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CONTACT LENSES 2019

A mostly quiet year of steady growth ended with an FDA decision that could prove to be the tipping point in how practitioners manage young progressive myopes.

Now that 2020 has arrived, let’s take a look back at what transpired in the contact lens industry over the last year. There weren’t too many surprises, with many of the trends in replacement schedules and certain lens designs continuing as they have over the last several years. That said, recent news from the U.S. Food and Drug Administration (FDA) will bring us even closer to changing the standard of care for young myopes as we move through 2020. We hope that the information in this 2019 Annual Report is helpful to you as you compare the data to that in your own contact lens practices.

OVERVIEW OF GENERAL MARKET TRENDS

The size of the contact lens market has historically been open for debate; as new lenses from smaller/lesser-known manufacturers, novel contact lens categories such as those for myopia control, and new direct-to-consumer selling models have begun to emerge, pinning down the market’s size and growth have become even more challenging. Data obtained from Baird (Jeff Johnson, OD, CFA, managing director, senior research analyst), however, suggest that the value of the global soft contact lens market (measured at the manufacturer level) likely approached $9 billion in 2019 and that growth for the market through the first three quarters of the year remained solidly in the range of 5% to 6% (after excluding the impact of fluctuating foreign exchange rates). This marks 10 consecutive years, dating back to the end of the Great Recession, of global soft contact lens market growth of at least 4% to 6%. Growth during this period was supported by a host of factors, including the industry’s continued transition to silicone hydrogel lenses, accelerating uptake of daily disposable lenses, and growth of new wearers driven by increased adoption of contact lens wear in developing markets.

Baird further estimates that the $3 billion U.S. contact lens market also grew roughly 5% to 6% through the first nine months of 2019, which is comparable to the 6% growth estimated for the domestic market for all of 2019. While hard to specifically dissect the contributors to U.S. growth, Baird believes that a majority of the growth for the U.S. market can be traced to patients upgrading to more expensive daily disposable lenses—and in particular, daily disposable silicone hydrogel lenses—from older-generation frequent-replacement, non-silicone-hydrogel lenses. A portion of the growth is also likely attributable to the broader availability and corresponding stronger uptake of toric and multifocal contact lens options from the major lens manufacturers.

Looking forward, with the economy still in a reasonably stable state and with several new daily disposable lens products expected to launch more fully, Baird expects this similar 5% to 6% global market growth to continue in 2020.

CURRENT PRACTICE TRENDS

Contact Lens Spectrum conducts its own market research in which we ask our readers about their general practice trends and about trends that relate to contact lenses. The many years over which we have performed this market research give us the opportunity for longer-term and longitudinal analyses. Respondents answer questions on a variety of topics such as the characteristics of their practice’s patient base, their practice’s business and financial characteristics, and their practice’s trends in contact lens fitting, prescribing, and care solutions. This year, 110 U.S. respondents completed the majority of the survey. We will use this information and information from other sources in discussing trends and observations in the contact lens field over the last year.

Practice and Business Trends Table 1 summarizes practice and business trends from 2009 to 2019. Our respondents were mostly optometrists (78%), followed respectively by opticians, contact lens technicians, and ophthalmologists. Most of our respondents were in solo private practice, with other modes of practice including group private practice, employee of either an optometrist or ophthalmologist, and employee of or independent affiliated with a retail corporation, in that order. A typical practice saw an average of 120 patients per week in 2019; contact lens wearers comprised approximately 35% of the patient base, and contact lens fittings and refittings averaged about 25 in a typical week.

TABLE 1 TRENDS IN THE BUSINESS PORTION OF PRACTICES
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Patients seen each week 108 116 107 127 125 117 124 105 105 109 120
% Contact lens-wearing patients 37 36 35 34 34 34 49 33 36 35 35
# CL fits/refits per week 27 27 24 26 25 24 29 26 31 34 25
Estimated % gross practice revenue from CLs 35 34 37 32 30 30 39 32 32 30 31
Estimated % net practice profit from CLs 29 28 26 27 25 25 27 27 27 26 28

Similarly, most respondents felt that the contact lens portion of their practices contributed about 31% of their gross revenue and about 28% of their net profit. Related to this from a materials standpoint, respondents reported that their patients purchase their contact lenses from the following locations: about 66% from their practice (64% in 2018), about 20% online (22% in 2018), 11% through a third-party retailer independent of a practice, and 3% from another practice setting (Figure 1).

Figure 1. 2019 estimates of contact lens purchase locations.

Respondents had a positive outlook with regard to the projected performance of their contact lens practice in 2020; 55% of practitioners believe that their overall contact lens practice will increase in 2020 (same as for 2019), 44% believe that it will stay the same (versus 38% for 2019), and only 1% felt that it will be decreasing further (versus 7% for 2019).

