Article Date: 4/1/2012

2012 ANNUAL Contact Lens Update
cl update

2012 ANNUAL Contact Lens Update

Patient visits for toric and silicone hydrogel lenses grew.

Tara Rosenzweig, contributing editor

Although total contact lens (CL)-related visits in 2011 decreased from 2010 (3.3%), visits for toric CLs, silicone hydrogel (SiHy), daily wear, daily disposable and monthly replacement CLs grew. Encuity Research, the market research and analytics subsidiary of Campbell Alliance, has provided these data based on its ongoing VisionCare Contact Lens Study. Encuity collects reported patient visit surveys from O.D. and M.D. offices, retail chains and independent retailers. (These data do not include Internet purchases.)

In addition to the Encuity data, Jeffrey D. Johnson, O.D., C.F.A., shares “Wall Street” data from Robert W. Baird & Co., an employee-owned wealth management, capital markets, asset management and private equity firm (See page 34).

Here's Encuity's 2011 data and related insights and practice pearls from CL experts. (See “Exceeding Patient Expectations,” below.)

Exceeding Patient Expectations
To increase a patient's likelihood of satisfaction, and, therefore, continuation with wear, here are six steps, courtesy of your colleagues:
1. Pinpoint ocular needs. Ask patients about their day-to-day vision and any potential problems, such as ocular allergy or dryness, suggests Dr. Kovacich. “The answers will enable you to select the best option for the patient, decreasing the likelihood of future problems,” she says.
2. Identify expectations. “If a patient's expectations are beyond what the best lens option can provide, then he/she won't be happy even with a successful fit,” Dr. DeNaeyer explains.
3. Stress proper lens care. Educate patients that compliance with your specific directions is essential to their success, suggests Ed Bennett, O.D., M.S. Ed., assistant dean of student services and alumni relations at the University of Missouri-St. Louis College of Optometry in St. Louis, Mo. “This tells the patient that you genuinely care about their eye health and want them to succeed,” he says. “And, several outstanding web resources can assist you here: www.contactlenses.org, www.contactlenssafety.org, www.allaboutvision.com, and www.aocle.org/healthyHabits.html.”
4. Implement the one-week visit. Have the new wearer return in one week to ensure he/she is comfortable with and correctly handling their CLs, and that he/she's been adhering to your wear and care directions, says Dr. Bennett. “I've found that this, again, lets patients know you genuinely care about their ocular health.”
5. Take an integrated approach to discomfort. “Wow” patients who complain of discomfort by telling them you're going to apply your knowledge of ocular surface disease therapeutics, CL material science and lens care system properties to return them to comfortable wear, says Dr. Eiden.
6. Stay current. Stay abreast of the latest developments, and offer them at every annual visit to patients whom you feel can benefit, even if the patient repeatedly says he/she is “doing fine” in their current CLs, advises Dr. Quinn. “Even if the patient says he's fine in his current lenses, he still appreciates that you're keeping an eye out for options that may enhance his wear experience,” he says. “And, in knowing that you're aware of the latest and greatest products, he'll be sure to come to you, should he decide he's ready to try something new.”

Toric CLs grew

Visits for toric CLs grew 1.5% from 2010 to 2011, comprising about 25% of all patient visits. Meanwhile, the proportion of visits for spherical and multifocal lenses (including multifocal torics) decreased slightly from 65.8% and 10.4% in 2010 to 64.8% and 9.9% respectively. (See “Patient Visits by Lens Shape,” page 26.)

S. Barry Eiden, O.D., F.A.A.O., of North Suburban Vision Consultants in Deerfield, Ill., says he thinks the continued growth in toric CLs is likely due to the recent availability of expanded parameter ranges. Greg DeNaeyer, O.D., of Arena Eye Surgeons in Columbus, Ohio, adds he thinks the improvements of stabilizing designs has played a role in this growth in patient visits.

Practice Pearl: Encourage patients who have as little as -0.75D of astigmatism to try a toric CL in one eye and a spherical CL in the other (if both eyes have a similar degree of astigmatism), and let them evaluate the difference in vision. This can stimulate increased sales in toric CLs, says Phyllis Rakow, C.O.M.T., F.C.L.S.A., director of contact lens services at Princeton Eye Group in Princeton, N.J.

Patient Visits by Lens Shape

SiHys continued reign

Visits for SiHy CLs continued to reign in the soft lens category, comprising almost 67% and growing 4.1% between 2010 and 2011. (See “SiHy vs. Regular Soft Hydrogel,” right) Of interest: In 2011, 38% of non-SiHy CL patient visits resulted in a switch to a SiHy lens, while the remaining 62% stayed in a HEMA or GP lens.

