As 2018 turns into 2019, we focus our attention to the very interesting trends in the contact lens market. The past few years have been very interesting, with continued trends in segments that relate to replacement schedules, certain designs, and contact lens care. We hope that you find the information provided in the 2018 Annual Report valuable as you evaluate your own contact lens practices.

OVERVIEW OF GENERAL MARKET TRENDS

It’s always tough to pin down the size of the contact lens market given the many products sold across far-reaching parts of the globe. Data obtained from Robert W. Baird & Co. (Jeff Johnson, OD, CFA, managing director, senior research analyst), however, suggest that the global market value for soft contact lenses (measured at the manufacturers’ level) likely exceeded $8.5 billion in 2018 and that growth for the market improved modestly through the first three quarters of the year to just greater than 6% (after excluding the impact of fluctuating foreign exchange rates). That marks nine straight years dating back to the Great Recession of global soft lens market growth of at least 4% to 6%, with the continued transition to silicone hydrogel (SiHy) lenses, an accelerating uptake of daily disposable lenses, and volume expansion into developing markets supporting this solid growth in recent years.

Baird further estimates that the $3 billion U.S. contact lens market also grew roughly 6% through the first nine months of 2018, which is an improvement compared to the close to 3% to 4% growth for the domestic market that we realized in 2017.

While hard to trace this improved market growth back to one specific factor, Baird believes that the domestic market’s conversion to daily disposables has accelerated recently, as daily disposable SiHy lens parameter availability has expanded and newer toric and multifocal daily disposable options have launched. Promotional activity (mainly in the form of patient rebates) also began to stabilize in 2018 after rising in the prior year or two. And, while these heightened promotional efforts in 2017 may have cost manufacturers a slight amount of growth that year, Baird believes that manufacturers are now seeing the benefit of having locked these patients into the daily disposable category (hopefully) for many years to come.

CURRENT PRACTICE TRENDS

Contact Lens Spectrum also conducts market research whereby the readers are asked about their practice trends and patterns both generally and as they relate specifically to contact lenses. We have conducted this market research for many years, which allows for some longer-term and longitudinal analyses. The questions cover a variety of topics, including characteristics of the patient base of a practice, business and financial aspects of a practice, fitting and prescribing trends, and care solution trends. This year, 103 U.S. respondents completed the majority of the survey. In proceeding ahead to discuss trends and observations about the contact lens field, we will draw on information provided through this market research as well as through other sources.

Practice and Business Trends Table 1 summarizes trends in practice and business characteristics from 2009 through 2018. Most of our respondents were optometrists (85%), followed by opticians, contact lens technicians, and ophthalmologists, respectively. Modes of practice varied, but the most common was solo private practice, followed by group private practice and employee of either an optometrist or ophthalmologist. In 2018, the typical practice saw an average of 109 patients per week. The patient base of the typical practice consisted of approximately 35% contact lens wearers, and the average number of contact lens fittings and refittings in a typical week was about 34. Correspondingly, in 2018, respondents felt that about 30% of their gross profit and about 26% of their net profit was derived from the contact lens portion of their practices. These numbers are very similar to what we’ve seen for the past few years.

Figure 1 shows that practitioners estimate that 64% of their patients purchase contact lenses from their practice (67% in 2017), whereas 22% of patients purchase their contact lenses online (19% in 2017), 12% purchase their lenses through a third-party retailer independent of a practice, and 2% purchase their contact lenses from another practice setting (both just slightly changed from 2017, for which we reported 10% and 3%, respectively).

In addition, only 55% of practitioners believe that they will see an increase in their overall contact lens practice in 2019 (versus 67% in 2018), while 38% believe that their practices will stay the same (versus 31% in 2018) and 7% indicated that their practices will be decreasing further (versus 2% in 2018).

Lens Dispensing and Mode of Wear Trends As we have reported in years past, SiHy materials make up the majority of the fits and refits that are conducted today (Figure 2, Contact Lens Spectrum market data). In 2011, we noted the first slowing of the SiHy category. For 2018, SiHy lenses have a reported usage at 69% of fits, whereas hydrogels were reportedly used in 19% of fits in 2018; GPs were reportedly used across 9% of fits.

Data from Contact Lens Spectrum’s market research showed that, across all contact lens designs, most of the reported fits and refits are with soft spherical lenses (49% versus 48% in 2017), followed by soft toric lenses (24% for both 2018 and 2017), soft multifocal lenses (12% for both 2018 and 2017), spherical corneal GPs (6% versus 4% in 2017), and scleral designs (3% versus 5% in 2017) (Figure 3).

