Article Date: 4/1/2011

cl update
cl update

2011 Annual Contact Lens Update

40+ patients lead the pack in visits, and SiHys make up more than 50% of visits, our annual report reveals.

Tara Rosenzweig, Contributing Editor

Regardless of a slight decrease (4.1%) in patient visits for contact lenses when comparing 2009 to 2010, the CL market revealed a continuation of certain trends, with, arguably, the most exciting being that 40+ patients comprised the largest age group for CL visits.

These data are courtesy of Advance Insights, an inVentiv Health company, which culls reported patient visit surveys from eyecare practitioners located at O.D. and M.D. offices, as well as retail chains and independent retailers. (This data do not include Internet sales).

In addition to Advance Insights data on patient visits, research from Robert W. Baird & Co. suggests CL market growth accelerated in both the U.S. and worldwide in 2010. (See “A Wall Street Perspective,” in this month issue.)

Here's an in-depth look at Advance Insights' 2010 data and practice pearls from CL specialists based on this information.

40+ patients ruled

The total market for U.S. CL patient visits over the last three years amounted to:

► 27.4 million (2010)
► 28.6 million (2009)
► 28.5 million (2008)

Patients age 40 and older made up the largest age group for CL visits in 2010, edging out patients ages 25 to 39 34% vs. 32%. (See “Patient Visits by Age Group,” below.)

Glenda Secor, O.D., F.A.A.O., who practices in Huntington Beach, Calif., says this data reflects what she sees in her own practice: “Patients reaching presbyopia are heavily driven to immediately see their phones and computers, and they don't want to grow or look old,” she says.

So, were these patients' visits mostly for multifocal CL fittings? The answer is no. In the last two quarters of 2010, 45% of presbyopic patient visits were for spherical CL fits, followed by 36% for multifocal CLs and 19% for toric CLs, according to Advanced Insight's data. (See “Presbyopic CL Patient Fits,” below).

Robert L. Davis, O.D., F.A.A.O., of Davis Eyecare Associates in Oak Lawn, Ill., says he thinks these numbers may reveal practitioner reluctance to offer multifocal CLs:

“Because the first-generation multifocal lenses were inadequate, in terms of vision, they caused a lot patient complaints for practitioners. As a result of this experience, I think some of these practitioners have decided to offer their 40+ patients spherical lenses and reading glasses or monovision,” he explains. “These practitioners need to realize that today's multifocal offerings work quite well, and by not offering patients these options not only can this effect their bottom line, but patients will leave their practice and find someone who will offer these new lens designs.”

*Proportion of patient visits, in which presbyopia was indicated. Source: Advance Insights Contact Lens Report


Source: Advance Insights Contact Lens Report

Practice Pearl: Barry Eiden, O.D., F.A.A.O., president and medical director of North Suburban Vision Consultants, in Deerfield and Park Ridge, Ill., says you can capitalize on 40+ patients by educating yourself and your patients on the latest multi-focal offerings. “Even though contact lens manufacturers have continued to develop better and better multifocal CL options—in soft, GP and hybrid formats—many of our patients aren't aware that we can fit them successfully with these types of contact lenses,” he says. “In addition to that, the more you fit the array of designs available, the more success you'll have, as you'll understand each design's optics, and therefore, which lens to choose for a specific patient.”

Christine Sindt, O.D., F.A.A.O., associate professor of clinical ophthalmology and contact lens service director at the University of Iowa Healthcare Ophthalmology and Visual Sciences, in Iowa City, Iowa, adds that many “40-something” patients grew up wearing CLs successfully, and thus, want to stick with them. “This age group doesn't see themselves as glasses wearers. They also are not the generation that has run right out and had LASIK done,” she says. “So this age group is very interested in multifocal lenses, especially as technology improves.”

Still, just because the 40+ patients comprise the most CL visits, you shouldn't abandon offering CLs to your younger patients, says Susan Resnick, O.D., F.A.A.O., who's in private practice in New York City. “It is important for the O.D. to target all age ranges, especially younger patients,” she says. “I've found that older patients tend to drop out earlier than young patients, due to aging issues,” she says. “Younger patients infuse a long-lasting fresh resource stream into the practice.”

Daily disposables and monthlies grew

Analyzed on an as-marketed basis (vs. as-prescribed by the eyecare practitioner [ECP]), the proportion of patient visits for planned replacement monthly CLs grew the most in 2010, up 5% from 2009, while the proportion of patient visits for one-day disposable CLs grew 3.5%. Meanwhile, the proportion of patient visits for two-week disposable CLs dropped 7.1% from 2009. (See “Modality (as Marketed) by Year,” below.) Also, daily wear continued to trump extended wear, as it comprised almost 94% of patient visits for 2010 (see “Wear Schedule by Year,” below.)


