When I look at the contact lens business in 2020, several things worry me a bit. I’d like to discuss them here.

The Contact Lens Rule

Enforcement First, the Fairness to Contact Lens Consumers Act and the Contact Lens Rule have been a benefit to U.S. contact lens patients. But, the original intent was a good balance between consumer rights to purchase mass-produced contact lens products in an open marketplace and the need to ensure that patients’ health risks relative to contact lenses were mitigated through valid prescriptions and proper surveillance by a licensed prescriber.

The failure of the Act, and subsequently of the Rule, is that an agency whose culture and competence is in the area of trade, and which is not powered to address the health risks of contact lenses, is in charge of both. This reality has led to the Federal Trade Commission (FTC) seemingly embracing one of its responsibilities much more so than it does the other. The FTC chafes at the notion that a free marketplace in contact lens sales increases health risks, and there seems to be a greater focus at the FTC regarding its charge to enforce on trade.

I wish that the U.S. Food and Drug Administration (FDA) was charged with enforcement on the health side and that the FTC was charged with trade issues, but that would require changing the Act; with the limited budgets for enforcement that both agencies have, I’m not sure that this would make a practical difference. So, I wish that the FTC would improve efforts to serve both masters of its mandate.

Compliance My next worry has to do with changing technologies and vertical integration of online companies that allow them to sell lenses in ways that frustrate or circumvent the Act and the Rule. Such companies promote unproven “online refraction” to renew contact lens prescriptions and sell lenses that have not been trialed on patients’ eyes, without any conscious consideration of the risks of those activities. How are they getting away with that?

In addition, overseas companies sell into the U.S. marketplace, often with little regard for U.S. law. We run into these companies especially around Halloween, but they work year round to the detriment of our patients.

To be fair, there have been victories in this area. The FTC and, especially, the FDA should be commended; but, it is almost always because of the profession that these violators are exposed and prosecuted.

Microbial Keratitis

I worry that nothing seems to move the needle on microbial keratitis. Given the limits of polymer chemistry, we might not ever see an affordable contact lens that solves this problem and that might not cause some other unforeseen problem.

I am worried that, despite our best efforts, patient compliance with prescribed wearing schedules, lens replacement intervals, and care regimens is rarely followed properly. Perhaps, if we (again) redouble our efforts here, then our patients might buy into the risks of what they are doing. Proper care and handling are just as important to patient success with contact lens wear as are the lenses that we prescribe. We are loathe to admit that fact, and patients are even more loathe to embrace it.

Where’s the Myopia Control?

Finally, I am worried about the myopia control effort. I know that it is hard to start a movement, but start we must. Every practice in this country should be getting serious about myopia prevention. It is not resonating the way that it should. CLS