Along these same lines, when asked about the greatest growth potential in 2019 of several popular specialty lens options, most practitioners indicated scleral lenses (50% compared to 43% for 2018), followed by custom soft lenses (26%, the same as was predicted for 2018), hybrids (13% compared to 11% for 2018), and orthokeratology (11% compared to 20% for 2018).

When we asked practitioners to estimate the distribution of lenses by category of lens design for lenses containing any GP lens material (Figure 4), it is perhaps not surprising that corneal designs made up the bulk of fits (77% versus 70% for 2017), followed by sclerals (13% versus 16% for 2017), hybrids (7% versus 8% for 2017), and ortho-k (4% versus 6% for 2017).

Data obtained from ABB Optical Group (an independent optical industry platform) and GfK Retail and Technology (a market research service) showed a similar trend for 2018 when comparing what are considered the four major soft lens categories (spherical, toric, multifocal, and cosmetic). In Table 2, data from our three sources show slight variability in soft spherical lens prescribing (range 53% to 59% versus 52% to 60% for 2017) and for multifocal soft lens prescribing (range 10% to 16% versus 9% to 17% for 2017); the data show a little more consistency in prescribing habits with soft torics (range 26% to 29% versus 25% to 28% for 2017) and soft cosmetic lenses (range 2% to 5% for both years). When the Contact Lens Spectrum readers were asked which soft lens categories they anticipated using more of in 2019, 62% indicated daily disposables (versus 58% in 2018), followed by multifocals (34% in both 2017 and 2018), torics (3% versus 5% in 2018), and cosmetic lenses (1% versus 3% in 2018).

Also in addition to the Contact Lens Spectrum Reader Profile Survey, market insights were gleaned from ABB Optical Group and GfK Retail and Technology in terms of replacement schedule usage (Table 3 and Figure 5). When comparing among the data sources, interesting trends emerge; for two of the three sources, the daily disposable modality emerges as leading in terms of prescribing by soft lens replacement schedule (range of 35% to 46% versus 35% to 44% for 2017), followed by the monthly category (range 34% to 41%). The weekly/two-week category continues to show declines (ranging up to –8%), and the daily disposable category continues to be associated with the most growth (ranging up to 7%)—a trend that we have observed for the last several years.

As has been the case for several years now, for presbyopic patients wearing contact lenses, most practitioners continue to indicate a strong preference for multifocal lenses (64% in 2018 compared to 70% in 2017) compared with monovision (27% in 2018 compared to 23% in 2017) and over-spectacles (9% for 2018 and 6% for 2017). In practice, more of your presbyopic patients are prescribed a multifocal (45% of your contact lens-wearing presbyopes versus 50% in 2017) compared with monovision (35% of your contact lens-wearing presbyopes, which is unchanged from 2017).

Myopia control with contact lenses is certainly a growing practice in the contact lens community, albeit it is still off-label in the United States. In 2018, 28% of Contact Lens Spectrum Reader Profile respondents indicated that they actively practice myopia control with contact lenses (compared with 44% in 2017). Of those who are practicing myopia control with contact lenses, most do so with soft multifocal designs (52% versus 41% in 2017), followed by orthokeratology designs (45% versus 54% in 2017) and GP multifocals (3%) (Figure 6).

CONTACT LENS WEAR AND CARE COMPLIANCE

As Figure 7 shows, practitioners indicated that only 39% (44% in 2017) of their patients using one- to two-week replacement lenses were compliant with the replacement schedule, whereas practitioners indicated that 61% (66% in 2017) of their patients using monthly lenses were compliant and 75% (79% in 2017) of their patients using daily disposable lenses were compliant. The trends observed this year are similar to what we have reported in prior years.

LENS CARE TRENDS

According to our survey, the majority of respondents reported using chemical care systems (64% versus 67% in 2017) with contact lens patients, followed by hydrogen peroxide-based systems (35% versus 33% in 2017); the hydrogen peroxide usage category has been trending upward over the last several years (Figure 8). The most significant factor in why practitioners make their selected recommendation is improved comfort (32%), followed by disinfection efficacy (19%) and cleaning efficacy (18%), with material/care solution compatibility (17%), convenience (10%), and cost (4%) rounding out the list.

YESTERDAY AND TODAY

To put all of these statistics in context, it’s important to see how they relate to the industry of years gone. To that end, let’s start by examining the top news stories of a decade ago and how they relate to what’s going on today.

