There is no doubt that 2020 has been a challenging year, given it occurred in the midst of a pandemic caused by the virus SARS-CoV-2, leading to the disease called COVID-19. As of this writing, COVID-19 has taken the lives of 301,000 Americans and 1.62 million people worldwide. It has certainly impacted us personally, in addition to our practices. With great optimism, we look to moving past this disease into 2021. Nonetheless, the past few years have been very interesting, with continued trends in modalities that relate to replacement schedules, certain designs, and contact lens care. We hope that you find the information provided in the 2020 Annual Report valuable as you evaluate how your own contact lens practices look today and in anticipation of what’s happening tomorrow.  

OVERVIEW OF GENERAL MARKET TRENDS

In a normal year, it can be challenging to track the many moving pieces impacting global demand for contact lenses. But add in a global pandemic, and the process becomes exponentially challenging. Data obtained from Baird (Jeff Johnson, OD, CFA, managing director, senior research analyst), however, suggests that the global market value for soft contact lenses (measured at the manufacturers’ level) will likely fall by approximately 10% in 2020 to just over $8 billion compared to nearly $9 billion for the global contact lens market in 2019. With this likely decline (results are only available thus far through the first nine months of 2020), 2020 will be the first year since the Great Recession in 2008 that the global contact lens market failed to grow in its typical 4% to 6% annual range.

While a 10% market decline isn’t ideal, readers shouldn’t lose sight of the fact that optical retailers were reporting 80% reductions in overall optical sales (including contact lens sales) in the second quarter of 2020, as offices across the globe were shuttered by stay-at-home orders. This weighed on new patient starts for contact lenses, which tend to account for roughly 15% of global contact lens revenue in any given period. Additionally, more limited consumption of contact lenses also happened early on in the pandemic as a certain percentage of patients reduced contact lens wear in favor of glasses while they stayed home from the office, the gym, and restaurants, many of the social settings where contact lenses are often preferred.

Even so, contact lens revenues were less impacted during this time, as consumers could still order lenses through online retailers or even pick up their lenses at those offices that remained open for emergency care during that time. To that end, Baird’s analysis suggests that global soft contact lens sales held in better than overall optical retailer (and likely private eyecare practitioner [ECP] office) revenues during that time, falling some 50% to 60% relative to the prior year in April and another 30% to 40% versus the prior year in May.

Soon after, however, ECP offices began to open across a number of markets, and with contact lens inventories also getting replenished at a variety of private offices, retailers, and distributors, contact lens market growth rebounded fairly quickly to only modest year-over-year levels of decline in June. For the remainder of the summer and into the fall, contact lens market revenue began to stabilize at flat to slight levels of year-over-year growth in some markets but remained lower by upper-single to low-double-digit percentages in other markets, depending on a number of factors tied to the pace of recovery and continued control of COVID-19 case counts.

In the United States specifically, the fall-off in soft contact lens market revenue was a bit steeper in the early part of the pandemic compared to what we saw across international markets in Q2 and early Q3, due in part to a faster and earlier recovery in some international markets such as China, where contact lens market growth returned to nearly flattish year-over-year levels as soon as Q2. By Q3 and beyond, however, U.S. growth largely returned to levels roughly in line with international levels. For the full year, we’re anticipating a similar 10% decline relative to 2019, likely putting the value of the U.S. contact lens market in 2020 at roughly $2.7 billion.

Looking into 2021, we expect many of the same drivers of growth that have long influenced the global contact lens market to return as patients continue to transition to silicone hydrogel lenses, including daily disposable silicone hydrogel lenses. Myopia control and frustrations that many seem to have with glasses when wearing a face covering also represent potential areas of growth tailwinds for the contact lens market in the New Year. Early in 2021, however, we’ll also need to watch at-home contact lens inventory levels, which may have entered the year higher than in past years due to the lower consumption of annual lens supplies during 2020 as well as rising COVID-19 case counts that continue to plague some markets. With these moving parts, it increasingly feels as if much of the world, including the contact lens world, may not return to pre-pandemic normalcy until 2022.

CURRENT PRACTICE TRENDS

Contact Lens Spectrum also conducts market research in which the readership is asked about its 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 a practice’s patient base, its business and financial aspects, fitting and prescribing trends, and care solution trends. This year, we had 48 U.S. respondents complete the majority of the survey. While discussing trends and observations about the contact lens field, I will draw on information provided through this market research in addition to other sources.

