ANNUAL REPORT

Contact Lenses 2013

Growth in some specialty areas and consensus on lens discomfort highlighted an otherwise stable year.

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

Dr. Nichols is the Kevin Mc-Daid Vision Source Professor at the University of Houston College of Optometry, as well as the editor-in-chief of Contact Lens Spectrum and editor of the weekly email newsletter Contact Lenses Today. He has received research funding or lecture honoraria from Vistakon, Alcon, and Allergan.

It’s that time of year again—our January issue is among our favorites of the year. Each January, we present our annual report of the previous year, which is associated with analyzing and identifying trends in the field and changes in the contact lens marketplace. We saw a few marked changes going from 2012 to 2013, but the contact lens market remained relatively stable as a whole.

Let’s look now at 2013 to see where the field stood during this past year.

Overview of General Contact Lens Market Trends

To analyze trends in the contact lens market, we use a variety of sources to help arrive at our estimates. It appears that data from those sources all demonstrate relative agreement and consistency. One of the more important figures that we try to estimate from year to year is the overall size of the contact lens market—both figuratively and in terms of an absolute value of contact lens wearers. We believe that the market remained relatively stagnant in 2013 in terms of the potential growth in the overall number of U.S. contact lens wearers—which we estimate to be about 37 million.

That said, data from sales estimates tend to show slight-to-modest gains when comparing 2013 to the same period for 2012. Data obtained from GfK Retail and Technology (Jim Fleckenstein, vice president Optics-North America) show a continued upward trend in the sales volume for soft lenses in the United States in 2013, indicating that U.S. sales of soft contact lenses grew 4.7% for January 2013 through September 2013 compared to the same period for 2012. Likewise, data obtained from the ABB Optical Group also showed a healthy increase in U.S.-based sales of soft contact lenses over the same period for 2012, with an 11% increase. (In the 2012 Annual Report, we reported between a 4.5% and 9% increase in overall sales volume compared to 2011.)

However, data from the ABB Optical Group showed a slight decline (–0.7%) in the GP category in 2013 compared with the same period in 2012. Lastly, data obtained from Robert W. Baird (Jeff Johnson, OD, CFA, director, senior research analyst) show that as of the third quarter of 2013, contact lens trends have been healthy on a market-wide basis, with U.S. sales growing 6% through the first nine months of the year and worldwide sales just under 5% (after excluding the impact of recent fluctuations in foreign currency exchange rates).

As for the contact lens market size, Baird’s 2013 data suggest that the value of the worldwide contact lens market currently stands at roughly $7.6 billion, with the U.S. market valued at approximately $2.5 billion. Looking to worldwide market share of the four largest contact lens manufacturers, Baird estimates that market shares were fairly stable in 2013. Specifically, it appears that Johnson & Johnson Visioncare maintained its low-40% market share, and Alcon maintained its mid-20% market share worldwide. For CooperVision, Baird estimates its share of the worldwide contact lens market may have increased slightly to just under 20%, with Bausch + Lomb likely maintaining the close to 10% market share that the company had entering the year.

Current Practice Trends

Contact Lens Spectrum also conducts market research, whereby we ask our readership about their practice trends and patterns both generally, and as they relate specifically to contact lens practice. We have conducted this market research for many years, although in the previous five years we have employed a similar methodology that now allows for some five-year trend analyses.

Our questions cover a variety of topics, including characteristics of the patient base of a practice, business and financial aspects of a practice, contact lens fitting and prescribing trends, and contact lens care solution trends. This year, we had 352 respondents who accessed the survey link, 334 who completed the entire survey, and 18 who answered a portion of the survey. As I proceed ahead in discussing trends and observations about the contact lens field, I will draw on information provided through this market research, in addition to the other sources mentioned previously.

Practice and Business Trends Most of our respondents were optometrists (87%), followed by opticians, contact lens technicians, and ophthalmologists. Modes of practice varied, but the most common was solo private practice (approximately one-third), followed by group private practice, employment by an optometrist, and retail setting.