Specialty CLs Thriving
Here's how the specialty CL companies fared and what's coming in 2012.
Alden Optical noticed a significant increase in CL orders intended to replace products discontinued by the larger CL companies and an uptick in soft specialty lens interest, due to NovaKone, Alden's keratoconus soft lens, says Tom Shone, Alden Optical president. He adds he sees this interest continuing in 2012.
Art Optical experienced a “huge spike” in custom made-to-order soft contact lenses, due to the major soft CL companies discontinuing some of their older hydrogel CLs, says Michael A. Johnson, director of consultation services at Art Optical. He adds the company will launch a GP presbyopic design in mid-2012 for post-LASIK patients.
Blanchard Contact Lenses, Inc. experienced a significant increase in their mini scleral design lens orders in 2011 and continued growth in their large diameter Rose K2 IC lens products, says Lee Buffalo, national sales director for the company. He adds that Blanchard is focused on scleral lens launches in 2012.
Menicon saw trends toward more large-diameter CL designs, irregular cornea fitting and custom soft CL offerings, says Jonathan Jacobson, general manager, global strategies and operations at Menicon. He adds that the company continued to expand the Rose K products with the Rose K 2 NC launch, for nipple cones, and will launch the Rose K XL, a large diameter (14.5mm) lens, later this year.
Metro Optics saw tremendous growth in specialty soft lenses due to the success of its RevitalEyes post-surgical lens becoming more widely prescribed and the “proliferation” of Definitive (Contamac), a latheable SiHy material for custom lenses, says Joe Brown, the company's Sales & Marketing manager. He says he forecasts strong growth in all categories of custom soft lenses with designs for post-surgery and ectasias leading the way.
SynergEyes Duette family of contact lenses, which includes Duette HD and Duette Multifocal, moved beyond the specialty niche in 2011, says Christina Kirby, SynergEyes' marketing product director. “We expect the Duette family of lenses to reach an even broader range of patients in 2012,” she says.
Unilens saw growth among specialty lenses for astigmatism and presbyopia during 2011, largely due to the C-Vue Advanced line of custom lenses, says Michael Pecora, Unilens CEO. During 2011, Unilens introduced the C-Vue Advanced HydraVue, a SiHy custom monthly replacement lens.
Roxanna T. Potter, O.D., F.A.A.O., of Sylvania, Ohio, says there's never been a better time to fit specialty lens patients, as chair time is minimal thanks to lab consultants and various specialty lens educational resources, there isn't a mass specialty lens retailer, and this patient population tends to comply better with follow-up appointments and yearly exams.

Dr. Eiden says these numbers are a reminder that SiHy is not the answer for all patients. “There are many HEMA soft lens wearers who are totally comfortable in their lenses and show absolutely no clinical signs of hypoxic sequelae,” he says.

Practice Pearl: Don't hesitate to recommend SiHy CLs to those who weren't successful with first generation SiHys. Those who tried them and were disappointed may be pleasantly surprised with the comfort and vision of the current generation of these materials, says Ms. Rakow.

SiHy vs. Regular Soft Hydrogel

Age and wear

Patients age 19 to 29 comprised the largest age group of wearers (roughly 30%), followed by those age 30 to 39 (roughly 20%). The proportion of visits for the youngest group (age 18 and younger) decreased (-1.28% from 2010) and the proportion of visits for those age 19 to 29 increased (0.99%.) (See “Patient Visits by Age Group,” page 29.)

Meanwhile, patients age 40 and older made up 1/3 of all patient visits, revealing this patient population is an important segment for practitioners. Interestingly, most CL visits for presbyopic patients were not for multifocal CLs (33% of visits) but for spherical lenses (46%), the data show. (Toric CLs accounted for 20% of these visits.) Further, visits by presbyopic patients for multifocal CLs, a modality that has improved by providing clearer vision, actually decreased by 3% from 2010 to 2011. (See “Presbyopic CL Patient Visits 2011,” page 29.)

Patient Visits by Age Group

Presbyopic CL Patient Visits

“Numerous studies have shown that multifocal lenses are preferred over monovision by seven out of 10 patients,” Thomas Quinn, O.D., of Drs. Quinn, Quinn and Associates in Athens, Ohio, says. “Perhaps providers need to be made aware of this to give them more confidence in recommending the multifocal contact lens option. I've found that these patients love the freedom multifocal lenses provide during their active daily lives.”

Milton M. Hom, O.D. of Azusa, Calif., adds he thinks these stats may be a reflection of presbyopic patients seeing older generation doctors, who attended optometry school when the first crop of multifocal CLs bombed. “What we learned in optometry school influences us for the rest of our careers,” he explains. “Back then, monovision was preferred because it worked better than multifocals. For many of these practitioners, I think this thought process has carried over to today.”

Wear Schedule (as Practitioner Recommended) by Year

Practice Pearl: Inform pre-presbyopic patients that good CL multifocals exist today, and present these options to all presbyopic patients, says Susan Kovacich, O.D., F.A.A.O., associate professor and chief of the Cornea and Contact Lens Service at Indiana University School of Optometry, in Bloomington, Ind. “My patients are staying in contact lenses longer and trying contact lenses for the first time in their 40s and 50s,” she says.

Daily wear rose

A total of 95% of patient visits involved a daily wear schedule, up 1.2% vs. 2010, with 5% of visits involving an extended wear recommendation. (See “Wear Schedule (as Practitioner Recommended) by Year,” left.)

