Article Date: 5/1/2003

contact lens overview
A 'Big Picture' View of Contact Lenses
2002 statistics reveal consistency and opportunity for optometrists.
BY JIM THOMAS, Executive Editor

Listen long enough to any discussion on contact lenses and you're bound to hear any number of diverging opinions regarding opportunities. However, statistics suggest that optometrists can find lucrative patient and practice advantages in dispensing contact lenses.

Pharmaceutical research and consulting firm Health Products Research (HPR) provided research encompassing an estimated 24.5 million patient visits where contact lenses were dispensed in 2002. In this feature, Optometric Management will review this data and discuss its implications for optometrists.

Soft Lenses Dominate
Examining 25.5 million patient visits where contact lenses were dispensed last year, doctors prescribed soft lenses at most visits.

'Soft' market shows stability

In 94.2% (23 million) of the patient visits where contact lenses were dispensed, eyecare professionals (ECPs) dispensed soft contact lenses (see "Soft Lenses Dominate" below). Optometry locations held the greatest share of these visits, at nearly 45%, followed by retail chains, independent retailers and ophthalmologist locations (see "Optometrists Lead the Way" below right). The share for optometric dispensaries has remained consistent over the last five years, says Rebekkah Carney, market research manager, HPR. Over this period, the share for chain retailers increased 3.6 share points, while independent retailers' share dropped 3.5 points. From 2000 to 2002, the M.D. share dropped 6.0 points.

"Faced with the downturn in the economy, optometrists should find their consistent share of patient visits reassuring," Ms. Carney says.

She adds that the market share numbers indicate that "despite contact lens sales from mail-order companies and chains, 2002 was a stable year for optometrists."

The total number of patient visits declined in 2002 from 23.7 million in 2001, but they were above 1999's 22.9 million patient visits. Ms. Carney said that it's not unusual for the number of patient visits to fluctuate 2% or 3% year to year, and the number of patient visits should increase "once the economy rebounds."

"According to our data, patients tend to visit their doctors less and stretch recommended lens wear schedules during economic downturns," she reports. "Patients may even wear their eyeglasses in place of their contact lenses."

Optometrists Lead the Way
By far, optometrists held the greatest share of the 23 million patient visits where soft contact lenses were dispensed in 2002, according to HPR.

O.D.s adopt earliest

HPR numbers reveal that compared to other ECPs, optometrists dispense a larger share of specialty lenses, which employ the latest technology, provide greater profitability and allow a wider range of vision correction options. "Specialty lens dispensing represents a significant shift in favor of optometrists," says Ms. Carney.

Of the contact lenses O.D. locations dispense, 16.8% are toric lenses, vs. 13.7% for ophthalmologists, 13.8% for chains and 14.9% for independent retailers.

Toric lenses gained patient visit share among soft lens dispenses, from 12.4% in 1998 to 15.3% in 2002.

O.D.s Ahead in Multifocals
Percentage of patient visits by
type of practice where doctors
dispensed bifocal lenses

*Example: ECPs prescribed multifocal lenses in 5% of all patient visits attributed to O.D.s.

Ms. Carney points out that "optometrists were early adopters of multifocal contact lenses." Five percent of the soft lens dispenses in an O.D.'s practice are multifocal contact lenses -- a greater percentage than M.D.s, independent retailers and chains (see "O.D.s Ahead in Multifocals on page 35").

Though spheric lenses held the greatest share of patient visits among all ECPs, their share has diminished -- from 86.4% to 80.3%, over a five-year period ending in 2002 -- as patients and practitioners embrace new technologies. By comparison, the share of multifocals increased from 1.2% to 4.4%, and the share of torics has grown from 12.4% to 15.3% among soft lens dispenses.

Other specialties

HPR statistics don't include lenses for orthokeratology or corneal refractive therapy, but optometrists have adopted these modalities as well. (See the accompanying features on orthokeratology, page 43, and on CRT, page 47.)

ECPs have also adopted 30-day continuous wear silicone hydrogel lenses. According to CIBA Vision, the only U.S. manufacturer of these lenses, about 30,000 ECPs in the United States dispense the lenses to approximately 200,000 patients.

The share of cosmetic tint lenses, representing 9.2% of all patient visits in 2002, has remained constant in recent years. "This is a positive sign," says Ms. Carney. "A weak economy is not normally conducive to cosmetic contact lens sales; one could expect the number of patient visits to drop, but the new competition in this market has encouraged stability."


O.D.s Have More Locations
Of the 36,235 locations
surveyed, O.D.s operate the largest portion where contact lenses
are dispensed

But Chains Capture More Visits Per Location:

Competition from chains

HPR identified 36,235 U.S. locations where soft contact lenses are dispensed. Of these, O.D.s operate approximately 17,200, M.D.s operate approximately 7,150, independent retailers operate approximately 6,300, and chains operate nearly 5,700.

While optometrists lead in the number of locations and patient visits, the chain retailers hold a substantial lead in the number of contact lens patient visits per location, nearly doubling those of O.D.s (see charts, page 45).

Ms. Carney attributes the chains' leadership in this category to convenience, marketing dollars, and the ability to command lower wholesale prices from the manufacturers due to bulk orders.


How a Doctor Prescribes...
The wear schedules that doctors prescribe in soft contact lens patient visits:

. . . Doesn't Always Follow Manufacturer Recommendations
The patient visits for soft contact lenses broken out by manufacturer-recommended wear schedules:


What the numbers reveal

M.D.s prescribe a higher percentage of soft lenses for daily disposable use, 5.3%, compared to O.D.s (3.6%), independents (2.6%) and chains (2.7%). Observers speculate that M.D.s address specific patient pathologies, such as dry eye, allergies, and protein deposits for which a one-day regimen may be more appropriate to ensure patient comfort and compliance.

In terms of modality, it's not unusual for a doctor's contact lenses prescription to vary from the manufacturer's recommendations for the same lens (see "How Doctors Prescribe Lenses . . ." on page 45.)

For example, ECPs prescribe lenses for one- and two-week wear intervals in 52.3% of the patient visits, while according to manufacturer-recommended wear schedules, one- and two-week lenses are prescribed in 63.8% of the patient visits. While variance is common in two-week disposable and planned replacement lenses, it is not as common in daily disposable or traditional contact lenses.

About the Data

The information in this feature is from Vision Information Services (VIS) -The Contact Lens Report, provided by Health Products Research Inc. The VIS-Contact Lens Report is a quarterly diary survey conducted among U.S. contact lens dispensing locations. In 2002, 677 unique dispensing locations responded to the surveys. The records of more than 17,000 patient visits were collected each quarter. For Q4 2002, soft lens patient visits have a margin of error of + or - 5.4%. The study has been conducted continuously since 1977.


Definitions: O.D.s, M.D.s, Chains and Independents, etc.

The following definitions are provided to add clarity to the data reported in this feature.

  • OPTOMETRIST: a health provider practice where the dispensing ECP with the highest level of education is an O.D.
  • M.D.: a health provider practice where the dispensing ECP with the highest level of education is an M.D., although there may be an optometrist employed at the same practice
  • RETAIL CHAIN: one of the top 100 optical retailers (by revenue)
  • INDEPENDENT RETAIL: all remaining optical retail practices
  • OTHER DISPOSABLES: up to two-weeks, excluding dailies.
  • PLANNED REPLACEMENT = monthly, including 30-day continuous, quarterly and up to six-month lenses
  • TRADITIONAL = lenses with replacement periods of six months or more


Optometric Management, Issue: May 2003