Lens Dispensing and Mode of Wear Trends Similar to what we have reported in previous years, Figure 2 shows Contact Lens Spectrum market data indicating that silicone hydrogel materials make up the majority of today’s contact lens fits and refits. Our data indicated that the growth in silicone hydrogels first started to slow in 2011; for 2019, our respondents reported that silicone hydrogels are used in 65% of fits, followed by hydrogels in 24% of fits and GPs across 9% of fits.

Figure 2. 2019 contact lens fits & refits by material classes.

Figure 3 shows that with regard to contact lens designs, most respondents report using soft spherical lenses (48% versus 49% in 2018) for fits and refits, followed by soft toric lenses (26% versus 24% in 2018), soft multifocal lenses (13% versus 12% in 2018), spherical corneal GPs (4% versus 6% in 2018), and scleral designs (3% versus 3% in 2018) (Contact Lens Spectrum market data). In addition, when we asked our readers specifically about the 2020 growth potential among popular specialty lens options, scleral lenses topped the list (43% compared to 50% for 2019), followed by custom soft lenses (27% compared to 26% for 2019), orthokeratology (17% compared to 11% for 2019), and hybrids (13%, which was the same as for 2019).

Figure 3. 2018 to 2019 contact lens fits & refits by lens designs.

The Contact Lens Spectrum Practice Profile Survey also asked readers what designs they prescribe for lenses containing any GP material (Figure 4). As you might expect, most fits were performed with corneal designs (75% versus 77% for 2018), followed by sclerals (13% versus 13% for 2018), ortho-k (8% versus 4% for 2018), and hybrids (5% versus 7% for 2018).

Figure 4. 2019 overall estimated distribution of lens fits by design for any lens with GP material.

In addition to the data from our Practice Profile Survey, Contact Lens Spectrum also receives data and market insights from ABB Optical Group (ABB) (an independent optical industry platform) and GfK Retail and Technology (GfK) (a market research service). In comparing the major soft lens categories of spherical, toric, multifocal, and cosmetic lenses, trends among the three data sources were similar, although the Contact Lens Spectrum data is reported as the percentage of patients fit with each lens category compared to the ABB and GfK data, which are reported in percentage of sales. The most variability among the three sources was evident in the soft spherical lens category, which ranged from 51% to 59% (compared to a range of 53% to 59% in 2018), and in soft multifocal prescribing, which ranged from 9% to 17% (compared to 10% to 16% for 2018). The numbers were more consistent for soft torics, which ranged from 28% to 30% (versus 26% to 29% for 2018), and for soft cosmetic lenses, which ranged from 3% to 4%.

Contact Lens Spectrum also obtained market insights from ABB and GfK with regard to trends in contact lens replacement schedules (Table 3). The daily disposable modality leads for all three sources, ranging from 39% (Figure 5) to 50% (compared to 35% to 46% for 2018), followed by the monthly category (range 32% to 36%), which has been declining. The weekly/two-week category continues to decline; this contrasts with daily disposable lenses, which have steadily increased over the last several year and are associated with the most growth (ranging up to 10%).

TABLE 2 2019 CONTACT LENS SPECTRUM, ABB OPTICAL GROUP, AND GfK RETAIL AND TECHNOLOGY DATA FOR U.S. SOFT LENSES IN TERMS OF LENS TYPE
SOFT LENS CATEGORY CONTACT LENS SPECTRUM ABB OPTICAL GROUP GfK RETAIL AND TECHNOLOGY CHANGE FROM 2018
ABB GfK
Spherical 51% 56% 59% –0.7% 3%
Toric 28% 28% 30% 0.6% 9%
Multifocal 17% 13% 9% 0.5% 4%
Cosmetic 4% 3% 3% –0.4% 1%
Data from ABB and GfK are percentage of sales.
TABLE 3 2019 CONTACT LENS SPECTRUM, ABB OPTICAL GROUP, AND GfK RETAIL AND TECHNOLOGY DATA FOR U.S. SOFT LENSES IN TERMS OF REPLACEMENT SCHEDULE
SOFT LENS CATEGORY CONTACT LENS SPECTRUM ABB OPTICAL GROUP GfK RETAIL AND TECHNOLOGY CHANGE FROM 2018
ABB GfK
Daily 35% 50% 41% 4% 10%
Weekly/Two-Week 21% 18% 23% –2% –3%
Monthly 36% 32% 36% –2% 5%
Three-Month+ 4% 0% 0% –0.1% –19%
Data from ABB and GfK are percentage of sales.

Figure 5. 2019 soft contact lens fits & refits by replacement schedule.

This trend also bears out in our readers’ projected prescribing for 2020. When our survey respondents were asked which soft lens category they anticipated having the greatest growth potential in 2020 (for which they could choose only one), 64% selected daily disposables (versus 62% for 2019), followed by multifocals (33% compared to 34% in 2019), torics (3% versus 3% for 2019), and cosmetic lenses (1% compared to 1% for 2019).

