ANNUAL REPORT

Contact Lenses 2009

The contact lens industry remained healthy and strong in 2009 despite the global economic downturn.

By Jason J. Nichols, OD, MPH, PhD, FAAO

Dr. Nichols is an assistant professor of optometry and vision science at The Ohio State University College of Optometry. He has received research funding from Alcon, Ciba Vision, and Vistakon.

Without question, the current economic times are challenging for many of us. But on the bright side, we can take solace in the fact that our industry has done quite well under the circumstances. Let's take a look back at the contact lens industry in 2009, including an overview of industry trends and important events that will shape our future to come.

General Market Trends

Data obtained from Jeff Johnson, OD, CFA (vice president, senior research analyst, Robert W. Baird & Co. Inc.) show that as of September 2009, the ophthalmic sector as a whole was up 44 percent year-to-date. This is far ahead of the S&P 500, which was up only 18 percent year-to-date, but it certainly is lagging behind where it was five years ago. There was marked slowdown in the market starting in the 4th quarter of 2008, with slight improvement through 2009. The contact lens industry remains healthy with modest U.S. (4 percent) and worldwide (2 percent) growth predicted over the next year.

The data also show that the worldwide soft lens market is estimated at $5.3 billion while the U.S. market is estimated at $2.0 billion. Worldwide and U.S. contact lens market share estimates by company are similar to last year with Johnson & Johnson/ Vistakon leading at 47 percent and 46 percent, respectively followed by Ciba Vision (at 18 percent and 24 percent, respectively), CooperVision (at 17 percent and 17 percent, respectively), and Bausch & Lomb (at 13 percent and 12 percent, respectively). Figure 1 shows an overall comparison of company market share for the second quarters of both 2008 and 2009. As the figure reflects, Ciba has gained the most share in the soft lens market in the past 12 months.

Figure 1. A comparison of second quarter company market share for 2008 and 2009. Source Health Products Research.

When practitioners were surveyed about what contact lens brands they think they will use more of in the coming year, CooperVision led (38 percent of those surveyed), followed by Ciba (32 percent of those surveyed), Vistakon (25 percent of those surveyed), and Bausch & Lomb (12 percent of those surveyed).

Current Practice Trends

Contact Lens Spectrum also recently conducted market research whereby we asked our U.S. readership about practice trends and growth patterns. The questions covered a variety of topics including patient base of a practice, business and financial aspects of a practice, fitting and prescribing trends, and care solution trends. I will draw on information provided by the 445 individuals who responded to this market research as I proceed with discussing trends and observations in the field of contact lenses.

Practice and Business Trends Most of our respondents were optometrists, followed by opticians/contact lens technicians and ophthalmologists. Modes of practice varied, but the most common was solo private practice, followed by group private practice and practitioners who were associated with a retail corporation. In 2009, the typical practice saw an average of 108 patients per week (up five patients per week on average compared to 2008), and the patient base of the typical practice was comprised of approximately 37 percent contact lens wearers (up 3 percent from 2008). The average number of contact lens fits and refits in a typical week was about 27 (up five per week compared to 2008).

Correspondingly, most respondents reported that about 35 percent of their gross profit and about 29 percent of their net profit was derived from the contact lens portion of their practices (both up 5 percent compared to 2008). Overall, 62 percent of respondents felt that their overall contact lens practice growth would be increasing in the next year, whereas 34 percent of respondents felt it would be staying the same and only 4 percent of respondents felt it would be decreasing.

Our data also show that most contact lens patients purchase spectacles every two (43 percent) to three (42 percent) years, whereas most non-contact lens patients (requiring vision correction) purchase spectacles every one (22 percent) to two (68 percent) years. However, most contact lens patients return for a comprehensive eye examination every year (84 percent) whereas most non-contact lens patients return for a comprehensive eye examination every two years (61 percent).

Lens Dispensing Trends As we reported last year, silicone hydrogel materials dominate current U.S. fits and refits (Figure 2). About 60 percent of lens fits and refits were conducted with a silicone hydrogel (54 percent in 2008), whereas 29 percent were with a hydrogel (35 percent in 2008), and 9 percent were with a GP (10 percent in 2008). These trends continue to show that silicone hydrogel lenses are being adopted at the expense of traditional hydrogel materials, although traditional hydrogel materials certainly still make up a substantial part of contact lens practice.

Figure 2. Distribution of materials used in fitting and refitting.

