When we look at the future of contact lens practice, the three areas for which we need to prepare are adaptive technologies that utilize contact lenses, dry eye disease (DED) management, and myopia management.

Adaptive Technologies

Positioning your practice to incorporate adaptive technologies that utilize contact lenses is a way of distinguishing your practice from the herd, not to mention the fact that you will be offering products that will improve the quality of life of your patients. Whether talking about computer interfaces in contact lenses (Chokkattu, 2020) or monitoring of health telemetry through a contact lens (Harrison, 2020), these lenses will be profitable and exclusive. And, unless the current iteration of the Food, Drugs, and Cosmetics Act is changed at the federal level, contact lenses will still need to be prescribed by competent practitioners, and these lenses will be very difficult to commoditize.

Dry Eye Disease

DED management is a crucial area of competence for contact lens prescribers when dealing with the management of contact lens discomfort (CLD). In reports from the Tear Film & Ocular Surface Society (TFOS) International Workshop on Contact Lens Discomfort, the authors noted that “tear film stability (via evaporation)...is recognized as a key factor in CLD...” (Nichols et al, 2013). And, according to the latest articles in peer-reviewed journals, DED is one of the foundational failures that leads to contact lens dropout. Going forward, keeping existing contact lens patients is imperative to the health of a practice; it is also much less expensive to retain current patients than to acquire new ones.

Myopia Management

Those two aforementioned areas will be very important for practitioners, but the big ticket item right now is myopia management because myopia has become a global epidemic. In the United States, the prevalence of myopia has increased almost 49% in the last 20 years; by 2050, nearly 60% of Americans will be myopic, and the number of people who have myopia above –5.00D will likely be 1 in 10 (Holden et al, 2016).

According to the World Health Organization (WHO), high myopia (–5.00D and greater) can cause serious damage to the anatomy of the posterior retina, which can lead to irreversible vision loss. The constellation of changes to the macular anatomy—termed myopic macular degeneration (MMD)—“comprises diffuse, patchy macular atrophy with or without lacquer cracks, choroidal neovascularization, and Fuchs spots” (WHO, 2015).

The only way to prevent MMD seems to be the prevention of high myopia (WHO, 2015). Slowing axial growth may also reduce the risk of retinal detachment, glaucoma, and cataracts because high myopia is a risk factor for all of these conditions (WHO, 2015).

Knowing all of these things, it is important to place yourself in the shoes of every parent who has a myopic child. The first step to build up a successful myopia management practice is to develop a passion about the plight of the highly myopic and the very real chance that a child before you will, one day, have irreversible damage to his or her vision.

Plan for the Future

The eyes are not a vital organ; we can live without them. However, the entire essence of what we do as eye-care practitioners is to correct vision so that our patients can see. What would you do if you knew which of your current 10-year-old patients would later develop glaucoma? How would you act? The development of high myopia in a child is a window into the future of MMD.

As the evidence base suggests a mechanism for the development of high myopia as well as the possible methods of slowing the growth of axial length, practitioners must become experts in how that mechanism works and how to treat it—no undercorrection, plenty of sunlight exposure in early years, and the use of multifocal contact lenses, orthokeratology, and low-dose atropine (WHO, 2015). CLS

For references, please visit www.clspectrum.com/references and click on document #293.