Well into the second year of the COVID-19 pandemic, we are optimistic that there is light at the end of this tunnel. The pandemic certainly has changed the way that we go about our daily lives, extending to changes that we see in general medical and ophthalmic clinical practice.

Aside from our enthusiasm to “return to normal,” there is much to be excited about in the field of contact lenses. We continue to see these medical devices and the tools that we use to fit them evolve over time. It is also with much enthusiasm that in 2021, we celebrated the 50th anniversary of the soft contact lens, which is also our Contact Lens Event of 2021. We hope that our 2021 Annual Report will shed light on the market, both in terms of where we are as well as where we have been and where we are headed.

OVERVIEW OF GENERAL MARKET TRENDS

Despite the volatility of a global COVID pandemic, the soft contact lens market has proven nicely resilient over the past 18 months. Data obtained from Baird (Jeff Johnson, OD, CFA, managing director, senior research analyst) suggest that after falling approximately 9% in 2020 to roughly $8 billion (measured at the manufacturers’ level), the global soft contact lens market seems to be on track through the first nine months of 2021 to grow two-to-three points above 2019 levels, or back to nearly $9 billion.

While the market’s return to pre-COVID revenue levels thus far in 2021 has been encouraging, much of the momentum for this recovery occurred in the latter part of 2020 and in early 2021, as office re-openings across the globe and pent-up demand tailwinds for new patient fits and refits seemed to contribute. Moving deeper into 2021, however, as third and fourth COVID waves tied to the delta variant had impacts across the globe, end market growth faced renewed pressure late in the summer. Industry-wide revenues that were running 5%-to-10% above pre-COVID levels in the first quarter of 2021 slipped back to levels more in line with, to just above, pre-COVID levels by the second and third quarters.

Looking a bit closer at current market trends, Baird believes that contact lens consumption from current lens wearers has largely normalized and should provide underlying support for overall market growth going forward. But with foot traffic at large retail locations such as shopping malls still below pre-pandemic levels across a number of countries due to lingering COVID concerns, and as COVID has likely accelerated a shifting of consumer preference away from such locations, new patient fits still seem to be lagging behind pre-COVID levels. Specifically, Baird’s own eyecare practitioner survey from October suggested that new fits were still down roughly 10% from July through September in the United States, while other reports have pointed to similar—and in some cases slightly worse—pressures across other markets.

The good news is that contact lens market growth has proven resilient in the past, and despite lingering headwinds in recent months, many of the secular drivers of market growth remain in place. For example, Baird continues to point to the continued shift to daily disposable lenses, for which the U.S. and global wearer bases likely remain at roughly 35% and just over 50%, respectively. The uptake of silicone hydrogel lenses within the daily disposable category is also continuing, while most global manufacturers have also committed a growing amount of capital to aggressively expanding manufacturing capacity over the past few years to support further growth in daily disposable lens use over time. Add in the growing focus and future revenue potential from myopia management, and Baird believes that there are plenty of reasons to believe that the global contact lens market can eventually return to its healthy, long-term, pre-COVID rate of 4%-to-6% annual growth.

To that end, while the pre-pandemic U.S. contact lens market in 2019 was likely valued at roughly $3 billion and, by Baird’s math, fell to $2.7-to-$2.8 billion in 2020, Baird estimates that the domestic contact lens market value will likely finish at or even slightly above 2019 levels in 2021. Results through the first nine months of this year suggest that domestic revenue is trending closer to $3.1-to-$3.2 billion, up ~3%-to-5% versus 2019 levels.

CURRENT PRACTICE TRENDS

Contact Lens Spectrum conducts market research in which readers are surveyed about their practice trends and patterns both generally and as they relate specifically to contact lenses. We have conducted this market research for more than 10 years, which allows for longer-term and longitudinal analyses. The questions cover a variety of topics including characteristics of the patient base of a practice, business and financial aspects of a practice, and fitting and prescribing trends. This year, 125 U.S. respondents completed the majority of the survey. In moving forward with discussing trends and observations about the contact lens field, I will draw on information provided through this market research in addition to that from other sources.

Practice and Business Trends Table 1 summarizes trends in practice and business characteristics from 2009 to 2021. 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 independent affiliated with a retail corporation. In 2021, a typical practice averaged seeing 121 patients per week (it was 131 patients per week in 2020). The patient base of a typical practice was comprised of approximately 35% contact lens wearers, and the average number of contact lens fittings and refittings in a typical week was about 28.

Correspondingly, in 2021, most respondents felt that about 32% of their gross profit and about 28% of their net profit was derived from the contact lens portion of their practices. Practitioners estimated that 61% of their patients purchase contact lenses from their practice (64% in 2020), whereas 23% purchase their contact lenses online (25% in 2020), 12% purchase their lenses through a third-party retailer independent of a practice, and 4% purchase their contact lenses from another practice setting (Figure 1).

