New data from a Contact Lens Institute (CLI)-sponsored survey of nearly 1,000 U.S. adults indicates that 11% of Americans share a mistaken belief that contact lenses can become permanently stuck in the eye. What our patients know, don’t know, and mistakenly believe significantly impacts the likelihood of successful outcomes.

The survey reveals a large gap in what the average adult knows about contact lenses and indicates a crossroads where younger generations are turning less often to their eyecare practitioners (ECPs) to learn about contact lens technology or to get ocular health care advice than ever before. More effective communication is essential to preserving the practitioner-patient relationship.

In March 2022, CLI, a U.S. industry association for soft contact lens manufacturers that focuses on healthy wear and care practices and fitting growth, posed two fundamental questions:

How do consumers perceive contact lenses?

What are the implications of their beliefs?

The responses—many of which were surprising while instructive—serve to illustrate how even modest adjustments in practice can likely increase success across the board. Additionally, CLI’s See Tomorrow initiative explores how consumer sentiments, beliefs, and behaviors impact eye care, with the latest work pinpointing opportunities specific to contact lens adoption.

METHODOLOGY

CLI commissioned YouGov Plc to conduct a consumer omnibus survey of U.S. adults aged 18-plus years. The total sample size was 1,214 people, 959 of whom required vision correction per self-reporting.

The survey was conducted using an online interview administered to members of the YouGov Plc panel who agreed to take part in surveys. Emails were sent to panelists selected at random from the base sample, inviting them to take part in a survey and providing a generic survey link. Once a panel member clicked on the link, they were sent to the survey that they were most qualified to complete, according to the sample definition and quotas. The responding sample was weighted to the profile of the sample definition to provide a representative reporting sample. The profile is normally derived from census data or, if not available from the census, from industry-accepted data.

CLI survey fieldwork was undertaken between March 8 and 9, 2022. All figures have been weighted and are representative of all U.S. vision-corrected adults unless otherwise stated. Results for which there were fewer than 50 respondents are not reported, as they do not represent a wide enough cross-section of the target population to be considered statistically reliable.

EDUCATING THE UNINFORMED

The data show substantial missed opportunity when it comes to contact lenses. ECPs are failing to talk about contact lens options with 66% or more of their patients.

When asked about their most recent two visits to their ECPs, only 11% of patients remember that contact lenses were offered to them as “an occasional replacement for glasses,” only 6% remember contact lenses being offered to eliminate mask-induced fogging with their glasses, and only 4% of patients remembered them being offered as an alternative to reading glasses. A meager 7% of patients recalled their practitioner talking to them about new advances in the contact lens field.

Many ECPs are taken by surprise by those statistics. Although they talk about contact lenses all the time, these statistics reveal that many patients do not remember what is being said in the exam room. It is equally important for ECPs to focus on ensuring that patients remember what they say during an exam.

However, the data also make it clear that patients who are open to or interested in contact lenses won’t necessarily bring it up, and physicians need to proactively discuss contact lenses with everyone who is eligible. Many are interested, yet are waiting for you to raise the subject.

In the rush of patient care, proactively inquiring about contact lens interest is something that can easily get forgotten. It takes a daily commitment. Staff members are also valuable as the first point of patient contact. Include interest in contact lenses on your office intake form, and have staff members ask patients during the course of their routine work-up whether they would like to talk with the practitioner about the option.

Staff can also talk to patients about the contact lenses and eyewear that they personally wear. It’s so important that staff are empowered with the best technology—whether glasses or contact lenses—so that when a patient mentions a concern, they can share their own experience. Take time to fit your staff in preferred products; they will become advocates and drive internal referrals.

REINFORCING CONTACT LENS DIFFERENCES

The study revealed a lack of understanding about contact lenses as a prescription medical device that cannot be interchanged or substituted without affecting the visual, health, and comfort performance of their contact lenses.

About half of Americans aren’t necessarily aware that contact lenses can be different from each other—a recipe for inadvisable switching. Nearly half aren’t sure if all contact lens brands are essentially the same (44%) or if it’s OK to swap their prescribed brand for another (47%). Another 57% aren’t sure whether all contact lenses are made from the same type of plastic, and 46% don’t know whether they all use the same general design.

