From the first glass scleral lenses in the 1800s through today’s ever-developing technologies, the evolution of the art and science of contact lenses marches on. The pace at which contact lens technologies develop, however, has not been gradual; in fact, things have changed exponentially and now appear to be occurring at warp speed. An estimated 41 million people in the United States wear contact lenses, and worldwide this estimate is in excess of 140 million wearers.^1-3 As we look forward to the future of contact lenses and of contact lens practice, we can only predict—in a limited way—how things will change and develop over the years to come. Our predictions most likely will pale in comparison to the realities of the future. That being said, let’s attempt to envision what is on the horizon and what may be in terms of the future of contact lens technologies and practice patterns.

DEVELOPING AND FUTURE CONTACT LENS TECHNOLOGIES

A key element in developing contact lens technologies is their ability to optimize vision beyond maximum visual acuity. A number of new approaches to contact lenses will allow us to provide vision improvement in ways that we could only formerly imagine. For example, increasing awareness of the impact of higher-order aberrations (HOAs) on visual function, coupled with technologies that can measure and quantify these aberrations, has led to research and development in wavefront-correcting/HOA-correcting contact lenses. In addition, “accommodating contact lenses” are being developed in an attempt to mimic the natural change of focus power experienced in pre-presbyopic years. Several contact lens telescopic systems are also being developed to help those who have low vision.

Beyond vision, contact lens technologies are being developed that will address a number of ocular conditions in numerous ways. A contact lens for evaluating daily changes in intraocular pressure is already commercially available, and others are in development to manage glaucoma in various ways. There are numerous developments with regard to the use of contact lenses to treat ocular surface disease, ocular allergy, and ocular infection.

A number of future developments using contact lenses go beyond the eye specifically. Integration of contact lenses with sensing and measurement technologies may make what seems like science fiction a reality in the not-too-distant future. Such technologies include biometric-sensing contact lenses, through which a variety of physiological measurements are able to be detected. In addition, contact lenses for augmented reality are being developed by a number of companies for uses such as medical, gaming, athletic performance, military operations, and many others.

Some of these future contact lens technologies are discussed in greater detail in other feature articles in this issue. These and other emerging and evolving technologies are sure to have a profound impact on how we manage both our patients and our practices in the future. Planning ahead for what’s to come will help practitioners take these advances in stride.

WHAT WILL A FUTURE CONTACT LENS PRACTICE LOOK LIKE?

As we contemplate the multitude of emerging and yet-to-be discovered contact lens technologies, we must also consider how contact lens practice may change over the years to come. Similar to the speed at which these technologies develop, we are already seeing changes in the way that we practice on a daily basis. Recognizing changing practice patterns and adapting to change early on will allow contact lens practices to not only survive but to thrive.

Let’s take a closer look at some areas in which the face of contact lens practice will undergo change as new technologies continue to develop.

Use of Skilled Allied Health Professionals The days of one practitioner performing all diagnostic and therapeutic activities for each patient are fading fast. Efficient and successful contact lens practices have incorporated the use of technicians and assistants for many years. Empowering these individuals to perform testing and numerous treatment procedures has freed practitioners to do what they are best trained to do—to process the information provided into an effective diagnostic and management plan and to oversee the plan’s implementation.

Specific to contact lens practice, virtually all of the diagnostic testing and measurement procedures can easily be performed by skilled and highly educated ophthalmic technicians and assistants. Beyond that, initial contact lens fitting can be performed by these individuals and finalized by practitioners. Some of the most successful and high-volume contact lens practices have educated their technical staff to fit lenses as complex as sclerals as well as other designs intended for even the most irregular corneas. Practitioners at such practices simply integrate the diagnostic information provided and direct their staff as to what specific lens design they feel would best manage each patient; then the practitioners simply finalize the order or make minor design modifications. This trend will and should both continue and expand.

Integrated Remote Practices It’s possible to envision a time in the not-too-distant future when allied health professionals and skilled technicians practice physically in one location while eyecare practitioners function remotely at a central location, utilizing advanced imaging and communication technologies to oversee a number of affiliated locations. This model can be especially attractive when high-quality health care is needed in areas that may be less attractive to many new physicians entering practice over the years to come, such as in sparsely populated rural areas that would attract fewer patients.