Projecting forward, 56% of practitioners believe that they will see an increase in their overall contact lens practice in 2022 (versus 44% for 2021), while 39% believe that it will stay the same (versus 46% for 2021) and 5% indicated that it will be decreasing further (versus 10% for 2021). This reduction in the expected decline compared to 2020 may relate to the recovery experienced in the industry as practitioners and patients adjust to the new normal of the enduring pandemic.

Lens Dispensing and Mode of Wear Trends As we have reported in previous years, silicone hydrogel materials make up the majority of fits and refits conducted today (Figure 2, Contact Lens Spectrum market data). In 2011, we noted the first slowing of the silicone hydrogel category. For 2021, silicone hydrogels were reported in usage at 69%, while hydrogels were reportedly used in 20% of fits in 2021 and GPs were reportedly used across 7% of fits.

As Figure 3 shows, data from Contact Lens Spectrum’s market research indicates that across all contact lens designs, most of the reported fits and refits were with soft spherical lenses (48% versus 52% in 2020), followed by soft toric lenses (26% versus 23% in 2020), soft multifocal lenses (14% versus 12% in 2020), spherical corneal GPs (4%, the same as in 2020), and scleral designs (2% versus 4% in 2020). Along these same lines, when asked about the greatest growth potential of several popular specialty lens options in 2022, most practitioners indicated custom soft lenses (35% compared to 31% for 2021), followed by scleral lenses (30% compared to 47% for 2021), orthokeratology (ortho-k; 30% compared to 16% for 2021), and hybrids (5% compared to 7% for 2021). Anticipated use in 2022 within these categories shows a change from recent years, with the drop in projected scleral lens use and a large increase in anticipated use of custom soft lenses and ortho-k.

When we asked practitioners to estimate the distribution of lenses by category of lens design for lenses containing any GP lens material (Figure 4), it is perhaps not surprising that corneal designs made up the majority of fits (70% versus 73% for 2020), followed by sclerals (14%, the same estimate as in 2020), ortho-k (10% versus 3% for 2020), and hybrids (7% versus 9% for 2020). Again, an interesting shift in fitting trends, with a relatively large uptick for ortho-k.

Data obtained from ABB Optical Group (independent optical industry platform) and from GfK Retail and Technology (market research service) showed a similar trend for 2021 when comparing what are considered the four major soft lens categories (spherical, toric, multifocal, and cosmetic). As noted in Table 2, data from these three sources show slight variability when looking at the soft spherical category (prescribing range 50% to 56%) and more consistency with torics and cosmetics.

In addition to the Contact Lens Spectrum Practice Profile Survey (Figure 5), market insights were also gleaned from ABB Optical Group and GfK Retail and Technology in terms of replacement schedule usage (Table 3). When comparing among the data sources, interesting trends emerge—in particular, for all three sources, the daily disposable modality continues to lead in terms of prescribing by soft lens replacement schedule (range of 43% to 51%), followed by the monthly category (range 33% to 34%).

As has been the case for several years now, for presbyopic contact lens wearers, most practitioners continue to indicate a strong preference for multifocal lenses (80% in 2021 compared to 63% in 2020) compared with monovision (14% in 2021 compared to 28% in 2020) and over-spectacles (6% for 2021 and 9% for 2020).

Myopia management with contact lenses is certainly a growing practice in the contact lens community. In 2021, 48% of Contact Lens Spectrum Practice Profile Survey respondents indicate that they actively practice myopia management with contact lenses (compared with 39% in 2020, 42% in 2019, and 28% in 2018). Of those who are practicing myopia management with contact lenses, more are using a soft multifocal (72%) compared with orthokeratology (28%) (Figure 6). 

YESTERDAY AND TODAY

A tradition that we enjoy each year is to take a look back at what significant events occurred in the eyecare industry a decade ago and how those event have impacted us today. What events from 2011 shaped where we are in 2021?

Perhaps most significant was our Event of the Year for 2011: the publication of the Tear Film and Ocular Surface Society’s International Meibomian Gland Dysfunction (MGD) Workshop Report. This report set out to establish global consensus on the definition, classification, diagnosis, and therapy for MGD, which prior to this publication did not exist.¹ I noted in my January 2012 Editor’s Perspective that “the impact of the MGD Workshop Reports will be significant for many years to come,” and indeed that has been the case. Since that time, numerous devices, technologies, and products for both diagnosing and managing this condition have entered—and continue to enter—the market, to the benefit of the many patients who experience the effects of this common cause of ocular surface disease.