“The extended wear of soft contact lenses remains the number one risk factor for developing microbial keratitis,” explains Susan J. Gromacki, O.D., M.S., F.A.A.O., of Dayton, Md. “We've known this since the Poggio and Schein studies in 1989, but many practitioners resumed prescribing the modality with the advent of silicone hydrogels. While these materials are clearly superior to the 1989 soft lens materials in many ways, when worn overnight, research has shown they can result in an equal or greater incidence of microbial keratitis and corneal infiltrative events as compared with the older HEMA materials.”

2012 Trends
Daily disposable wear will grow. Daily disposable wear will increase, as manufacturers of these lenses increase parameter ranges, says Dr. DeNaeyer.
More and enhanced toric fits. Toric wear will continue to increase because more practitioners are fitting astigmatic patients in these lenses as opposed to the spherical equivalent for those patients who have 0.75D to 1.00D of astigmatism, says Dr. Kovacich.
Multifocal wear will increase. The success of modern multifocal CL designs coupled with the aging of the population should generate increased revenue and new patient referrals, says Dr. DeNaeyer.
Strong demand for specialty CLs. Custom specialty lenses will continue to grow mostly because of new and innovative designs, forecasts Mr. Pecora. “I predict that the soft toric multifocal market in particular, which represents a huge potential market, will continue to escalate, supported by new design technology,” he says.
Demand for GP fitters. As more specialty GP lenses become available for the traditionally hardto-fit, more practitioners will be needed to fit these designs, says Ms. Rakow. To acquire this fitting skill, they can attend the Global Specialty Lens Symposium, check out the Gas Permeable Lens Institute's website (www.gpli.info), and use the GP labs themselves as a resource, she says.

Practice Pearl: If a patient's lifestyle dictates he wear extended wear CLs, prescribe deposit-resistant materials approved for at least seven days of wear, ensure a healthy fit, and schedule regular visits, says Dr. Gromacki.

Daily disposables and monthlies increased

The proportion of visits for daily disposable and monthly replacement CLs slightly increased in 2011 from 2010. Specifically, the proportion of daily disposable CL visits increased 2.3%, while monthly replacement CL visits grew 3.2%. Meanwhile, the proportion of patient visits for two-week replacement CL visits decreased 4.8%. (See “Replacement Schedule (as Marketed) by Year,” which does not include quarterly or conventional, below.)

Dr. Kovacich says she thinks pre-teens and adolescents are driving daily disposable CL growth, as these CLs facilitate patient compliance to a practitioner's directions, decreasing the likelihood of CL complications, and thus, making parents amenable to the option.

Practice Pearl: Learn the lower infection and complication rates and higher compliance rates with daily disposable CLs, and share this data with both parents and patients. Then, present the fees in a cost per-day format and any rebates to reveal the true cost involved with daily disposable lenses, says Dr. Quinn.

Replacement Schedule (as Marketed) by Year

Regarding the monthly and two-week replacement CL data, CooperVision says that CL market data demonstrates no one modality works best for all patients, and that the ECP should use the patient's individual needs to best select a CL option.

Mohinder Merchea, O.D., Ph. D., M.B.A., F.A.A.O., F.B.C.L.A., director of Medical Affairs , North America, Bausch + Lomb Vision Care, says independent studies have consistently reported that monthly CL wearers have superior compliance when compared with two-week wearers, and that compliant patients have better comfort and wearing experience.

Rick Weisbarth, O.D., F.A.A.O., head of Professional Affairs for Alcon Vision Care, which includes CIBA Vision products, says he believes patient visits for monthly replacement lenses are growing because eyecare practitioners are recognizing they fit more naturally with a patient's lifestyle, and that studies have revealed enhanced compliance rates with these CLs.

Vistakon says it believes the change in category makeup for two-week disposable CLs has been predominately driven by competitive switching from older two-week products to monthly.

Females: the lion's share

Females continued to comprise the lion's share of CL visits. (See “Patient Visits by Gender,” below.)

Patient Visits by Gender

Lens Material by Year

“Men are really underserved when it comes to CL wear,” says Dr. Hom.

Practice Pearl: On your patient in-take forms, include “What are your hobbies?” so you can identify where CLs could enhance the hobby, and then discuss CLs with your male patients, Dr. Hom recommends.

Soft CLs ruled

Soft CLs (e.g. hydrogel and SiHy) made up most patient visits in 2011 with 97.3% vs. 2.7% for GPs. (See “Lens Material by Year,” below.)

Susan Resnick, O.D., F.A.A.O., of New York City, says these numbers aren't surprising, as soft lens technology exists for virtually all refractive conditions.

Practice Pearl: Don't overlook GP lenses, especially for patients who have special ocular needs, she says.

“Through the continued educational efforts of the Gas Permeable Lens Institute and the Colleges of Optometry, students, new and established practitioners have the resources to understand the design and fitting,” she says. (See “Specialty CLs Thriving,” page 26.)

To improve your practice's CL portion, use the aforementioned data and practice pearls. (See “2012 Trends,” page 30.) OM

If you would like to contribute to Encuity Research's Contact Lens Report, please visit www.rxsurvey.com/join.

Ms. Rosenzweig is a freelance writer and a 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, Volume: 47 , Issue: April 2012, page(s): 24 - 32