Future Diagnostic and Therapeutic Technologies Successful contact lens management depends on an integration of lens design and a clear understanding of the ocular surface. As such, diagnostic technologies that will be used in the future will combine these functions to produce the most effective outcomes and to provide optimized vision and physiological response. Look for platforms that comprehensively analyze visual system optics, anterior segment shape, and tear film/ocular surface status.

Without a doubt, developing artificial intelligence (AI) software will further automate the process. AI technologies likely will have the greatest influence on all health care. The explosion of information is simply too extensive to keep up with for any individual. AI will be able to store, update, and utilize developing evidence-based data to provide both diagnostic and therapeutic analysis and plans of action. We can clearly envision AI’s influence on contact lens management.

Virtual Contact Lens Design Today, we are already seeing the development of virtual contact lens fitting for corneal GP, orthokeratology, hybrid, and scleral contact lenses. Utilizing anterior segment topography and tomography, along with specific fitting algorithms, we are benefiting from high first-lens success outcomes. The events of COVID-19 this year have only accelerated both development and use of these virtual platforms.

The use of reusable diagnostic lenses will fade away—along with our concerns about their disinfection and safety—as virtual lens design capabilities continue to expand. We can expect more offerings and improved software in this arena over the years to come.

The Future of Contact Lens Sales and Distribution We are already seeing a movement today toward greater availability and uptake in alternative contact lens distribution. Whether from online internet companies, big box retailers, pharmacies, or others, at least when it comes to the sale and distribution of daily disposable and frequent replacement contact lenses for the correction of basic refractive errors, the trends are undeniable. There are countries in the world in which eyecare professionals are prohibited from selling contact lenses. They simply fit patients with diagnostic lenses and provide a prescription to be filled elsewhere. In other areas of the world, daily disposable and frequent replacement contact lenses are sold without an eyecare practitioner’s prescription.

As fitting accuracy and safety profiles of daily disposable and frequent replacement lenses continue to improve, it is likely that we need to prepare our practices for a world in which we may not be dispensing these types of lenses. In an effort to optimize patient outcomes and safety with contact lenses, we need to decide now whether we want to explore ways to work with the alternative distributors. Many of these companies are realizing that they will be more successful if they can work together with eyecare professionals, and they are already reaching out to establish relationships that hopefully will benefit all involved—most importantly our patients.

Disrupters, the Good and the Bad Disruptive technologies and organizations are impacting our lives across all areas; contact lens practice and business is surely no exception. These disrupters look for opportunities to do things differently and, in their view, better. Some disrupters fail in their efforts, while others are wildly successful.

Sometimes the influence of disrupters can be negative in some ways; however, oftentimes new approaches result in benefits both to the companies and to consumers. The bottom line is that disrupters are here to stay, and change is the rule. The question that we must address is whether or not we are able to adapt to change. Those practices that will survive and in fact thrive as we move toward the future are those that will be able to adapt to an ever-changing world.

CONCLUDING REMARKS

So, what’s in store for the future of contact lens practice? We have taken a brief glimpse into the crystal ball, and there will be both great opportunities and challenges. The world of contact lens practice surely will look quite different from how it appears today; but, if we look back to the early days of contact lens practice just a few decades ago, we would not recognize it in comparison to how we practice now. Embracing change is a formula for success. Enjoy the journey into the future of contact lens practice! CLS

REFERENCES

1. Cope JR, Collier SA, Rao MM, et al. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections — United States, 2014. MMWR Morb Mortal Wkly Rep. 2015 Aug;64:865-870.
2. Nichols JJ, Willcox MDP, Bron AJ, et al; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: executive summary. Invest Ophthalmol Vis Sci. 2013 Oct 18;54:TFOS7-TFOS13.
3. Stapleton F, Keay L, Jalbert I, Cole N. The epidemiology of contact lens related infiltrates. Optom Vis Sci. 2007 Apr;84:257-272.