With regard to the market overall, 2011 was also a year of recovery and rebuilding—from a global recession rather than from a global pandemic. Also in parallel with 2021, and as mentioned previously, 2011 was the first year in which we noted a slowing in the growth of silicone hydrogel lens prescribing; this was at 67% in 2011, which is very similar to this year’s 69%. We theorized at that time that this slowing was due to the growth in daily disposable lens prescribing, as daily disposables were primarily in hydrogel materials in 2011. Daily disposable prescribing has, of course, continued this upward trend, going from 15% of fits in 2011² to 43% in 2021.

TODAY AND TOMORROW

The year 2021 continued to be influenced in large part by the enduring COVID-19 pandemic. No one can say that the pandemic has been a good development. The continuing loss of so many lives globally is a terrible tragedy; and even with the development of vaccines, it is likely that SARS-CoV-2, like the flu virus, will never be completely eradicated. In spite of this, the pandemic did spur the advancement of certain technologies at a rate that would likely not have occurred otherwise, as the industry worked to resolve how to evaluate and manage patients in a socially distanced world.

Telemedicine One such advancement that has experienced continuing development since the start of the pandemic is telemedicine, particularly with regard to remote patient evaluation and monitoring. Over the last year, several diagnostic devices have entered the market that allow practitioners to perform refractions and other types of evaluations while in a different room from patients. This has implications that go far beyond social distancing for exams and follow-up evaluations. For certain types of patient encounters, such technology managed by skilled technicians can allow practitioners to “see” patients while they are in a different office that is connected through the internet to the diagnostic device. While not the same as being in two places at once, this could offer similar advantages for certain patient situations.

Empirical Fitting Another technology that has seen a significant boost due to potential decreased risk of spreading COVID-19 is empirical fitting of specialty contact lenses. As we know, such lenses traditionally have been primarily fit with reusable diagnostic lenses. Empirical fitting of more complex designs such as scleral, hybrid, and ortho-k lenses has seen a marked increase over the last year in particular, either through use of technology or through sending measurements to manufacturers. Evolving algorithms continue to increase first-lens success. A survey of Contact Lens Spectrum readers indicated that empirical fitting was preferred more than or equally to diagnostic fitting for five of seven GP lens categories in 2021.³ While empirical fitting is not perfect (see the Clinical Controversies feature on p. 40) and is not likely to ever completely replace lens fitters (see the GP Insights column on p. 14), the percentage of practitioners who prefer empirical fitting will continue to increase as the fitting technology improves.

Presbyopia Of course, not all recent and emerging developments in our industry are related to the COVID-19 pandemic. In fact, one area in which we have seen a great deal of interest and innovation over the last year is in presbyopia. This common visual condition that eventually affects all people as a natural part of the aging process seems to be on the rise as the next condition to tackle moving forward. Innovation in this category has taken place and is emerging in several different areas. In specialty lenses, more companies are allowing practitioners to design lenses with decentered optics so that the multifocal correction lines up better with a patient’s line of sight. In the soft lens category, lenses have launched this year with improved designs for easier fitting and better vision as well as with material upgrades and more daily disposable options. Soon to enter the market is a soft lens that offers a new way to correct vision at all distances (see Product of the Year sidebar) and may prove successful for patients who had failed in more traditional presbyopia lens designs. Perhaps the most innovative and anticipated advancement in correcting presbyopia is the development of several pharmaceutical options that decrease pupil size to provide extended depth of focus. One such option recently received U.S. Food and Drug Administration approval and entered the market.⁴

Myopia Management Finally, myopia management continued to gain momentum in 2021. In addition to innovations in contact lens designs, particularly for ortho-k, many efforts have been made to increase education and awareness for both practitioners and patients. We are finally reaching the tipping point to truly make myopia management a new global standard of care.⁵ CLS

REFERENCES

1. Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011 Mar 30;52:1922-1929.
2. Nichols JJ. Contact Lenses 2011. Contact Lens Spectrum. 2012 Jan;27:20-25.
3. Bennett ES. GP and Custom Soft Annual Report 2021. Contact Lens Spectrum. 2021 Oct;36:20-27.
4. Abbvie. VUITY™ (pilocarpine HCI ophthalmic solution) 1.25%, the First and Only FDA-Approved Eye Drop to Treat Age-Related Blurry Near Vision (Presbyopia), is Now Available. Available at https://news.abbvie.com/news/press-releases/vuity-pilocarpine-hci-ophthalmic-solution-125-first-and-only-fda-approved-eye-drop-to-treat-age-related-blurry-near-vision-presbyopia-is-now-available.htm . Accessed Dec. 10, 2021.
5. World Council of Optometry. World Council of Optometry Resolution: The Standard of Care for Myopia Management by Optometrists. 2021. Available at https://worldcouncilofoptometry.info/resolution-the-standard-of-care-for-myopia-management-by-optometrists . Accessed Oct. 27, 2021.