Every year, we go through the difficult process of determining what “event” was most impactful on the industry during the previous year. Because Dr. Nichols had just recently started his tenure as editor-in-chief of Contact Lens Spectrum, the Contact Lens Event of 2008 was his first go-around with this. That year, we contemplated corneal staining, microbial keratitis, new daily disposables, and advances in dry eye, among other topics. The one that stood out, however, was something that he noted was “one that we might consider somewhat overdue”—contact lens care. Specifically, we pointed to a meeting by the Ophthalmic Devices Panel of the Medical Devices Advisory Committee of the U.S. Food and Drug Administration (FDA) that was held in mid-2008. Topics discussed at the meeting included regulatory processes for care solution approval, with emphases on preclinical and clinical testing in addition to labeling considerations. While we acknowledged that more meetings and discussions were certainly on the horizon, we felt that “this meeting summarized the impact of many events that have happened over the past few years.”

One of the specifics at the heart of this debate was whether patients needed to “rub and rinse.” At that time, many solution manufacturers were not requiring a rub step when using their products. These days, the community appears to have returned to embrace the benefits of rubbing and rinsing. In addition to removing dirt, debris, and cosmetics, rubbing helps patients avoid irregular and hydrophobic surfaces on their lenses that attract more debris and foster a vicious cycle.¹ Practitioners now commonly recommend this step because evidence shows that omitting it renders multipurpose solutions less effective.^2-4 Today, several multipurpose solutions include rub steps in their directions.

Looking back at 2008, it wasn’t a surprise that this topic held a leading position. In addition to numerous columns, news stories, and Readers’ Forum articles, Contact Lens Spectrum also introduced a new monthly column called Cultivating Compliance. In subsequent years, this was merged with another existing column to become the present-day Contact Lens Care & Compliance column.

Care and compliance is still a topic that is discussed very frequently, both between practitioners and their contact lens patients as well as among the industry at large. And, as recently as 2017, the FDA and notable members of the industry were still debating care issues, albeit on hydrogen peroxide specifics this time.⁵

The issues surrounding lens care and compliance continue to be prominent as practitioners are constantly striving to improve their patients’ contact lens-wearing experience and to prevent unwanted complications. In the November 2018 issue alone, we had two feature articles that covered this topic as well as a Contact Lens Care & Compliance column.

In addition, some practitioners are prescribing daily disposable lenses because they exhibit a lower estimated risk of infiltrative events and microbial keratitis;^6-8 this most likely results from patients using a new, clean contact lens each day.⁷ In addition, this may be one factor contributing to the jump from 11% of patients wearing daily disposable lenses in 2008 versus the 35% reported in 2018 (Figure 5).

Another popular topic in 2008 was the use of contact lenses, specifically multifocals, for presbyopic patients. Eghbali et al⁹ noted that even though multifocal contact lenses had been in use for more than a decade, “many eyecare practitioners shy away from prescribing them.” At that time, industry reports showed that less than 3% of presbyopes were currently wearing multifocal lenses.¹⁰

In the 2008 Annual Report, most respondents reported prescribing spectacles, including progressives (for 37% of presbyopes) and bifocal/multifocal spectacles (for 16% of presbyopes). For presbyopic patients who were wearing contact lenses, most respondents indicated a preference for multifocal lenses (59%) compared with monovision (27%) and over-spectacles (14%). However, in practice, respondents reported that they prescribed slightly more presbyopic patients with monovision (16%) than with soft (15%) or GP (3%) multifocal contact lenses.¹⁰ In that article, we suggested that “although technologies for multifocal contact lenses have greatly improved, we still have a way to go to provide optimal presbyopic correction with a contact lens only.”¹¹

Comparing those statistics to today, we are now seeing a much different picture. Contact lens-only correction for presbyopes has grown over the last decade. As noted earlier, multifocals continue to be a preferred lens design for presbyopes (64%), with monovision coming in second (27%) and over-spectacles in third (9%).

Finally, there was one notable acquisition in 2008 that bears mentioning. In the third quarter, Novartis AG and Nestlé S.A. completed the first step purchase and sale of 74 million shares of Alcon, Inc. common stock, making Novartis the owner of a minority stake in Alcon equal to approximately 25% of Alcon’s issued capital; Nestlé remained the majority shareholder with approximately 52% of Alcon’s issued capital. An additional agreement between the companies gave Novartis options to purchase the remaining Alcon common shares between Jan. 1, 2010 and Jul. 31, 2011, which would make it the majority shareholder. Now, as we enter 2019, Novartis has announced its intentions to spin off Alcon into a separately traded standalone company in the first half of this year.