Table 1 summarizes practice trends and business characteristics from 2009 to 2013. In 2013, the typical practice saw an average of 125 patients per week. Contact lens wearers made up approximately 34% of the patient base of the typical practice, and the average number of contact lens fittings and refittings in a typical week was about 25; these numbers are virtually unchanged when compared with 2012. However, these numbers are higher than those from 2009 to 2011.

TABLE 1 Trends in the Business Portion of Practices

Correspondingly, most respondents felt that about 33% of their gross profit and about 25% of their net profit was derived from the contact lens portion of their practices. These are the lowest estimates for revenue associated with the contact lens portion of the business that we have ever noted. Yet, 62% of practitioners believe that they will see an increase in their overall contact lens practice in 2014, while 36% believe that it will stay the same, and only 2% believe that it will be decreasing further.

Lens Dispensing and Mode of Wear Trends As our market data have reported in years past, the majority of contact lens fits and refits conducted today are with silicone hydrogel materials (Figure 1). In 2011, we noted the first slowing of the silicone hydrogel category, which showed a bit of a decline (–3%) in 2012. For 2013, our data suggest that 66% of contact lenses prescribed are in the silicone hydrogel category compared to 64% in 2012.

Figure 1. Distribution of material classes used in fittings and refittings.

Data from GfK Retail and Technology indicate that silicone hydrogel lenses represent 66.5% of the soft contact lens market compared with hydrogels at 33.5%. The GfK Retail and Technology data also show a –0.2% decline in the silicone hydrogel category compared with 2012. Year-to-date data from the ABB Optical Group show a similar trend, with silicone hydrogel lenses making up 59% of the market and hydrogel lenses making up about 40% (with GP lenses and hybrids making up the other ~1% of the market). Data from the ABB Optical Group also show a slight declining trend in silicone hydrogel usage, with a –1% decline when comparing the 2012 to 2013 silicone hydrogel data.

Similar to years prior, data from Contact Lens Spectrum’s market analysis showed that 8% of fits and refits were conducted with a GP lens (respondents indicated that 9% of fits and refits were with GPs in 2012).

Figure 2 shows data from Contact Lens Spectrum’s market research, indicating that most of the reported fits and refits were with soft spherical lenses (51%) and in full-time daily wear (62%), followed by soft toric lenses (24%), soft multifocal lenses (13%), spherical GPs (5%), and multifocal GPs (2%). Overall, we saw little change in the specialty lens section of Figure 2, although the scleral lens category certainly deserves mention in terms of the enthusiasm of the populous for this modality. That said, when asked about the greatest growth potential of several popular specialty lens options in 2014, most practitioners indicated custom soft lenses (47%), followed by hybrids (26%), scleral lenses (20%), and orthokeratology lenses (7%). This is the same distribution that resulted when this question was asked in our survey from 2012 about anticipated usage in 2013. With these numbers remaining consistent, perhaps 2014 will be the year of custom and hybrid lenses.

Figure 2. Distribution of lens modalities used in fittings and refittings.

Data obtained from GfK Retail and Technology and the ABB Optical Group showed a similar trend for 2013 (Table 2)—including a comparison of both groups’ data to its own for 2012. However, direct comparison of these additional data to Contact Lens Spectrum market research is not appropriate given that different categories were used in the comparison (GfK Retail and Technology and the ABB Optical Group data focus on only predict four categories in the soft lens domain). In the longer term, when comparing the GfK data to the company’s data for 2009, there are decreases in both the spherical (–1.3%) and cosmetic categories (–1.9%), but growth in torics (1.3%) and multifocals (1.9%).

TABLE 2 2013 ABB Optical Group and GfK Retail and Technology Data for United States in Terms of Lens Modality

In terms of replacement schedules, Contact Lens Spectrum’s market research indicates that most contact lens patients are using monthly replacement schedules (44%) (Figure 3). Two-week replacement remained stable at 30% this year, representing the first time in a few years in which this segment did not lose traction. However, as noted in the last few years, the daily disposable category again showed modest gains—this year representing 20% of fits and refits. Our data indicated that the daily disposable category was at 17% in 2012 and at a mere 11% in 2009.