Source: Advance Insights Contact Lens Report


Source: Advance Insights Contact Lens Report

Gregory W. DeNayer, O.D., F.A.A.O., clinical director for Arena Eye Surgeons in Columbus, Ohio, says he thinks the reason daily disposable CLs visits grew is because of the expanding range of parameters and materials, such as SiHy.

Dr. Resnick agrees. “With new designs available for astigmatism, for instance, I've been able to satisfy an ever-increasing number of patients who desire optimal vision and the convenience of a one-use lens,” she says.

“Trends indicate that one-day and one-month replacement lenses will drive the growth of the contact lens market…” says Rick Weisbarth, O.D., F.A.A.O., and vice president of professional Affairs at Ciba Vision. “Reasons for the shift may include greater patient compliance, which can lead to increased practice profitability, plus improved comfort and vision.”

CooperVision says it believes wearers are driven to one-days in large part by their convenience, but primarily by their practitioners' recommendations, and that rebates and reduced solution usage is making practitioners not only more comfortable with the price/value relationship of one days, but also with offering them to patients. In terms of the move toward monthlies, the company says “… There is a clear market trend [toward] the one day and monthly modalities rather than the two week. Wearer compliance to a modality is so important for eye health and comfort. Wearers recognize these benefits and with the overall cost to the wearer always a consideration, they seem to be transitioning more to the one-day and monthly modalities.”

Bausch + Lomb says the growth of monthly replacement and daily disposable contact lenses relative to a decrease in the share of two-week replacement lenses is not surprising, given the increased awareness of the lower compliance with manufacturers' recommended replacement schedules by both ECPs and patients. “ECPs in some markets are more likely to provide compliant replacement schedule recommendations for monthly lenses vs. two-week lenses,” says Mohinder M. Merchea, O.D., Ph.D., M.B.A., F.A.A.O., FBCLA Director, Medical Affairs - Vision Care, for Bausch + Lomb North America. “… Additionally, wearing a lens longer than recommended by the manufacturer may predispose the patient for a less than ideal experience related to vision and comfort.”

The data show that two-week lenses continued to make up more than half (52%) of all soft CL patient visits, whereas monthly visits amounted to 34%.

“Despite manufacturers converting some of their own two-week contact lens brands into monthlies during 2010, doctors continue to prescribe their brands of choice,” says Vistakon. The company adds that it found that its Acuvue Oasys (manufacturers' recommended wear schedule: two weeks) grew faster in dispenses in 2010 (vs. 2009) than the most widely available monthly contact lenses, and that doctors prescribed Acuvue Oasys more frequently than monthlies to new contact lens wearers. Additionally, the company says it found that a key contributor to the 2010 daily disposable growth was the introduction of 1 Day Acuvue TruEye.

Practice pearl: Regardless of which replacement schedule CL you prescribe, Dr. Secor says it's essential you educate patients on the importance of compliance to their CL wear and care schedule. “Patients tend to overwear their lenses, putting them at risk for complications, and contact lens drop out,” she says. “But, we can remedy this problem by taking a minute or two in the exam room to reinforce the importance of compliance.”

Astigmats flocked to CLs

In 2010, 66% of patient visits were attributed to spherical CL fits (down almost 4% from 2009), 24% to toric (including multifocal toric) and 10% to multifocal CL fits. (See “Patient Visits by Lens Shape,” below).


Source: Advance Insights Contact Lens Report

Dr. Secor says she thinks the slight decline in spherical fits is the result of these patients transitioning into the aforementioned specialty CLs, which she says are easier to fit than spherical CLs on these particular patients.

Practice Pearl: Offer specialty CLs, says Dr. Kovacich. “New toric designs, for instance, are much more reliable and require less chair time, and give patients better vision and reduce eyestrain from uncorrected cylinder,” she says. “Studies have shown there is a greater population average for 0.75D of astigmatism or more, but toric fits lag behind that number, so ECPs still don't fit as many toric lenses as we probably should,” she explains. She adds that O.D.s should let patients know that toric lenses are more expensive than spherical lenses, but that the correction for astigmatism is in their spectacle prescription for a reason. “Since toric lenses are more challenging to fit, most doctors charge more for a toric fitting, and that should also be explained to the patient,” Dr. Kovacich says.

Women were the majority

Women continued to make up the majority (64%) of CL visits, although this is down very slightly (0.9%) from 2009. (See “Patient Visits by Gender,” below). Also, women made up the most new CL wear visits at 58%, up very slightly from 2009.

Dr. Resnick says she's found women have traditionally made up the majority of CL visits.

“I find that men are less likely to ‘compromise’ on their visual comfort and acuity during the day for business activities than are women,” she says. “For this reason, I've found that men are more apt to be part-time or weekend/athletic wearers.”