TODAY AND TOMORROW

As we look toward the future, there are several prominent topics in 2018 that we anticipate will continue to gain press coverage in the coming year.

Technology This past year, the industry saw a number of notable lenses and eye-related technologies introduced, some of which are not yet commercialized. The year began with a University of Canterbury study inventing a 3D-printed polarized contact lens that could have applications for sufferers of photosensitive epilepsy. Scientists at Newcastle University successfully 3D-printed a human cornea that could alleviate the shortage of corneas available to transplant. The FDA approved the first standalone prosthetic iris, which is made of thin, foldable, medical-grade silicone and can be custom-sized and colored for each individual patient. And, the U.S. Patent and Trademark Office issued a patent covering the utility of its iontophoretic contact lens. The patent relates to a multi-layer contact lens for ocular therapy, comprising a reservoir adapted to contain an electrically charged therapeutic compound and an electrode providing iontophoretic current to the charged compound to propel it into the ocular tissue.

Going into the future, one eagerly anticipated contact lens will provide wearers with vision correction in conjunction with a photochromic filter. It received 510(k) clearance from the FDA and a medical license from Health Canada in 2018. These lenses quickly adjust from clear to dark, according to the manufacturer, and will help the human eye manage different types of light and varying intensities of brightness throughout the day. They are expected to be launched commercially in the first half of 2019.

One disappointment on the contact lens technology front was the decision by Verily, Alphabet’s life sciences arm, to pause work on its smart lens program, which was aiming to put sensors on contact lenses to measure blood sugar levels in tears. However, the company says it plans to focus on other projects including a possible contact lens for age-related farsightedness or a smart lens for improving sight after cataract surgery.

Pharmaceuticals In terms of pharmaceuticals, we can expect to hear about several medications that received FDA approval in 2018, including those indicated for increasing tear production, reducing postoperative inflammation and pain, reducing intraocular pressure, and reducing ocular redness.

Myopia And, in the “Wait, haven’t you been saying this for years?” category, once again we have to point to myopia as an area that is still garnering much attention. In choosing it as our “Event of the Year,” we have seen a tremendous amount of ramping up, so to speak, by all players in the contact lens industry.

According to CooperVision, its acquisition of Paragon Vision Sciences early this year “provides the opportunity to grow its myopia management presence worldwide.” Subsequently, CooperVision created a Specialty Eye Care business unit that encompassed Soflex, Procornea, and Paragon Vision Sciences.

The Brien Holden Vision Institute (BHVI), which has consistently put up a rallying cry regarding the growth of myopia worldwide, engaged in several initiatives this year. The BHVI Academy launched a new myopia management course and had a second offering of its original course this past fall. It also launched a myopia management tool for practitioners and updated its Myopia Calculator. And, BHVI also announced a new online Global Myopia Centre that will host its education programs, online tools, global data, peer-reviewed references, and resources that can be used for advocacy efforts.

Other myopia-related educational resources made available this year included the following: Thomas Aller, OD, who has been conducting myopia control research for more than 25 years, launched managemyopia.org, an educational and informational website; and, Drs. Kate and Paul Gifford updated the Myopia Profile website with additional educational resources, podcasts, and news. In addition, one contact lens received CE mark approval for myopia control in Europe.

Several partnerships and coalitions took form in 2018 as well. BHVI and the World Council of Optometry entered into a partnership to promote Myopia Awareness Week in 2019. The Singapore National Eye Centre (SNEC), the Singapore Eye Research Institute (SERI), and Johnson & Johnson Vision (J&J Vision) announced a $26.35 million research collaboration to tackle myopia. And, the Global Myopia Awareness Coalition (GMAC) held its second meeting at the end of the year to approve a governance structure and funding mechanism to formally launch its efforts.

And finally, next year is starting strong with several conferences that are concentrating all or in part on myopia: the focus of part of Opti 2019’s lecture series will be on myopia management; the 2019 Global Specialty Lens Symposium is offering close to 10 hours of myopia-specific CE courses in January; and The Myopia Meeting is offering a five-hour CE program in February. CLS

REFERENCES

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3. Tam NK, Pitt WG, Perez KX, et al. Prevention and removal of lipid deposits by lens care solutions and rubbing. Optom Vis Sci. 2014 Dec;91:1430-1439.
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