Over-the-counter (OTC) contact lenses (CLs) can be broadly defined as any CL obtained without a valid prescription or authorization by an eyecare professional. Both the U.S. Food and Drug Administration (FDA) and the U.S. Federal Trade Commission (FTC) regulate the sale of CLs, and advertising lenses as cosmetics or selling them OTC without a prescription—a concept that is accepted by many other countries—is not legal in the United States (FDA, 2017). Teenagers and young adults who do not fully understand the injurious consequences of purchasing and using non-prescribed CLs frequently fall prey to these unscrupulous sellers (Steinemann et al, 2005). This is a problem in many countries, especially in some Asian countries such as India, where CL sales are not related by the government. Such unregulated CL sales are a health (e.g., eye injuries) and economic (e.g., loss of CL sales) burden to both patients and the CL industry (American Optometric Association, 2007).

Loss for the Patient

While in India, Mr. Savla has witnessed patients who were lured by online retailers that used “easy to order”-themed ads and large discounts to convince them to buy OTC CLs. However, with unauthorized CL sales, patients are not taught the correct procedures for proper CL use, care, or maintenance, and the CLs may be inappropriate for these patients’ lifestyles (Steinemann et al, 2005). Unauthorized CLs may lead to a poor fit or handling habits that could subsequently result in ocular discomfort or a vision-threatening condition such as microbial keratitis (MK) (Steinemann et al, 2005; Sankaridurg et al, 2013; Young et al, 2014). Additionally, being unaware of potential complications and their symptoms could cause patients to wait longer to seek medical attention (Young at al, 2014).

In the absence of severe complications, patients also may have symptoms of dryness, itching, or watering due to an ill-fitted lens. Such patients are unlikely to visit eyecare professionals because symptoms are often mitigated by removing the CLs (Begley et al, 2001). They also may arrive at the conclusion that CLs are a poor solution for their visual needs, which may cause them to drop out of CLs.

Loss for the Community

It can be difficult to convince patients who have dropped out of OTC CLs to be fitted into prescription CLs because of their previous poor experience. In the Asia-Pacific region, this is at least partly due to patients believing that all CLs fit poorly and are uncomfortable (Rumpakis, 2010).

Eyecare providers also need to manage high-risk complications such as MK that develop from improper CL use (Sankaridurg et al, 2013). Patients may be confused by the negative publicity associated with OTC CLs, and non-wearers may fear trying CLs. Likewise, the negative word-of-mouth from past OTC CL wearers may further discourage others from trying CLs. This a huge loss to the industry in potential CL sales, and unauthorized CLs likely contribute to the large annual cost associated with treating keratitis (Collier et al, 2014).

The Solution to OTC CLs

Governments and practitioners around the world must actively work to prohibit non-prescribed CL sales by educating patients about the dangers of doing otherwise. Education in unregulated countries is especially important because healthcare providers can positively influence CL sales. Industry leaders should also advocate in these countries for ethical practices and encourage patients to routinely visit their eyecare professionals when seeking CLs. CLS

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