There are many reasons why patients may choose to wear their contact lenses on a part-time basis. The 2017 data on international prescribing trends (Morgan et al, 2018) highlights the differences among countries with regard to many aspects of contact lens wear. One piece of information captured is the percentage of patients who wear their lenses on a part-time basis, defined as three days per week or less.
Two Asian countries, Japan and Taiwan, boldly report that no patients are wearing contact lenses part time. Standing alongside them in the line-up of countries with minimal uptake of the part-time wear modality are Hungary and Denmark, which both report 1%, and Germany, Moldova, and the Philippines, which report that only 2% of their patients utilize part-time wear. Conversely, some countries report about one in three contact lens patients to be part-time wearers: Australia, 29%; Czech Republic, 30%; Finland, 34%; and Iran, 27%.
There doesn’t seem to be a pattern between neighboring countries, with Asia and Europe both showing wide diversity. Similarly, North America is also diverse, with the largest market of all—the United States—reporting that only 8% of its patients are part-time wearers, while Canada reports 21%. Table 1 shows the entire list of countries and their respective part-time wear percentages (Morgan et al, 2018).
|COUNTRY||PERCENTAGE OF PART TIME (≤ 3 DAYS)|
Why do patients wear contact lenses on a part-time basis? Is it because they can’t wear them full time, or do they only want wear them part-time? A look at the literature tells us that contact lens drop-out is a constant hurdle to growing the contact lens market. Chalmers et al (2009) reported on a cohort of patients aged 18 to 35 years. They found that, as patients got older, they tended to be less tolerant of their lenses and were more likely to consider dropping out of lens wear.
In 2013, Dumbleton et al reported the results of a survey of more than 4,000 contact lens wearers in Canada. Of patients who had ceased lens wear for a period of four months or more, the ones who did return to lens wear were more likely to wear lenses on a part-time basis. This paper also detailed the reasons for stopping lens wear, and the main reason was lens discomfort (Dumbleton, 2013). Interestingly, it was noted that older patients were more likely to report “vision” as being an issue, while younger patients were more likely to report “cost.”
Are the presbyopic patients pushing up the numbers of part-time wearers? A look at retention rates for new contact lens wearers in the United Kingdom showed that retention rates for patients older than 60 years were lower than for younger patients (Sulley et al, 2018). This intuitively makes sense, because older patients not only have more complex visual demands as presbyopia sets in, but they are also more likely to suffer from ocular dryness that, in turn, can lead to contact lens discomfort issues.
Does the cost of lenses play a part? As noted earlier, younger patients cited cost of lenses as an issue (Dumbleton et al, 2013). To state the obvious: the less that lenses are worn, the less they cost; this is certainly the case for daily disposables.
What about the use of frequent replacement lenses on a part-time basis? Opinions differ about how often lenses/solutions should be replaced when part-time wear is the chosen modality. Efron et al (2010) looked at a cost-per-wear model and concluded that, for all modalities in the Australian market, the break-even cost balance point was five days per week. Therefore, for patients wearing contact lenses four days or less per week, it was less expensive to use a daily disposable than it was to use a reusable lens modality. This could be a factor in the part-time wear choice of patients. Unfortunately, the survey does not provide information on whether the part-time wearers were wearing daily disposable or frequent replacement lenses.
Is part-time wear proactively offered as a viable option in some countries but not in others? Offering part-time wear of contact lenses to seasoned spectacle wearers may provide an opportunity for eyecare practitioners to grow their market share of contact lens wearers. Spectacle wearers may not be aware that they could wear contact lenses solely for an occasional social event.
Being proactive in offering contact lenses as an option to patients can significantly increase the numbers of contact lens wearers in practice. One study that used a proactive approach to contact lens fitting, in which all patients were offered the option to try contact lenses irrespective of their perceived interest, resulted in greater than six times the number of new wearers compared with waiting for patients to bring up the topic for discussion (Jones et al, 1996). Atkins et al (2009) conducted a similar proactive study in which patients were fit with contact lenses to aid their spectacle dispensing experience. They reported that 33% chose to purchase contact lenses following this experience. They also noted an additional benefit of a 32% increase in the spectacle sales from these patients compared with the group that was not offered the contact lenses.
A New Way of Thinking
There perhaps needs to be a mind-shift to appreciate that a part-time lens wearer is still a “successful” lens wearer. There will be times when contact lenses fulfill all of the patients’ needs and times when they don’t. This could be due to visual demand, environmental conditions, fashion needs, or to many other considerations that may not be modifiable. As practitioners, we need to embrace the part-time wear modality and be proactive to encourage growth in this market segment. CLS
For references, please visit www.clspectrum.com/references and click on document #277.