Reader and Industry Forum
How to Grow the Contact Lens Marketplace
By Barry A. Weissman, OD, PhD, FAAO (DIP CL)
I think we have all heard the data suggesting that the contact lens “marketplace” is flat at about 30 to 35 million contact lens wearers in the United States, and it has remained flat for the past several years. There are a number of new lens wearers every year, but this growth is neutralized by the loss of other wearers, mostly the so-called “dropouts,” and is not due to mortality or refractive surgery gains.
It Just Doesn't Make Sense
The contact lens industry—GP, soft, silicone hydrogel, hybrid, toric, bifocal, etc.—is in a tizzy: What can be done to “grow” the marketplace? Our collective research and marketing efforts have therefore concentrated on the manufacturers' perceived reasons why patients drop out that are gleaned from studies and focus groups: dry eye symptoms, poor presbyopic optical corrections, and discomfort at the end of the day, etc.
But those of us who have been around for a few decades know that we, as a collective industry, have never, ever, had it so good as we do with our modern contact lens materials and designs. Corneal hypoxia has been conquered, at least for daily wear, with high-oxygen-permeable soft and GP materials. The whole kit and caboodle of corneal edema, central corneal clouding, edematous corneal formations, epithelial microcysts, neovascularization, etc. has, to all intents and purposes, gone the way of the dinosaur.
We now have great toric soft contact lens designs that are effective, reproducible and relatively inexpensive. We even have slowly improving bifocal contact lens designs. Our modern GP, spherical, toric, and multifocal lenses, though multifocals are now increasing in cost as this mode of care becomes more of a “custom” endeavor, have quality that knocks the socks off of those of us who grew up struggling with PMMA contact lenses manufactured on jewelers' lathes in someone's garage.
Something to Consider
So why the malaise? Why the dropouts? Why doesn't this marketplace grow? As one who now has earned more than a few grey hairs in service of this field of human science and clinical care for about four decades, I will make a modest proposal for your consideration. And the answer is not dry eye, lens discomfort, or presbyopia, although these may contribute. It is the very idea that this is a marketplace—that soft lenses have become a consumer item—that is really at the center of this malaise in my opinion.
Why should practitioners expend the effort it takes to fit bifocal contact lenses if patients want to use their insurance to pay a reduced reimbursement for their practitioners' time and expertise in the exams, then want to fill their gained “prescription” from the lowest cost provider, and then want to return to their practitioner (without charge of course!) for the inevitable troubleshooting? It seems far easier, and more financially rewarding, to just do medical and refractive eye exams and simple soft lens dispensing (notice this is not “fitting” in my opinion).
I remember when I started contact lens practice 40 years ago, we provided only “hard” contact lenses and a few early soft lenses that were of questionable quality and caused many complications/ problems and often poor quality of vision, and we charged about $300 for our time, expertise, effort, and materials. In terms of 2011 dollars, this would probably be about $1,000 to $2,000. So what I propose to the manufacturers is to change the paradigm. I think if we can make contact lens prescribing more rather than less remunerative for practitioners, the contact lens field will grow again.
Of course some feel that the other road is better. Who needs clinicians when these devices are so simple that you may just take the spectacle prescription and provide contact lenses without the intervention of a qualified eyecare professional assessing the lens on the eye? The assumption is that when patients have a problem, they will then seek out a professional. Is this good public health? Is this quality of care?
We have published the results of what we think will be the future of further weakening of professional contact lens practitioners (Wong et al, 2003), wherein we reported a patient who wore soft contact lenses that she bought over the Internet without a prescription and without seeing any eyecare professional for five years: she developed deep stromal vascularization and secondary lipid deposits that obscured her vision in both eyes. Please also see our recent report (Forister et al, 2009) in which we evaluated almost 600 patients and found that >50 percent had some contact lens-related complications worthy of professional management, although only 1.5 percent were symptomatic.
What's the Solution?
So I challenge this “marketplace.” Make contact lens prescribing more financially viable for clinicians, and I think that more clinicians will be interested in prescribing and caring for both simple and complex contact lens patients. And I bet that more patients will be prescribed and more contact lenses will be sold and more patients will be helped, even those who have keratoconus, corneal grafts and corneal scars—and yes, dry eyes, presbyopia, and poor end-of-day tolerance. And then the contact lens “marketplace” will grow. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #184.
Dr. Weissman is a professor of Ophthalmology and chief of the Contact Lens Service of the Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles. He is also an adjunct professor at the Southern California College of Optometry. He is an advisor to Vistakon, Alcon, and B+L and has received an educational grant from The Vision Care Institute, a Johnson & Johnson Company.