There’s an old-school philosophy that “prescribing” a contact lens is all the patient needs to know. If the “why” conversation is bypassed, the patient is left to assume that contact lens selection was either unimportant, chosen with little thought, or based on price alone.

While diving into a deep explanation of oxygen transmission levels and optical design may be unwarranted for most, even a simple explanation like “I am prescribing this lens based on the thin, tapered edge design that will give you better comfort during the day” can help the patient realize that contact lenses are inherently different and that each brand or category has specific characteristics that uniquely address their specific needs.

We have noticed an increasing frequency of patients calling to switch their contact lens brands, sometimes due to advertisements for cheaper prices found online or from peer influence. When a patient is fit in a contact lens, then goes home and talks with family, they sometimes come back and ask to be refit into the same product that their friends/family members are using. It is important to connect them with the “why”—e.g., how the lens is prescribed for their specific eyes because of shape or tear film interaction—and how that might be different than what is best for a friend or spouse.

There are also case reports about patients who purchased contact lenses through online retailers, with substitutions resulting in significant vison and/or comfort changes.¹ During a CLI webinar that addressed the recent survey results (bit.ly/CLIOnDemand22 ), it was shared how patients successfully fit with multifocal contact lenses then shopped online, only to discover they couldn’t see at near after buying spheres.

The problem is exacerbated by an unlawful lack of proper contact lens verifications performed by some online retailers. Practitioners can fight back by making sure our patients are better informed.

MYTH BUSTING

Urban legends can also be an issue. For example, about 1 in 2 adults who require vision correction believe myths that may prevent them from wearing contact lenses. With viral stories like the one in which practitioners found “27 lenses in a woman’s eye,” is it a surprise that 14% of CLI survey respondents think contact lenses can get lost behind the eye?² This includes 10% who stated that contact lenses are “dangerous,” but the spread and stickiness of misinformation is most dangerous of all.

Psychological science shows that misinformation persists because it is easier to accept a myth, especially when the message conforms to a pre-existing belief. Eyecare practitioners can use evidence-based strategies to “de-bias” their patients regarding myths that may be preventing them from contact lens wear. One report suggests the following strategies:³

• Provide people with a narrative that replaces the gap left by false information.
• Focus on the facts you want to highlight, rather than the myths.
• Make sure that the information you want people to take away is simple and brief.
• Consider your audience and the beliefs that they are likely to hold.
• Strengthen your message through repetition.

For instance, when educating patients on contact lens wear and care, it is important to explain the anatomy of the eye to patients and let them know that it is anatomically impossible for contact lenses to get stuck behind the eye. Although it is possible for a contact lens to temporarily be positioned under the eyelid, it is important to focus on the facts. Continuously reassure patients that, as their eyecare practitioner, you are available to help if anything occurs or if concerns arise.

In the same manner that a myth is shared and spread, truths can spread when a practitioner is proactive with patients by providing information, warnings, and troubleshooting tips before they leave the office with their contact lenses. For instance, teaching someone what to do if they suspect a contact lens is stuck can help dispel the myths. That patient can then share these professionally delivered tips with others.

Perhaps even more concerning than a lack of information is direct-to-consumer marketing misinformation, which can drive false beliefs and lead to patient-initiated brand swaps. While sources serving up misleading information may be acting intentionally or unknowingly, the result is that too many Americans believe that all contact lenses are created equal. The CLI research discovered that about 3 out of 5 adults may not check with their practitioners before switching brands. Approximately 1 in 5 adults definitively stated that contact lens brands are interchangeable.

Although contact lenses are medical devices for vision correction, therapeutic uses, and cosmetic uses, social media marketing often does not indicate that prescriptions are specific to a brand. That leads to mixed messages for patients. According to the CLI survey, people ages 18 to 34 years old are three times more likely to look to social media for information about contact lens wear than the total population. That highlights why a social presence is more crucial than ever for practices.

It’s important for patients to be reminded to not just get any contact lens they find on the internet, but to return to their ECP to find the lens that is right for them.