Source: Advance Insights Contact Lens Report

Practice Pearl: Go that extra mile to make women patients happy, say Drs. Kovacich and Sindt. “Female patients tend to provide the most referrals, as they are often the healthcare decision–makers for the family,” says Dr. Kovacich. Dr. Sindt adds, “If you make a 40-something female happy, she will send her husband, her children and her best friend to your practice.”

Soft CLs dwarfed GPs

Soft CLs (SCL) continued to comprise the vast majority of patient visits, rising 0.7% from 2009 to make up 97% of CL visits. (See “Lens Material by Year,” below).


Source: Advance Insights Contact Lens Report

“Now, we have highly effective soft torics, soft multifocals and even custom design soft lenses for irregular corneas,” says Dr. Eiden. “This is presenting a challenge for what were once ‘GP niches.’”

Practice Pearl: Dr. Eiden says that despite this growth, it's imperative you still keep GP CLs in mind: “Although it's wonderful that more and more specialty lenses are being manufactured in soft materials, we should still remember the many advantages that exist with GP lenses,” he says. “These include optimal optics, low rates of corneal infection, excellent multifocal and irregular cornea management and corneal reshaping technologies.”

SiHys continued to soar

SiHy CLs comprised almost 60% of CL visits in 2010. (See “SiHy vs. HEMA,” below). In fact, 2010 was the first year SiHy visits made up more than 50% of visits. In addition, non-SiHy wearers who switched to SiHy rose 7.5% from 28.5% in 2009 to 36% in 2010, according to the patient visit surveys. (See “Non-SiHy Wearers Who Switched to SiHy,” below.)


Source: Advance Insights Contact Lens Report


Source: Advance Insights Contact Lens Report

“I think this increase is the result of the expanding availability of both parameters and designs now available in SiHy material,” says Dr. Resnick. “Practitioners generally prescribe SiHy designs for new fits whenever possible and will educate existing wearers as to the benefits of being refit in a SiHy lens.”

Practice Pearl: Use the availability of SiHy technology as a platform to present new CL designs to your patients, says Dr. Eiden. Dr. Sindt suggests using in-office education, such as point-of-purchase materials or videos in the waiting room, to educate patients on the benefits of SiHy CLs.

One caveat: Keep in mind that SiHy isn't for everyone, says Dr. Davis. “Many of my contact lens wearers have wettability and drying problems, vs. oxygen permeability issues,” he says. “So, remember to make your lens selection based on the wearing characteristics and problems of individual patients.”

Despite the slight decrease in overall patient visits for CLs, the 2010 CL market revealed a continuation of certain trends on which your practice can capitalize, especially 40+ patients. So, use the data and the advice of your colleagues to make the remainder of 2011 beneficial for your CL practice revenue and your patients. OM

If you would like to contribute to Advance Insights' Contact Lens Report, please visit www.rxsurvey.com/enroll to register.

Specialty CL Options Abound
Specialty CLs continued to experience growth in 2010, including specialty GP CLs and multifocal and toric CLs. Multifocal CLs had the most growth, up 2.1% from 2009. Toric CLs, including multifocal toric CLs, also rose a bit, 1.7%, according to Advance Insights' data.
Michael A. Johnson, director of consultative services at Art Optical, says the company experienced its strongest year to date in the soft CL category in 2010 with its multifocal and multifocal toric options leading sales. “The expansion of the design options available in the Renovation platform—our most popular GP multifocal—also gave our overall presbyopic category a boost,” he says.
Scleral and large diameter lenses did extremely well for Blanchard Contact Lenses, Inc., last year, says Lee Buffalo, the company's national sales director. “We saw increases and interest in many scleral lens designs or large diameter GP lenses,” he says. “As a result of that, we saw our unit sales increase nicely.” Mr. Buffalo adds that the company also saw strong demand for its new bi-aspheric multifocal lens.
Jonathan Jacobson, general manager, global strategy and operations for Menicon says 2010 was an “excellent” year for the Rose K business globally. “Year-over-year units were up 11%, with particularly strong growth in the post-graft and irregular cornea segments. Rose K2 sales grew 16% while the original Rose K declined 4%. Most fitters outside North America have already switched most of their Rose K fits to Rose K 2, as it gives improved comfort and vision over the original design,” he says. “This trend is expected to take hold in North America.” Mr. Jacobson adds that Paul Rose, O.D., is working on the development of new designs that will target disease conditions not fully addressed with the existing family of Rose K products. “We expect at least one new product to launch in 2011,” he says.
In terms of the orthokeratology sector, Pam Scoggins, director of sales and marketing development for Paragon Vision Sciences, says the company continues to expand its CRT product line, which grows in sales year after year. The reason for this growth: “We have identified three key areas, where CRT continues to make a strong impact domestically: the tween and teen market, the Asian market, patients who either aren't candidates for or are afraid of refractive surgery, patients who experience discomfort with soft contact lens wear and/or those who experience daytime contact lens discomfort,” she says.
Michael Pecora, CEO of Unilens Vision, says he anticipates continued growth in the specialty CL arena. “I am confident that specialty contact lenses that address the presbyopic needs of the growing ‘baby boomer’ demographics will continue to significantly grow during 2011 and beyond,” he says. “In particular, the soft contact lens market for presbyopes with astigmatism is in its infancy and just now starting to develop.”
Dr. Resnick agrees with Mr. Pecora. “Because the baby boomers comprise such a well-adapted contact lens population and potential new wearer base that is growing at such a rapid rate, it behooves practitioners who want to capture this segment (or at the very least not lose from their existing patient base), to become as proficient and knowledgeable in the presbyopics' contact lens physiologic and visual requirements and to be able to differentially select the best design for a given patient,” she says. “This would include successfully managing dry eyes, fitting astigmatic presbyopic lenses, limiting optical aberrations that naturally increase in the aging eye and satisfying patients desires for convenience.”