Most of the reported fits are with soft spherical lenses (50 percent) and in full-time daily wear (63 percent), followed by soft toric lenses (25 percent), soft multifocal lenses (12 percent), spherical GPs (6 percent), and multifocal and toric GPs (3 percent and 2 percent, respectively) (Figure 3). Most of your patients are in full-time, daily wear soft lenses and most are using a two-week (40 percent) or monthly (40 percent) replacement schedule (Figure 4). This is an interesting trend compared with 2008, during which more patients were using two-week replacement lenses (44 percent in 2008) compared with monthly lenses (38 percent in 2008).

Figure 3. Distribution of lens types used in fitting and refitting.

Figure 4. Distribution of replacement schedules used with soft lens patients.

A potentially related connection is that practitioners seem to believe that patients using two-week replacement lenses are the least compliant. In our survey, only 54 percent of practitioners believed that their patients using two-week lenses were compliant, whereas 66 percent of practitioners believed that their monthly lens patients were compliant and 77 percent of practitioners believed that their daily disposable lens patients were compliant.

Speaking of daily disposable lenses, their U.S. market share appeared to remain the same in 2009 compared to 2008 at about 11 percent, while there were slight decreases in the use of quarterly (7 percent in 2008 versus 4 percent in 2009) and annual (4 percent in 2008 versus 2 percent in 2009) lenses.

As mentioned previously, at least 60 percent of respondents' soft lens wearers are presently in a silicone hydrogel material (compared with 54 percent in 2008). Certainly there is variability in these numbers, but even a conservative estimate would suggest a 5-percent increase in silicone hydrogel utilization per year. Thus, the percentage of U.S. fits and refits with silicone hydrogel materials is estimated to reach 65 percent in the next year for silicone hydrogel fits. However, the use of silicone hydrogels is less on a worldwide basis, with silicone hydrogels making up only about 50 percent of the U.S. market utilization (approximately 30 percent of fits and refits worldwide are with silicone hydrogels) in terms of spherical fits in this regard (Robert W. Baird & Co.).

Relative to toric soft lenses, our estimates show an overall increase in soft toric lens fitting in 2009 compared with 2008, at approximately 25 percent of all lens fits. Of soft toric lens fits, estimates suggest that about 60 percent of those in the United States are performed with a toric silicone hydrogel lens, which represents significant growth from last year. It is estimated that there will be continued silicone hydrogel penetration in the toric lens market, possibly up to nearly 80 percent over the next two years.

Daily disposables make up about 11 percent (CLS) to 12 percent (Robert W. Baird & Co.) of lens fits in the United States, with projected growth of one to two share points per year in the United States. This is identical to data from our 2008 survey, which showed daily disposables comprising 11 percent of fits and refits. Obviously, this is different on a worldwide basis, with estimates suggesting that daily disposables make up about 38 percent (Europe) to 54 percent (Asia/Pacific) of soft lens fits depending on the region (Robert W. Baird & Co.).

Over the next year, most respondents thought that silicone hydrogels materials (either two-week or monthly), multifocals, and daily disposables would be increasing further in their practices, whereas all classes of traditional hydrogels would be decreasing further. Respondents felt that extended/continuous wear, cosmetic lenses, and GPs would all be staying the same in their practices.

For presbyopic patients, most respondents reported using spectacles including progressives (43 percent of your presbyopes) and bifocal/multifocal (16 percent of your presbyopes). For presbyopic patients wearing contact lenses, most respondents indicated a preference for multifocal lenses (68 percent) compared with monovision (22 percent) and over-spectacles (8 percent). In practice, slightly fewer presbyopic patients are now prescribed monovision (14 percent of your total presbyopes) compared with soft (16 percent of your total presbyopes) and GP multifocals (2 percent of your total presbyopes). This new trend possibly suggests that multifocal lens technologies have come a long way, as monovision utilization far outpaced multifocals for years.

Prescription Pharmaceuticals In terms of prescription pharmaceuticals, most respondents indicated writing between 10 to 15 prescriptions over the course of a typical week. Within the major anterior segment ophthalmic categories, most prescriptions were written for dry eye (average of 15/week) followed by anti-allergy (average of 10/week), anti-in-flammatories (average of 9/week), and antibiotics (average of 8/week).