Practice and Business Trends Table 1 summarizes trends in the practice and business characteristics from 2010 to 2020. Most of our respondents were optometrists, 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 2020, the typical practice averaged seeing 131 patients per week. The patient base of the typical practice was made up of approximately 35% contact lens wearers, and the average number of contact lens fittings and refittings in a typical week was about 24.

Correspondingly, in 2020, most respondents felt that about 29% of their gross profit and about 23% of their net profit was derived from the contact lens portion of their practices. Figure 1 shows that practitioners estimate that 64% of their patients purchase contact lenses from their practice (66% in 2019), whereas 25% purchase their contact lenses online (20% in 2019), 9% purchase their lenses through a third-party retailer independent of a practice, and 2% purchase their contact lenses from another practice setting. 

Further to this, 44% of practitioners believe that they will see an increase in their overall contact lens practice in 2021 (versus 55% for 2020), while 46% believe that it will stay the same (versus 44% for 2020), and 10% indicated that it will be decreasing further (versus 1% for 2020). This larger expected decline probably relates to the economic impact of the pandemic.

Lens Dispensing and Mode of Wear Trends As we have reported in years past, silicone hydrogel materials make up the majority of the fits and refits that are conducted today. This is shown in the Contact Lens Spectrum market data reported in Figure 2. In 2011, we noted the first slowing of the silicone hydrogel category, and for 2020, we note that silicone hydrogels are being reported in usage at 70% of fits while hydrogels were reportedly used in 19% of fits in 2020, and GPs were reportedly used across 9% of fits.

As shown in Figure 3, 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 (52% versus 48% in 2019), followed by soft toric lenses (23% versus 26% in 2019), soft multifocal lenses (12% versus 13% in 2019), spherical corneal GPs (4%, the same as in 2019), and scleral designs (4% versus 3% in 2019). Along these same lines, when asked about the greatest growth potential of several popular specialty lens options in 2021, most practitioners indicated scleral lenses (47% compared to 43% for 2020), followed by custom soft lenses (31%, compared to 27% for 2020), orthokeratology (ortho-k) (16% compared to 17% for 2020), and hybrids (7%, compared to 13% for 2020).

When we asked practitioners to estimate the distribution of lenses by category of lens design for lenses containing any rigid GP lens material (Figure 4), it is perhaps not surprising that corneal designs made up the bulk of fits (73% versus 75% for 2019), followed by sclerals (14% versus 13% for 2019), hybrids (9% versus 8% for 2019), and ortho-k (3% versus 5% for 2019).

Data obtained from the ABB Optical Group (independent optical industry platform) and GfK Retail and Technology (market research service) showed a similar trend for 2020 when comparing what are considered the four major soft lens categories (spherical, toric, multifocal, and cosmetic). Data from these three sources show slight variability when looking at the soft spherical category prescribing (range 52% to 57%) and more consistency with toric, multifocal, and cosmetic lenses (Table 2). When the Contact Lens Spectrum readers were asked which soft lens categories they anticipated more of in 2021, 57% indicated daily disposables (versus 64% for 2020), followed by multifocals (34%, the same as in 2020), cosmetics (7% versus 1% for 2020), and torics (2% versus 3% for 2020). 

In addition to the Contact Lens Spectrum Reader Profile Survey, market insights were also gleaned from ABB and GfK in terms of replacement schedule usage (Table 3). When comparing among the data sources, interesting trends become apparent; for all three sources, the daily disposable modality emerges as the one leading in terms of prescribing by soft lens replacement schedule (range of 43% [Figure 5] to 50%) followed by the monthly category (range 33% to 37%).

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 (63% in 2020, compared to 75% in 2019) compared with monovision (28% in 2020, compared to 16% in 2019), and over-spectacles (9% for 2020, the same as it was for 2019). In practice, more of your presbyopic patients are prescribed a multifocal (44% of your contact lens-wearing presbyopes versus 46% in 2019) compared with monovision (39% of your contact lens-wearing presbyopes versus 33% in 2019).

Myopia control with contact lenses is certainly a growing practice in the contact lens community. In 2020, 39% of Contact Lens Spectrum Reader Profile Survey respondents indicated that they actively practice myopia control with contact lenses (compared with 42% in 2019 and 28% in 2018). Of those who are practicing myopia control (Figure 6), most believe that contact lenses are most efficacious (multifocal or ortho-k) (49%), followed by a combination approach of a contact lens and atropine (44%), and atropine alone (8%).

