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.
This episode, which aired on Nov. 23, 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 Asian contact lens market with Kah Ooi Tan, BOptom (Hons), MBA, PhD. Dr. Tan has worked for Ciba Vision and CooperVision in Asia, with academic positions at Singapore Polytechnic and the University of Manchester. He is currently the director of business development for Nthalmic, an eyecare research and development center based in Sydney. He is also regional director for Asia Pacific for the International Association of Contact Lens Educators.
Q: Philip Morgan, PhD, MCOptom: Suppose I’m a straightforward 20-year-old myope wanting contact lenses for the first time. How would I go about getting those?
A: Kah Ooi Tan, BOptom (Hons), MBA, PhD: In Asia, it’s a very diverse market. In general, contact lenses can be easily available from any optical practice in Asia, particularly in South Asia. There are extreme cases —for example, in Japan—where contact lenses can only be prescribed by ophthalmologists. In countries like Malaysia, Singapore, and Thailand, any teenager or young adult interested in contact lenses can walk into an optical shop, have their eyes checked, contact lenses fitted, and then they can just get the pair of contact lenses from there.
Specific products like orthokeratology (ortho-k) can be treated differently. The most stringent markets for medical device registration are Japan, Taiwan, and mainland China, and the least regulated is Hong Kong. If you go to different markets, the rules and research are different, so a consumer may not know where and from whom they should get their contact lenses.
Q: Dr. Morgan: In how many Asian markets can lenses simply be purchased from a store or a vending machine without a prescription?
A: Dr. Tan: In Singapore, the consumer must buy contact lenses from qualified optometrists. So, if they walk into an optical shop or practice without an optometrist present, they’re not allowed to buy contact lenses at all. On the other hand, Taiwan has very strict product registrations, but contact lenses can be easily obtained from a convenience store or even from a vending machine.
Q: Dr. Morgan: With myopia being more prevalent in East Asia and ortho-k becoming very popular, what’s the situation with regulation around ortho-k lenses?
A: Dr. Tan: Ortho-k is still regarded as a medical device, and it needs to be registered in this market. The only exception is Hong Kong.
In Japan and Taiwan, ortho-k can only be prescribed by ophthalmologists. In mainland China, there are different categories of practitioner; those who are qualified with five years of training are allowed to prescribe ortho-k, but that’s under the assumption that they are working in a hospital setting or a setting where they have the medical device license.
So, if optometrists are working in a practice or shop in China without any medical device practicing license, they are not allowed to prescribe ortho-k lenses. But in Singapore and Malaysia, ortho-k lenses are easily available through qualified practices.
Thailand is also unique. Right now, practitioners in Thailand are very interested in prescribing ortho-k lenses for myopia correction and myopia control. However, only ophthalmologists can prescribe ortho-k lenses.
Q: Dr. Morgan: Let’s talk about China, the world’s most populous country. The incidence of myopia is relatively high, certainly across the urban centers. What do we know about the number of contact lens wearers in China?
A: Dr. Tan: That’s a question that most contact lens suppliers and manufacturers try to answer. There’s no official data available, but it is estimated that there are between 10 million to about 25 million. Why is there such a big range? Partly because there’s a mix of different contact lens modalities available in China. There are also some part-time wearers.
Q: Dr. Morgan: I think a lot of people maybe don’t appreciate that Taiwan is an important center for contact lens manufacturing. Can you tell us about that?
A: Dr. Tan: Other than the multinational companies supplying lenses across the world, Taiwan is probably one of the markets that has its own local manufacturers who produce lenses, including lathe-cast, spin-cast, and now cast-moulded lenses.
Generally, they often supply private-label color contact lenses to chain stores and private buying groups. So, Taiwan has a history of very established quality and technology in producing soft contact lenses and supplying them to the other parts of the world, but mainly not under their own brand.
Q: Dr. Morgan: Taiwan is an outlier in that it has a relativity low uptake of silicone hydrogels, a low number of torics, and a low number of multifocals. Why might the uptake of soft toric lenses be lower than what we see in Europe or North America?
A: Dr. Tan: Part of the reason is because the fitting philosophy is perceived to be more complex, so practitioners probably need to spend more time in fitting and prescribing and taking longer chair time. Second, [these lenses have a] higher retail price, so consumers maybe not be able to accept it.
Q: Dr. Morgan: What’s the potential for India in the contact lens market?
A: Dr. Tan: Initially, people believed that India’s contact lens market could be quite low. On one hand, that’s probably because myopia prevalence in India is relatively low; on the other hand, it’s probably because of the awareness and also the readiness to prescribe contact lenses.
But we can see that India is now actually booming, with the emergence of many optometry schools. Also, India has just passed legislation to allow optometrists to have proper practice guidelines, which puts the profession at a high level. I believe that, in the very near future, the contact lens revenue or market in India will be going up.
In India, we can see that the ortho-k demand is increasing as well. Even though myopia prevalence is really low, we can see that in certain areas there are some practitioners looking for ways to prescribes ortho-k lenses not only for vision correction but also for myopia control. In the next couple of years, we can see that could be trending up in contact lens demand in India.
Q: Dr. Morgan: What part of contact lens practice do you feel is important but perhaps we don’t pay enough attention to?
A: Dr. Tan: In Asia, practitioners perceive contact lens fitting as a complex process. But, in fact, it’s not. Contact lens fitting is as simple as doing a refraction. So, if they can master and understand the overall procedure in contact lens fitting (including the aftercare), I believe that they should be able to benefit more from contact lens prescribing to patients—at least to offer the option to the patient.
Those who have been wearing contact lenses for years…they will not go back to spectacle lenses. So, it’s time to actually consider not only toric lenses but also multifocal contact lenses that can benefit contact lens wearers. CLS
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