Contact Lens-Related Dry Eye Relevant to dry eye, we know that many of our contact lens patients suffer frequent and severe complaints during lens wear. We asked our readers to rank their perceived top three most efficacious “treatments” for contact lens-related dry eye. The most frequently ranked option was refitting into a new contact lens material (89 percent), followed by rewetting drops (82 percent), changing the contact lens care solution (64 percent), refitting in a new wear schedule (19 percent), prescribing a pharmaceutical agent (19 percent), and punctal plugs (10 percent).

Lens Care Trends According to our survey, the vast majority of respondents reported prescribing chemical care systems (80 percent) for contact lens patients, followed by hydrogen peroxide-based systems (20 percent). However, as shown in Figure 5 (data from AC Nielsen), total hydrogen peroxide use was about 11 percent. Figure 5 also shows that Opti-Free Replenish (Alcon), private-label solutions, ReNu MultiPlus (B&L), and Opti-Free Express (Alcon) hold the largest market share of all soft lens care products. For GP lenses (Figure 6), Boston Simplus, Advance and Original (B&L) hold the largest market share of associated disinfectants/conditioners.

Figure 5. Market share of all soft lens care products.
Source AC Nielson 10/3/09 (year-to-date).

Figure 6. Market share of all GP lens care products.
Source AC Nielson 10/3/09 (year-to-date).

Our data show that 92 percent of you are recommending specific brands of contact lens care systems to your contact lens patients. The largest factor in your selection is lens material/solution compatibility (70 percent), followed by the potential impact on comfort (~17 percent), and other factors (12 percent), while cost played an insignificant role (1 percent). Interestingly, most of you believe that the majority (67 percent) of your patients are indeed compliant with their lens care instructions.

Events and Innovations

The information in this section is derived from manufacturers' press releases that were printed in Contact Lenses Today as well as in Contact Lens Spectrum's News Spectrum and Product Spectrum throughout 2009. Thus, they may not be fully inclusive of all lens or care solution parameter changes, lens introductions, or new product introductions over the last year. Please see our annually published Contact Lenses & Solutions Summary for full details on lens materials, parameters, care solutions, and rewetting drops.

Contact Lens Care Early in 2009, Abbott Laboratories and Advanced Medical Optics announced a definitive agreement for Abbott to acquire AMO. The acquisition was completed in forthcoming months and the company is now known as Abbott Medical Optics.

Alcon announced the launch of Opti-Free GP, which incorporates HP-Guar, tetronic 1304, and polyquad.

Bausch & Lomb announced a rebranding of its care solutions for soft lenses to ReNu Fresh Lens Comfort (formerly ReNu MultiPlus) and ReNu Sensitive Eyes (formerly ReNu Multi-Purpose Solution).

As per our coverage last year, the Food and Drug Administration (FDA) became even further involved in the issues surrounding contact lens care. By midyear, the FDA developed educational materials for patients associated with contact lens safety and proper lens care habits. The educational series emphasized, among other things, the importance of fresh solution use, the use of a rub-and-rinse step for additional effectiveness, and proper care of the contact lens case. Furthermore, the FDA also continued meetings associated with regulatory aspects of contact lens care solution development and product labeling. On May 19, 2009, the FDA's Center for Devices and Radiological Health issued a letter to manufacturers of contact lens multipurpose solutions that offer an option for cleaning without a step for rubbing the lenses. This letter informed these manufacturers of the panel's conclusion that there is improvement in lens care when using a rub-and-rinse regimen as compared to a rinse-alone regimen, which omits the rubbing step.

GP Lenses Art Optical Contact Lens, Inc. released Thinsite2—a lens that is thinner and higher in oxygen transmissibility and manufactured in Boston XO₂ (B&L). The lenses are promoted to be good for patients who have extreme refractive error. Art Optical also expanded the Renovation lens by introducing the Renovation E, toric options, and availability in a high-index material. The company also began manufacturing and distributing the BiExpert GP Bifocal.

Blanchard Contact Lens, Inc. introduced a new multifocal lens—Reclaim HD. It is a bi-aspheric multifocal lens created using Blanchard's S-Form Technology.

Contamac introduced the Optimum HR 1.51 and Optimum HR 1.53 high-index GP lens materials. The materials offer the benefits of reduced specific gravity and allow additional presbyopic add power in multifocal lens designs.