The Nine: Trends to Watch in 2011
1. CLs for astigmatism are becoming less of a specialty. “There are many highly effective toric lenses now available,” says Dr. Eiden. “So, the management of astigmatism with contact lenses should no longer be considered a specialty area, unless the patient has high astigmatic levels or irregular astigmatism.” Translation: Start fitting toric CLs, or these patients will find a practitioner who will.
2. More SiHy CL designs will make their debut. Dr. Kovacich says she thinks more SiHy designs are forthcoming, as they offer comfort and enhanced eye health. “It is believed that a healthy eye is a more comfortable eye, so a patient who was having comfort issues with hydrogel lenses may be able to wear SiHy contact lenses for more years successfully,” she says.
3. Generation Xers will continue to widen the emerging presbyope market. “We are not only fitting the presbyopic baby boomers but also Generation Xers, who began turning 40 in 2005,” says Dr. Kovacich. “As a result, if you actively fit these lenses, you should experience a growth in your practice revenue.”
4. More multifocal CLs will emerge. Presbyopic patients are willing to pay for designs that provide good vision, comfort, reduced adaptation time and, of course, a youthful appearance,” says Dr. Resnick.
5. More busy patients will be willing to pay for daily disposable CLs. Patients who desire occasional CL wear, or who have a busy lifestyle will gladly pay for this modality, says Dr. Kovacich.
6. More children will become wearers. While presbyopes offer growth potential as CL options expand, so do children, says Dr. Kovacich. “Recent studies reveal that children between the ages of eight and 12 can manage contact lens wear as well as their older counterparts,” she says. “The marriage of daily disposable lenses with younger patients is a great opportunity to fit these patients.”
7. Specialty CLs appear almost “recession-proof.” Lee Buffalo, national sales director at Blanchard Contact Lens, Inc., says new designs in the specialty GP CL market are providing incremental growth that is somewhat protected from economic downturn. “Overall, the specialty GP lens market is growing with the advent of new designs,” he says. “When people wear specialty GP lenses, it's because they are unable to wear other modalities of vision correction.”
8. Demand for specialty GP CLs will continue to flourish. Art Optical's Mike Johnson says he believes a continued growth will occur for GP CLs in the presbyopic segment in the next few years. “We will also continue to see steady interest in GP design options for keratoconus, irregular cornea and post-surgical application,” he says. “These are smaller segments of the market but a necessity to patients afflicted with these conditions.” He says he also believes “a number of currently exclusive GP laboratories” will begin including custom soft lenses with their product offerings.”
9. O.D.s will have to choose between becoming CL specialists or a CL practitioner. Dr. Davis says he envisions further differentiation between CL specialist and CL practitioners that compete with retail CL distribution. “Problem-solving contact lens patient complaints requires experience in special design fitting and increase chair time for success. Their cost of business is reflected in their fee schedule,” he explains. “Contact lens practitioners prescribing high-volume, disposable lenses do not have the time or profit margin to offer specialty fitting, such as scleral lenses or bifocal lens designs. Patients will either seek out contact lens practitioners who will deliver the goods at the same margins as other retail outlets or look for practitioners who will offer remedies to their contact lens problems.”

Tara Rosenzweig is a freelance writer and former editor of Eyecare Business magazine (a sister publication of Optometric Management) who lives in the Philadelphia area. E-mail her at Tara.Rosenzweig@verizon.net, or send comments to optometricmanagement@gmail.com.


Optometric Management, Issue: April 2011