CONTACT LENS WEAR AND CARE COMPLIANCE

Practitioners indicated that 39% (48% in 2019) of their patients using one-to-two week replacement lenses were compliant with the replacement schedule, whereas practitioners indicated that 62% (61% in 2019) of their patients using monthly lenses were compliant and 76% (80% in 2019) 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 (72% versus 73% in 2019) with contact lens patients, followed by hydrogen peroxide-based systems (27%, the same as in 2019), which is opposite to the trending toward increases in hydrogen peroxide usage over the last several years. The largest factor in your selected recommendation was improved comfort (31%), followed by disinfection efficacy (26%), material/care solution compatibility (19%), convenience (16%) and cost (7%), and cleaning efficacy (2%).

YESTERDAY AND TODAY

No one would disagree that 2010 was nothing like 2020. But, as we do every year in the annual report, let’s take a look back at what was happening in our industry 10 years ago and whether those past events had any influence on our current market.

While not the global pandemic of today, 2010 saw its fair share of disasters: the disruption of air traffic across a portion of Europe due to volcanic ash from the eruption of Eyjafjallajökull, Haiti hit with a massive 7.0-magnitude earthquake, and an oil spill in the Gulf of Mexico that was the largest in history. On the medical side of things in 2010, scientists created a functional synthetic genome, and the World Health Organization (WHO) declared the H1N1 pandemic over. As for that last item, the COVID-19 pandemic is definitely not over, but we are seeing a light (albeit faint) at the end of the tunnel. At press time, new therapeutics and one vaccine have already been approved by the U.S. Food and Drug Administration (FDA) to treat coronavirus patients, and FDA advisory committees are meeting to determine the fate of additional vaccine candidates.

On the contact lens front, Contact Lens Spectrum declared 2010 the Year of the Contact Lens Solution. In the January 2011 Editor’s Perspective, we wrote “The scientific advancements associated with entirely new contact lens care solutions are significant events in and of themselves. However, the launch of new care solutions represents something much more significant to the field—specifically, the resiliency of industry to continue to provide new products even after experiencing significant set-backs with major recalls just a few years ago.”

As noted in this month’s editorial, resiliency of the contact lens market, especially those in specialty lenses, is once again prevalent. And it is the industry’s resiliency that we have determined to be our Event of the Year.

In other 2010 industry news, Novartis became the majority shareholder of Alcon, a move that was basically reversed with Alcon’s spinoff from Novartis in 2019. The first hybrid contact lens receive clearance from the FDA a decade ago; the lens itself had its national launch in 2011. Finally, 2010 was the year that the Scleral Lens Education Society was formed.

Also noted in the January 2010 editorial was an increase in attendance at contact lens meetings that were held around the world. This year, the coronavirus pandemic shut down or postponed many events. However, many conferences, trade shows, and information sessions turned this into an opportunity by transforming into virtual events, highlighted by livestream lectures and interactive exhibit halls. Contact Lens Spectrum was proud to sponsor one such offering with the Global Myopia Symposium, which had its inaugural meeting in September 2020. Additionally, we are excited about the lineup for the virtual 2021 Global Specialty Lens Symposium, which will be held from Jan. 21 through 23.

TODAY AND TOMORROW

The start of 2020 brought along with it the promise of the “Year of Perfect Vision.” Quite a few of the columns in this magazine touted ways to capitalize on the built-in marketing opportunities that 2020 brought. By March, however, that changed with the rise in coronavirus cases and the subsequent shut-downs/stay-at-home orders prevalent across the globe. The new buzz words became “unprecedented” and “new normal.” With masking recommendations established almost everywhere, people began looking for ways to reduce spectacle fogging. At the same time, misinformation abounded regarding the safety of contact lens use during coronavirus. While some would like to forgot large portions of last year, there are still many events, technologies, and innovations that will have an impact on the contact lens industry in 2021 and beyond. Here are some highlights.

Telemedicine One of the most notable changes in eyecare practice to come out of the pandemic is the increased use of telemedicine. The technology provided a way for practitioners to evaluate, and sometimes treat, patients in a “socially distant” way; patients who had more severe issues could be triaged virtually and then brought into the office as necessary. To help practitioners adopt to the technology, manufacturers and industry organizations held webinars on the topic. And other companies added telemedicine services to their business software suites.

Throughout the year, Contact Lens Spectrum columnists noted and agreed that while returning to seeing patients regularly (i.e., in person) again for routine eye care will happen, telemedicine will remain a part of the post-pandemic future for eye care.^1,2

Myopia As noted earlier, a majority of those practicing myopia control believe that contact lenses (multifocal or ortho-k) are most efficacious. While the percentage of respondents was down slightly from last year, there was also an increase in those who are using a combination of contact lenses and atropine. Contact lens manufacturers appear to be capitalizing on that increased need. An example is an FDA-approved lens that launched in early 2020 (see sidebar). There were also alliances started and licenses acquired with the purpose of tackling myopia or bringing new lenses to market. With all this in play, we expect more myopia announcements in the year to come.