Paragon Vision Sciences announced FDA approval of its high-index material Paragon HDS HI 1.54. It is reported to potentially deliver as much as 1.00D of incremental add power, in addition to providing a low specific gravity. Paragon also announced the immediate availability of the Paragon CRT Dual Axis design that allows for modulation of the lens periphery in two locations. The design expands CRT availability when corneal elevation of curvature differences limit the success of the fit. Lastly, the company announced the availability of its CRT SureFit Delivery System, which provides certified practitioners with a single-use, three-lens-per-eye fitting and dispensing system to ensure first fit success. The 100-lens CRT Diagnostic Dispensing System remains the company's recommended fitting method.

SynergEyes, Inc. announced a parameter expansion for the SynergEyes Multifocal hybrid contact lens for presbyopia (+5.00D to −8.00D in 0.25D steps, −8.50D to −20.00D in 0.50D steps) and an additional add power (+0.75D). The company also announced parameter expansions for the SynergEyes PS hybrid lens for post-surgical patients (+6.00D to −8.00D in 0.25D steps and −8.50D to −12.00D in 0.50D steps in base curves from 7.2mm to 9.00mm in 0.20mm steps). Lastly, the company launched the ClearKone lens for keratoconus, which offers a patent pending vault design and reverse geometry landing system.

TruForm Optics announced availability of the DigiForm semi-scleral contact lens. The lens was designed to fit all irregular corneal shapes and uses the DigiForm Technology from optical coherence tomography to image the eye and fit the lens.

Hydrogel Lenses Ciba introduced three new colors in the FreshLook brand including Brilliant Blue, Gemstone Green, and Sterling Grey.

CooperVision expanded the parameters for Proclear Toric XR lenses to include low cylinders (−0.75DC to −2.25DC) in high plus and high minus sphere powers. The company also changed the name of its multifocal lens for emerging presbyopes from Biomedics EP to Proclear EP. Lastly, the company expanded the sphere powers of its Proclear 1 Day daily disposable contact lens to +8.00 to −12.00D.

Hydrogel Vision Corporation announced the expansion of its Clarity H₂O monthly replacement lens made from hioxifilcon D material. The lens was launched in three base curve/power combinations: median/+6.00 to −10.00D, flat/−0.25 to −6.00D, and steep/−0.25 to −10.00D.

PolyVue Distribution, Inc. announced the introduction of the company's second-generation high definition contact lenses—the HD2 and HDX2— both made from methafilcon A. The HD2 is designed to reduce spherical aberration and provide up to +1.00D add. The HDX2 is a progressive multifocal that provides up to +2.25D add.

Unilens Vision, Inc. announced the launch of the C-Vue Advanced Toric Multifocal lens for astigmatic presbyopes. This is a monthly replacement lens made from hioxifilcon D.

Silicone Hydrogels CIBA announced the release of the Air Optix Night and Day Aqua lens, which is intended to replace the original Night and Day lens. Made from lotrafilcon A, the lens also incorporates the Aqua Moisture System to help with initial comfort. It remains approved for up to 30 days and night continuous wear.

CooperVision expanded the parameters of its Avaira two-week replacement silicone hydrogel contact lens (enfilcon A), ranging from −0.25D to −12.00D (0.50D steps above −6.00D). It later introduced a new 8.4mm base curve lens for plus powers of +0.25 to +8.00D. The company also announced the introduction of the Biofinity Toric (made from comfilcon A) contact lens. It is offered in sphere powers of +6.00D to −8.00D with cylinder powers of −0.75, −1.25, −1.75, and −2.25D in around-the-clock axes.

Vistakon announced the introduction of the Acuvue Oasys for Presbyopia lens, which combines Stereo Precision Technology optics with senofilcon A material. At launch, the lens was introduced with distance parameters of −0.50D to −9.00D in 0.25D steps and near additions of “low” and “mid” (+0.75 to +1.75D).

LensDen, LLC launched a trial lens contact lens storage system for in-office use that allows for optimized storage of trial lenses.

Global Specialty Lens Symposium

The inaugural Global Specialty Lens Symposium (GSLS) convened between Jan. 15 and 18, 2009 in Las Vegas, Nev. The meeting drew nearly 325 participants from 22 countries with more than 35 sponsors/exhibitors present. Contact Lens Spectrum and the Lippincott, Williams & Wilkins Health Care Conference Group hosted the event, which focused on the latest in contact lens technologies for pediatric and adolescent fitting, myopia management, keratoconus, irregular astigmatism and other irregular corneas, large corneal and scleral lens designs, presbyopia management, lens care and compliance, and coding. The Symposium included information for all vision care providers with 17+ credit hours of COPE, JCAHPO, and NCLE accreditation, and the international faculty provided cutting edge information on these conditions that affect so many of our patients.