Figure 3. Distribution of replacement schedules used in fittings and refittings.

Data were also obtained from the ABB Optical Group and GfK Retail and Technology in terms of replacement schedule usage (although again, direct comparison with Contact Lens Spectrum market data is not appropriate as the categories differ slightly). When comparing the data between these two groups, a similar sort of trend emerges—that is, the monthly category still holds the most market share, the weekly/ two-week category shows no growth, and the daily disposable contact lens category is associated with continued growth (Table 3).

TABLE 3 2013 ABB Optical Group and GfK Retail and Technology Data for United States Soft Lenses in Terms of Replacement Schedule

When asked about the contact lens design or modality with the greatest growth potential over the next year, 63% of respondents in our market research indicated daily disposables, followed by soft multifocals (33%) and soft torics (4%). When asked about anticipated use in 2014, 71% of respondents in our market research responded that they anticipate using silicone hydrogel daily disposables (up from 64% in 2012), and 49% anticipate using traditional hydrogel daily disposables at a greater rate in 2013. Other lens categories with greater anticipated use included soft torics (54%) and silicone hydrogel multifocals (67%); this was also true in 2012, although growth in these categories in 2013 was modest at best.

For presbyopic patients wearing contact lenses, most practitioners continue to indicate a strong preference for multifocal lenses (72%) compared with monovision (20%), and over-spectacles (8%); we have observed this trend of multifocal preference increasing year-after-year since our Annual Report for 2008, when only 59% of practitioners notes a preference for multifocals. Indeed, in practice, more of your presbyopic patients are prescribed a multifocal (46% of your contact lens-wearing presbyopes) compared with monovision (36% of your contact lens-wearing presbyopes). Soft multifocals (40% of presbyopic lens wearers) and soft monovision (31%) make up the bulk of the presbyopic correction modes for contact lens wearers, and these numbers appear to have remained stable for 2013 compared to 2012.

Forecasting into 2014, most practitioners responding to our survey felt that their overall contact lens practice would increase (62%) or stay the same (36%), as opposed to decreasing (2%). In terms of specific categories, there were four types of contact lenses that respondents predicted would be increasing in utilization (compared to either staying the same or decreasing): hydrogel daily disposables (49% of practitioners), silicone hydrogel daily disposables (71% of practitioners), silicone hydrogel torics (54% of practitioners), and silicone hydrogel multifocals (67% of practitioners). For every other lens option, including daily wear, one- to two-week and monthly replacement hydrogels and silicone hydrogels, all other toric and multifocal options, extended and continuous wear, cosmetic/colored lenses, orthokeratology, GPs, hybrids, and scleral lenses, practitioners generally felt that these modalities would all be staying the same in terms of utilization in their practices in 2014 rather than increasing or decreasing.

Contact Lens Wear Compliance

Our data on practitioner-perceived compliance remain relatively unchanged, and have so in a relative sense since 2009. Respondents indicated that only 48% of their patients using one- to two-week replacement lenses were compliant with the replacement schedule, whereas 66% of their patients using monthly lenses were compliant, and 78% of their patients using daily disposable lenses were compliant (Figure 4). Generally, practitioners indicated that about 68% of all contact lens patients in their practice properly comply with lens replacement per instruction.

Figure 4. Practitioner-perceived patient compliance associated with lenses of various replacement schedules.

Lens Care Trends

According to our survey, the vast majority of respondents reported using chemical care systems (76%) with contact lens patients, followed by hydrogen peroxide-based systems (24%), which has been trending up over the last several years (Figure 5). Our data show that 85% of you are recommending specific brands of contact lens care systems to your contact lens patients, while 15% of you are not—which indicates a continued downward trend in care solution recommendations over the last few years. The most significant factor in determining the selected recommendation was improved comfort (27%), followed closely by lens material/solution compatibility (26%), and then cleaning efficacy (19%), disinfectant efficacy (18%), convenience (8%), and cost (2%).

Figure 5. Lens care systems prescribed to patients from 2009 to 2013.

