Each month, Contact Lens Spectrum broadcasts a livestream series called CLS Live! during which the host sits down with leaders in the world of contact lenses to discuss new and future products, the latest research, and worldwide trends in prescribing—and even brings viewers up to date live from the floor of CLS conferences such as the Global Specialty Lens Symposium.

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This episode, which aired on Oct. 17, was hosted by Philip Morgan, PhD, MCOptom, professor of optometry, head of optometry, and director of Eurolens Research at The University of Manchester, and continues a series that looks at contact lenses around the world. Here, Dr. Morgan discusses the European contact lens market with Ann Elisabeth Ystenæs, BSc, MScOptom, an optometrist at the University of South-Eastern Norway in Kongsberg; and Christina Grupcheva, MD, PhD, head of the Department of Ophthalmology and Vision Sciences at the Medical University in Varna, Bulgaria.

Q: Philip Morgan, PhD, MCOptom: If you look at the 27 countries of the European Union, there’s an approximately similar population between the EU 27 and the U.S., but we see a much greater variation in contact lens practice—however we might wish to define that term.

Let’s suppose I’m a 20-year-old myope. I’m living in Varna, and I want to get contact lenses. How would I go about doing that?

A: Christina Grupcheva, MD, PhD: If this young person is happy to have a private consultation, they can have it from a contact lens practitioner, which can be optometrists, but is more likely be an ophthalmologist. They can have lots of advice, a thorough examination, and get their contact lenses.

If they want to save some money, they can go via the health insurance system, and that means a little bit of waiting—two to three months. After that, they can get to an eye doctor, who may decide not to prescribe them contact lenses, and they may try to convince them that glasses are better.

There is, of course, a third option when they decide to help themselves and order contact lenses; we see those patients in the emergency department.

Q: Dr. Morgan: You mentioned a minority might be prescribed by optometrists. Is that a new thing?

A: Dr. Grupcheva: It’s absolutely a new thing in Bulgaria. Our university was a pioneer in the medical optician specialty, and we upgraded it to optometry. Currently, there are two more universities that are producing optometrists, but we are the only medical university that produces medical opticians and ophthalmologists as well.

Q: Dr. Morgan: Ann, I’m still the same simple myope and I’m living in Kongsberg. How would I get contact lenses?

A: Ann Elisabeth Ystenæs, BSc, MScOptom: In Norway, only optometrists fit contact lenses. [In Kongsberg], we have eight optometry stores and the university clinic fitting contact lenses. So, you will probably go to one of the stores or book an appointment at the university. It’s also possible to buy over the internet, and some people probably do without having any consultation first.

Q: Dr. Morgan: Is internet supply an issue for getting contact lenses in Bulgaria?

A: Dr. Grupcheva: At the beginning, it was a big issue because everybody was scared that something would go wrong. But after being educated, lots of my peers realized that if you put your prices to the consultation, not to the margin of the contact lenses, you can be very competitive to internet [sales].

Even if they need to pay a little bit more, patients are happier to buy at the optical shops. They know from whom they buy the lenses; if they have problems, they can consult this person. In Bulgaria, there are many patients who are attached to a certain shop and even to a certain consultant there.

Q: Dr. Morgan: Let’s look at the lenses that are prescribed in your markets. Something that stood out to me is the long-term high rate of daily disposable prescribing [in Norway]. Why do you think that is?

A: Associate Professor Ystenæs: First, the economy is good, so it’s affordable for lots of people. Second, it’s very convenient. And third, it’s safe. All these aspects make it easy to communicate all of the advantages to the patients, so they easily understand the arguments. Also, we have a very long history of frequent or planned replacements. So, it wasn’t a long way to go to daily disposables. And, we had heard that daily disposables would be very advantageous for patients; now they have sterile lenses every day.

Q: Dr. Morgan: Another notable characteristic of the Norwegian market is the very high level of extended wear prescribing (15% or 20% of soft lens fits). This is two or three times the global average—why?

A: Associate Professor Ystenæs: Studies said the lenses were pretty safe with few complications, so we had high expectations. We also were very interested in having something new. It was debated in a lot at conferences. To be in the discussion, you had to fit a lot of those lenses.

Dr. Morgan: I guess with all optometrists going through the one department in Kongsberg, there is a potential for a lot of influence from people teaching contact lenses there as part of the curriculum.

Associate Professor Ystenæs: Early on, we did a study on the extended wear of contact lenses and talked a lot about the study during [classes]. So, students heard of the progress of the products and studies and complications and everything. It might have influenced fitting.

Q: Dr. Morgan: Now to talk about the situation in Bulgaria, one contrast is a much lower rate of daily disposal prescribing. Thoughts on why that might be?

A: Dr. Grupcheva: This is a more cultural thing. Bulgarian prescribers are afraid to put patients into the position of having to purchase something that is more expense. Because of this, they give them a choice [instead of] just saying “This is a better alternative and I recommend exactly this.”

The second reason is the economic situation here. The health insurance system never reimburses for any kind of contact lenses regardless, and patients have to pay out of their pockets. Especially now, when the economic situation is not so good, they try to save some money.

Another possible reason may be that patients try to read a variety of different sources, and some are getting wrong information [because they are] reading something that is not targeting their audience.

Q: Dr. Morgan: What aspect of contact lens practice do you think is important but perhaps does not receive enough attention?

A: Associate Professor Ystenæs: Ethical aspects related to myopia treatments, because it’s very important that they are doing it properly. If they want to fit contact lenses to arrest myopia, they should do axial length measurements, they should do cycloplegics, all those things. If people don’t have access to the instrumentation or drops, they shouldn’t actually do it. That might be undercommunicated.

A: Dr. Grupcheva: Presbyopia and accommodative lenses. Currently, presbyopia correction is a compromise. And the efforts of the industry and the practitioners should be in this direction. Hopefully some IT companies can help, because adaptive optics may help for this issue. CLS

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