Mourning Their Loss

2009 was a particularly difficult year for our profession in that several of our colleagues passed away including Pat Cummings, OD, FAAO; Robert Breece, OD; Jeffrey Gilbard, MD; and N. Rex Ghormley OD, FAAO. As we have reported, each of these individuals had a tremendously significant impact on our profession and the field of contact lenses, and each will be missed. Our sincerest condolences go out to their friends and families.

Looking Ahead

We are indeed optimistic for the 2010 year in contact lenses. We suspect that there could be several completely new contact lens and care solution introductions. There should also be significant activity in the regulatory aspects of lens care solutions, and possibly progress in the pharmaceutical treatment of dry eye disease.

Again, thank you to all of our readership and supporters for a fabulous 2009. We are indeed excited and optimistic about 2010. CLS

A Look Back 20 Years Ago I always find it especially interesting to look back at the CLS Annual Reports summarizing activities of yesteryear. Twenty years ago in the January 1990 issue, Emeritus Editors Joe Barr, OD, MS, and Neal Bailey, OD, PhD, estimated that 24 million Americans wore contact lenses in 1989, and they discussed the recently introduced frequent replacement modality (much of soft lens wear until the late 1980s was with annual replacement lenses). They made the case that there were benefits (vision, comfort, and health) to support the use of disposability, which is pretty well accepted today. Vistakon had expanded its Acuvue lens into the plus power range and suggested the possibility of daily disposability in the future. Other companies were beginning to enter the disposable market as well (The figure at right shows three of the disposable lenses at the time). There was also buzz around new soft multifocals entering the market (Allergan's Echelon Bifocal and Ciba Vision's Spectrum bifocal). Probably the biggest news of 1989 was the September 21 issue of the New England Journal of Medicine's articles on risks of ulcerative keratitis with daily and overnight wear lenses. The FDA had correspondingly issued a statement suggesting a maximum of one week of extended wear with contemporary materials. As seems to be a pervasive topic throughout the years, the annual report on 1989 discussed issues with care solutions. Brien Holden, PhD, was quoted as saying, “Low toxicity preservative solutions have shifted many wearers out of peroxide solely because of convenience. Effectiveness of these solutions is assumed by the patient purely on the basis of FDA approval. This assumption could be a mistake.” It is interesting that this quote is still very relevant 20 years later. As noted elsewhere in this issue, it is typical for us to recognize a “Contact Lens Event of the Year.” For 1989 Dr. Barr described that event as “The Increased Acceptance of Disposable and Frequent or Planned Replacement Programs.” 10 Years Ago Ten years later (January 2000) in his annual report on 1999, Dr. Barr quoted the expected worldwide market for manufacturers' total sales for contact lenses at $3 billion, with approximately 33 million lens wearers in the United States and 80 million worldwide. Nearly 90 percent of these sales were reported to be for soft contact lenses. He also estimated that the lens care solution market would approach $1 billion. Similar to today, two-week replacement lenses were highly utilized (41.5 percent then and 40 percent now), but daily disposables only made up about 5 percent of the market (we find that daily disposables make up about 11 to 12 percent of the market today). In terms of care solutions, Dr. Barr reported that chemical care systems made up about 86 percent of care systems prescribed to patients (80 percent today) and hydrogen peroxide made up 13.5 percent (20 percent today). Interestingly, practitioners in 1999 averaged seeing 15 contact lens fits and refits per week, whereas our survey indicates that practitioners today average seeing about 27 contact lens fits and refits per week. Certainly, the pressures associated with reduced reimbursements/coverage for contact lenses may have had an impact on this. As noted previously, the impact of multifocal technologies over the last decade is astounding. In 1999, 21.5 percent of fits were with monovision (14 percent today), 9 percent were with soft multi-focals (14 percent today), and 3 percent were with GP multifocals (2 percent today). In the January 2000 issue (summarizing 1999), Dr. Barr took things a step further by also naming a “Contact Lens Event of the Millennium” in addition to the Event of the Year. So, what were these events? The Contact Lens Event of the Millennium was described by Dr. Barr as Otto Wichterle's invention of the hydrogel (soft) contact lens. Correspondingly, in 1999, Bausch & Lomb had introduced the first silicone hydrogel (PureVision) lens to the contact lens market, which was named the Contact Lens Event of the Year for 1999.