A Look Back

We always find it interesting to look back at the contact lens market of years past to see where it has been and why it has changed. Ten years ago in January 2004, then Editor Dr. Joe Barr and the staff of Contact Lens Spectrum discussed several issues that impacted the contact lens market in 2003. In considering the event of the year for 2003, Dr. Barr and his staff noted several companies for their product innovations. Specifically, Vistakon was acknowledged for a silicone hydrogel entry, while Ciba Vision was acknowledged for its work on the continuous wear modality (30 days/nights).

With regard to continuous wear of lenses approved as such in 2003, it was interestingly asked, “will practitioners proactively prescribe these lenses for this regimen?” Fast forward to 2013, and we now know that the answer to that question is “no”—rates of continuous wear prescribing have remained relatively flat through the years.

So, what was the “Contact Lens Event of 2003?” It turns out that it was once again associated with the United States Federal Government. Specifically, the Fairness to Contact Lens Consumers Act (HR 3140) was called the most significant event impacting the contact lens market in 2003. The act ultimately required eyecare practitioners to provide contact lens patients with their prescription following their examination (and fitting) and successful follow-up care in addition to some prescription specifics for dispensers.

Today and Tomorrow

Without question, we saw some great technological advances this year in contact lens materials and designs. There was expansion in many specialty lens categories including specialty soft lenses, hybrids, scleral lenses, and even contact lens care cases—simply too many to mention here. We also saw expansion in the daily disposable contact lens category, both in terms of product technology advancement with new silicone hydrogel materials and product packaging, and in terms of continued growth in the category segment itself, as noted elsewhere in this report. In fact, this is the second straight year that the daily disposable category demonstrated significant growth compared with the year prior.

There is no doubt that the business of contact lenses continued to evolve in 2013—in a major way. In fact, Bausch + Lomb, the company that brought the very first soft contact lens to market, was acquired by Valeant Pharmaceuticals International for around $9 billion. While it is too early to tell, it will be interesting to see how Valeant works with Bausch + Lomb as they proceed ahead and how this partnership will impact the company’s visioncare business.

Another notable event that occurred in 2013 was the U.S. Federal Government’s implementation of both the Physician Payments Sunshine Act and the Patient Protection and Affordable Care Act (a.k.a., Obamacare). While Obamacare certainly got off to a very slow and challenged start, it remains to be determined what sort of impact it will have in ophthalmic care and on the contact lens industry.

Finally, as noted in this issue’s Editor’s Perspective, we’ve chosen the TFOS (Tear Film and Ocular Surface Society) International Workshop on Contact Lens Discomfort as our “2013 Contact Lens Event of the Year.” Like other TFOS-sponsored workshops of the past (e.g., the International Dry Eye Work-Shop and the International Workshop on Meibomian Gland Dysfunction), this “workshop” was really a series of meetings and process spanning 18 months that included nearly 80 of the world’s best and brightest experts who worked together to build consensus on the significant problem of contact lens discomfort. The workshop was structured with nine subcommittees aimed at tackling all facets of contact lens discomfort—from identifying a definition and classification scheme to its epidemiology, understanding the roles of lens materials, designs, and care systems, understanding the underlying biology and pathology of the ocular tissues and tear film, recommending clinical study and trial etiquette, and recommending a management and therapy approach.

All of this work was published in an entire single issue of Investigative Ophthalmology and Visual Science in October 2013. Given the nature of contact lens discomfort, including its extremely high frequency among contact lens wearers and no single effective treatment, the consensus building workshop was indeed a critical step forward by the contact lens community in making progress in this important area.

In summary, the contact lens field did well in 2013, but there is room for growth in 2014. There were some healthy growth-related trends in some interesting contact lens material and modality categories, which are likely to continue through 2014. We anticipate several new contact lens offerings in 2014, and perhaps a contact lens care solution or two to enter the market as well.

We continue to be optimistic about the state of the contact lens market, and we look forward to returning next year to report further on these trends. CLS

* The change data printed in Tables 2 and 3 each correctly represents its source data, but the ABB Concise change data were based on the sales volume percentage change while the GfK data reported the share point change. We apologize for any confusion that may have resulted by pairing two different types of change-from-previous-year information in these tables.