THINGS ARE LOOKING UP

Amidst these concerns, there’s significant room for optimism—if we choose to listen, educate, and act. The CLI findings revealed that there is an unmet opportunity for ECPs to be the source for eye health facts, directly with patients and through supplemental means, especially when nearly 7 out of 10 (68%) people turn to their ECP for contact lens information.

Practitioners can close the gap by having a presence where patients are searching for insights. Spanning all surveyed ages, 3 in 5 adults seek out alternative information sources for contact lens wear—including friends and online. When eyecare providers are at the forefront of sharing how to access and understand accurate information, alternative sources can be powerful tools.

The practitioner-patient relationship is essential to healthy contact lens wear and a healthy contact lens practice. Rapport between a practitioner and a patient begins with intake, and the timing of when to share contact lens-related information is critical to understanding, retention, and decision-making. For example, approximately 1 in 3 people state that they don’t wear contact lenses or don’t wear them more often because of comfort issues, although this may or may not be known by their ECP.

Practitioners can take a proactive approach, describing what they see with patients’ lenses to give them an opportunity to open up about any discomfort. Asking exploratory questions regarding how the lenses may feel on the eyes or if they are hard to wear toward the end of the day is an opportunity to bring up new advancements in contact lenses and get the conversation started, switch lenses, or review their cleaning routine.

Likewise, the CLI data shows that 1 in 5 people state they don’t wear contact lenses or don’t wear them more often because care is perceived to be difficult.

After a slit lamp exam and between refraction and dilation is a prime time to talk about the option of contact lens wear. At this point, eyecare professionals have clinical information to make recommendations that are relevant to the patient’s eyes, needs, and lifestyle.

Tie contact lens wear into a finding that you can make better. If you want to build rapport and trust, a patient must understand why you want to enhance the outcome. It is easier to introduce new technologies to patients once they are assessed for conditions like dry eye and allergies and the physician has a better understanding of patient needs for relief or improvement.

CHANGING EXPECTATIONS

Post-refraction is also a good time to check whether a patient would benefit from an add power. The CLI findings indicated that only 4% of adults aged 55-plus recalled their eyecare provider having discussed contact lenses as a potential alternative to readers during the last two visits.

The first millennials turned 40 last year, marking a new generation facing an age-old problem—but with new expectations. People are redefining what is young—holding onto their youth and heightening their desire to continue or begin wearing contact lenses.

Presbyopia management presents a major opportunity for practices, including financially, as people who have presbyopia often have higher incomes and flexible lifestyles. With increased contact lens options like multifocal toric and hybrid lenses, the lifetime value of caring for this patient population can soar.

There is always a place for contact lenses if a patient wants them, as long as expectations are established first. Eyecare providers should not promise perfection, but give all patients the chance to choose if they want improved vision or an alternative to glasses, even if it is part time. Patients can be successful part-time wearers when presented with options and education to make informed decisions. This leads to more patients wearing contact lenses successfully, even if it is just situational.

Whether it is for certain activities or tasks, a few hours during a night out, or to change one’s eye color, contact lenses offer advantages beyond all-day wear. Eyecare practitioners have a critical role in providing patients with information regarding new and innovative technologies and options available for their refractive errors or eye conditions. For instance, the survey found that only 56% of vision-corrected adults are aware that colored contact lenses are available.

Presenting and explaining the pros and cons of these tiny yet remarkable medical devices not only builds the practitioner-patient relationship, but decreases the spread of misinformation too.

ELEVATING MYOPIA MANAGEMENT

With the U.S. Food and Drug Administration approval of a contact lens that has a specific indication for myopia control in late 2019—and others forthcoming—the future is bright for ECPs embracing myopia control.⁴

Studies show that while there is growing interest in myopia management by practitioners, the number of them who are providing myopia management care remains low. A global survey indicated that North America-based practitioners are prescribing myopia management for progressing/young myopes with approved multifocal soft contact lenses 9.6% of the time and with orthokeratology 12.3% of the time.⁵ Despite these lower adoption numbers overall, myopia control contact lens fitting increased from only 0.2% of contact lens fits in 2011 to 6.8% of fits in 2018, an increase of 34 times!⁶

The CLI survey reveals similar statistics on patient familiarity with myopia control options. Survey results showed that 12% of vision-corrected U.S. parents who have children under the age of 18 years were aware of the current availability of contact lenses that manage myopia compared to only 5% of parents of children over 18 years and those who were not parents—a greater than two times difference in awareness among the target population.

