear CLs, says Dr. Riley, “so there's a huge opportunity for [practitioners to help] those patients who aren't even in contact lenses yet.” Adds Dr. Mack, “We have not come close to maximizing the potential to fit patients who desire to wear contact lenses with our current offerings of daily disposables, torics and multifocals. Often, patients don't ask to be fitted because they simply are not aware of the possibilities, new technologies or that they are a candidate for contact lenses. It is our role as the ECP to offer the best vision solution meeting the health, vision and lifestyle needs of each patient.”

2. Brace for the pent-up demand. This is typical after a recession, but Dr. Chalmers says she's reminded of another dynamic unique to CLs: Prescriptions expire after a year. “There should be some type of pent-up demand there,” she predicts. Dr. Schachet says he's already seen steady growth in CL fits in the first two months of this year. “I think it directly relates to what people are willing to spend, and now people are getting back on a spending path,” he says.

3. Specialty CLs are becoming less specialized. Dr. Sindt says she expects interest in toric and multifocal CLs to continue to grow. “Going toward the bifocals and specialty gas permeable lenses, there are a lot of new lenses coming out, but all the new lenses that are debuting are concentrated in the specialty lens category,” she says. She says she stays busy with “a lot of damaged eyes.” As she puts it, “I have a lot of options I can offer these people.”

4. SiHy options will keep coming. Industry watchers say you can expect more designs and parameters in SiHy material. “It would be nice to have some silicone hydrogel lenses that are bifocal torics,” says Dr. Townsend. Dr. Szczotka-Flynn says she anticipates the one-day SiHy lens. “That'll finally combine the two most positive things we've been talking about,” she says. “That'll give us really something new to tell patients in 2010. I don't know how it'll be priced, but if it's priced competitively, that can really drive the market.”

In the specialty CL area, Menicon's Jonathan Jacobson anticipates a lathable SiHy button to be available “soon” in North America. “And when it happens, with all the great interest around silicone hydrogel lenses, this could accelerate growth of the custom soft lens category,” he says.

5. Children are interested in CL wear too. Although visits by patients 17 and younger declined last year, according to the Advance Insights data, Dr. Chalmers advises that they're still an excellent population to target, as her work with the Contact Lenses and Youth (CLAY) Trial suggests. “The youngest children especially are being prescribed lenses for really difficult prescriptions — high-plus lenses, a lot more astigmatism, or a significant difference between the two eyes,” she says. “The children in our study did markedly better than older teens and younger adults.” Watch for the publication of the CLAY results in 2010, she says.

6. Astigmats will continue to march in. Despite the growth in new toric contact lens products in the past few years, many astigmatic patients still don't know that CLs are an option for them, says Dr. Riley. “That is an underserved population in general,” she says. “If you look at the number of people who have astigmatism and wear contact lenses, the penetration is low.”

7. And so will the presbyopes. Forget the old rules about presbyopic patients and CLs. As Dr. Sindt says she's seen, not only are the 40-something patients staying in CLs, but even older patients are taking the plunge. “I even have people coming in between [age] 40 and 50 and saying, ‘I want to wear contacts for the first time,’ because I have [contact lenses] to offer [them],” she says. Adds Dr. Hom: “Monovision is dead, so get over it.”

8. CLs continue to be an alternative to refractive surgery. “There are a lot of people who still would prefer successful CL wear to refractive surgery,” says Dr. Townsend. “They still have some reservations about [refractive surgery].” Presbyopes who've been wearing CLs for decades and ask about refractive surgery are primed to stay in CLs, he says.

9. Topography will continue to be important. Dr. Townsend says he's found having a corneal topographer invaluable. “One of the things that really enhanced our ability to help gas permeable contact lens patients is the consistent use of topography,” he says. Mr. Pantle says he's seen the impact topography has had on CL labs. “More practitioners have corneal topographers in their offices now and can identify those patients [who have corneal abnormalities] earlier than before, which lends to the dispensing of more gas perm lenses as well,” he says.

10. 2010 is the year of solutions. Dr. Hom cites three major manufacturers due to unveil new lens care systems in the coming months. “Solutions have undergone major crises in the past,” he says. “2010 will bring a renaissance in lens care with safer, more effective systems.”

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.

Mr. Kirkner is a medical editor and writer in suburban Philadelphia.


Optometric Management, Issue: April 2010