New Contact Lenses Last year’s upheaval didn’t seem to stop contact lens manufacturers from bringing new lenses to market. Practitioners and patients welcomed a monthly toric multifocal, a one-day contact lens that touts all-day comfort, a daily disposable that helps prevent end-of-day dryness, and a daily disposable that helps reduce dryness and discomfort. Additionally, the FDA cleared a new ultra-high-Dk GP lens material. The scleral lens sector also saw several acquisitions and partnerships that should produce improved lens technology going forward. In addition, the ortho-k space has seen lots of movement this past year via licensing of lens technology and new lenses as well as acquisitions.

Of note this year was an increased interest in smart lenses. One company received a notice of allowance from the U.S. Patent and Trademark Office for a patent for the use of its proprietary process to manufacture a contact lens capable of providing enhanced myopia management; the novel product will allow patients who are suffering from, or at a high risk of developing, myopia to wear a contact lens that can automatically and continuously deliver a drug to control myopia (such as low-dose atropine) to a patient’s eye. In addition, that company filed an FDA investigational new drug application for its a proprietary drug-eluting lens to treat patients suffering from primary open-angle glaucoma or ocular hypertension.

The FDA also granted Breakthrough Device Designation to another company for the development of its smart lens, which provides information to users without forcing them to look down at a screen. Subsequently, in December 2020, that company announced an agreement with a contact lens manufacturer to collaborate on feasibility studies on lens materials, cleaning, and fitting.

Contact Lens Rule In 2018, the Federal Trade Commission (FTC) held a workshop on its Contact Lens Rule. Then, in 2019, it sought additional public comment about newly proposed changes. Being considered was whether or not the FTC should amend the Contact Lens Rule to require prescribers to obtain written verification from patients that they had received a copy of their prescription. In June 2020, the FTC announced the approval of a final rule amending the agency’s Rule. The final rule requires prescribers to request that their patients confirm that they have received their prescription and allows flexibility in the way that the prescription and confirmation are provided. These changes were not well received by all parties. In the August 2020 Editor’s Perspective, we wrote about some of the disappointment being expressed by advocacy groups “The pendulum has swung from the protection of consumers (as it related to medical devices, such as contact lenses) to that of promoting fraudulent sales of contact lenses without eyecare practitioner involvement. The FTC Office of the Commissioner even went as far as to suggest that prescription requirements ‘strike the word “manufacturer”’ as an essential element of the prescription. That would obviously ignore important material and design elements associated with the contact lens fitting process required for successful fitting of contact lenses to patients.”³ Contact Lens Spectrum will continue to report on the repercussions of these changes, which took effect in October 2020.

Future Eyecare Professionals Regardless of level, all students experienced hurdles during the coronavirus pandemic. Luckily, for optometry students, quite a few organizations stepped up to help out. The American Academy of Optometry (AAO) established a virtual clinical training program to assist with case-based learning for optometry students and to keep them on a path to graduation. The AAO worked with the Association of Schools and Colleges of Optometry (ASCO) and optometric schools to develop an online experience that will continue students’ clinical education. Similarly, the International Association of Contact Lens Educators (IACLE) launched an Online Student Trial Exam (STE) to support educators whose students are currently unable to attend their institutions in person or who want to assess students’ knowledge online. IACLE also launched Teach. Learn. Connect. (TLC), a new online education program and communications campaign that will supplement IACLE’s existing educational activities as the recovery from the pandemic continues. Assistance also came in the form of financial help with donations to the ASCO Student Relief Program, which will provide emergency funding to support students attending an ASCO member school or college of optometry.

In other education news, due to circumstances related to COVID-19, Tusculum University in Greenville, TN had to pause its accreditation for its Niswonger College of Optometry. However, Rocky Mountain University of Health Professions in Provo, UT, announced that it is establishing a school of optometry with an anticipated opening in 2023. CLS

REFERENCES

1. Brujic M, Kading DL. Is Telemedicine a New Normal? Contact Lens Spectrum. 2020 Sep;35:46.
2. Kading DL, Melchione C. Telemedicine—It’s Here to Stay. Contact Lens Spectrum. 2020 June;35:44.
3. Nichols JJ. Hot Topics of the Summer of 2020. Contact Lens Spectrum. 2020 Aug;35:11.