Continuing to grow awareness of myopia management as an option by communicating its availability to eligible patients is an important part of practice and the standard of care, as defined by the World Council of Optometry.⁷

Not all patients will be interested in pursuing myopia management, but every single one of them should know that it is an option. Share informational pamphlets with parents of myopic children at every exam, invest in technology to monitor children’s axial length growth, and communicate about the elongation of the eye as the area of concern above and beyond just the prescription.

COMMUNICATING VALUE

Discussing the value of contact lenses is at the heart of growing patient interest. The CLI survey pointed out that about 1 in 5 adults feel that cost prevents them from wearing contact lenses at all or more frequently, and this number was true across all income segments.

That means that it’s not the price holding patients back but the perceived value of the lenses. The only way to increase the perceived value is to talk about the technology and how it can benefit that person’s life.

Start by addressing patients’ unique visual needs or issues, then provide them a chance to experience the technology for themselves with trials. Show patients how, in specific circumstances, contact lenses would work best for them. For example, talk with patients about specific sports that they play or hobbies they enjoy (e.g., “Wouldn’t it be nice if it was easier to wear a headset when you were playing video games, or to more comfortably wear your football helmet?”)

When asked if inexpensive contact lenses work just as well as more expensive types, 4 in 5 patients agreed or did not know about the advantages that premium contact lenses can offer. To combat this issue, provide education and samples of upgraded contact lens technology to existing wearers at each annual exam. If new advancements provide better vision, comfort, and experience, price is not a limiting factor to prescribing.

CONTACT LENSES AND PRESBYOPIC PATIENTS

Self-Reported Vision Correction Among U.S. Adults Ages 55+
4% of adults ages 55+ recall their eyecare practitioner having discussed contact lenses as a potential alternative to readers during their last two office visits.

SHAPING OUR FUTURE

We are at a pivotal time in health care when patients have more information sources than ever that are influencing their decision-making. Where in the past an ECP would educate the patient during the exam as the primary way of driving behavior, patients now arrive at a practice with misperceptions that can lead to poorer outcomes and less open dialogue about available options.

Instead of holding onto “the power of the pen” as the sole reason that patients should listen to what you prescribe, the CLI findings remind us of a universal truth: building relationships through listening and thoroughly explaining the best options for a patient’s unique needs will drive better outcomes.

Keep in mind that educating our patients is not just about practice success and happy patients, but also about shaping the future of our industry. Will contact lenses always require a prescription? Will annual comprehensive ocular health examinations remain the standard of patient care?

Educating patients about the vitality of our relationship, and how the specific contact lens technology they’ve been prescribed today is addressing their specific ocular health and performance, builds the holistic value in contact lenses, our examinations, and our profession. CLS

Acknowledgments: The consumer research cited in this manuscript was funded by the Contact Lens Institute.

Note: All figures, unless otherwise stated, are recreated from information from YouGov Plc. Total sample size was 1,214 adults, 959 of whom required vision correction. Fieldwork was undertaken between March 8 and 9, 2022. The survey was carried out online. The figures have been weighted and are representative of all U.S. vision-corrected adults (aged 18-plus) unless otherwise stated.

REFERENCES

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3. Lewandowsky S, Ecker UKH, Seifert CM, Schwarz N, Cook J. Misinformation and Its Correction: Continued Influence and Successful Debiasing. Psychol Sci Public Interest. 2012 Dec;13:106-131.
4. U.S. Food and Drug Administration. Premarket Approval for MiSight 1 Day (Omafilcon A) Soft (Hydrophilic) Contact Lenses For Daily Wear. 2019 Nov 15. Available at accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P180035 . Accessed July 6, 2022.
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