According to our Contact Lens Spectrum market data, an increasing number of practitioners strongly prefer multifocal lenses for their presbyopic patients (75% compared to 64% in 2018) compared with monovision (16% versus 27% in 2018) and over-spectacles (9% for both 2019 and 2018). As far as what happens in clinical practice, respondents indicated prescribing more multifocal lenses (46% of contact lens-wearing presbyopes versus 45% in 2018) compared with monovision (33% of contact lens-wearing presbyopes versus 35% in 2018).

Myopia control with contact lenses demonstrated an upward trend among our Practice Profile Survey respondents in spite of the fact that it was an off-label use for all contact lenses in the United States until very recently. In 2019, 42% of practitioners who participated in our survey indicated that they actively practice myopia control with contact lenses (compared with 28% in 2018). In addition, most practitioners who are using any type of myopia control indicated that contact lenses are most efficacious (multifocal or orthokeratology) (53%), followed by a combination contact lens/atropine approach (38%) and atropine alone (10%) (Figure 6). Related to this, in terms of atropine concentration, most responded that they use 0.01% (72%) as opposed to 0.1% (19%) or 0.5% (8%).

Figure 6. 2019 perceived most efficacious therapy for myopia control.

CONTACT LENS WEAR AND CARE COMPLIANCE

This year’s trends in replacement schedule compliance are very similar to what our market data has shown in previous years. Practitioners who responded to our survey indicated that 48% (39% in 2018) of their patients using one- to two-week replacement lenses were compliant with the replacement schedule, 61% (61% in 2018) of their patients using monthly lenses complied with this schedule, and 80% (75% in 2018) of their patients using daily disposable lenses were compliant.

LENS CARE TRENDS

In 2019, most practitioners reported using chemical care systems (73% compared to 64% in 2018) with contact lens patients, followed by hydrogen peroxide-based systems (27% versus 35% in 2018), which is opposite to the trend toward increasing hydrogen peroxide usage that we’ve reported over the last several years (Contact Lens Spectrum market data, Figure 7). Disinfection efficacy (29%) was the most important factor in this selection, followed by improved comfort (24%), material/care solution compatibility (18%), cleaning efficacy (13%), convenience (12%), and cost (5%).

Figure 7. 2009 to 2019 lens care trends.

YESTERDAY AND TODAY

It’s often amazing what a difference a decade can make. We like to take the opportunity in the annual report each year to look back and remember what was happening in our industry 10 years ago and how those events influenced where we are today.

In the January 2010 issue, we looked back on a year in 2009 that had a vastly different global economic landscape from what it is today. The world was only just starting to see the first signs of recovery following the Great Recession, which began in late 2007 and lasted until mid-2009. Sparked in part by a housing boom that led to an excess of risky, subprime mortgages, the Great Recession bankrupted mortgage lenders and financial institutions, decimated home values, spiked the unemployment rate, and cut the Dow Jones Industrial Average by more than half, causing disastrous financial losses for individuals who had invested heavily in the stock market. Major investment/insurance companies and corporations that were on the brink of bankruptcy—including AIG, General Motors, Chrysler, and Bank of America—had to be bailed out by the Federal Government in an effort to prevent a complete economic collapse. While the economic downturn officially ended in June 2009 according to the National Bureau of Economic Research, the after effects of the Great Recession continued to be felt in many areas for the next five years.1

In spite of the devastation that the recession caused to the U.S. and the world economies, the ophthalmic sector as a whole did surprisingly well overall in 2009. As stated in the January 2010 Editor’s Perspective: “As many of you have experienced firsthand, 2009 turned out to be a challenging year.... However, as our Annual Report in this issue indicates, our field is still doing modestly well. In fact, the ophthalmic sector as a whole was still up 44 percent year-to-date going into the fourth quarter of 2009, which is far above many other economic indices. More specifically, the contact lens industry is predicted to grow slightly in 2010, and the majority of you report that you feel your contact lens business will be even better this year. In light of all of the financial crises that we have encountered over the last year, the fact that our industry has maintained itself with signs of growth is truly remarkable—so remarkable that it is our Contact Lens Event of 2009.”

As mentioned earlier, this growth in the contact lens sector has continued every year over the past decade, demonstrating the ongoing stability and momentum of our industry and providing a positive outlook for the next decade to come.

Another notable series of events that occurred in 2009 was related to contact lens care. In January 2009, a public workshop on “Microbiological Testing for Contact Lens Care Products” took place to evaluate the activity of contact lens care products against Acanthamoeba. This workshop was cosponsored by the American Academy of Ophthalmology, the American Academy of Optometry, the American Optometric Association, and the Contact Lens Association of Ophthalmologists, in conjunction with the FDA.

Signifying another nail in the coffin of no-rub multipurpose solutions, later that same year on May 19, 2009, the FDA’s Center for Devices and Radiological Health issued a letter to manufacturers of multipurpose care systems that offered no-rub lens care instructions. As we reported in our annual report that year, “This letter informed these manufacturers of the panel’s conclusion that there is improvement in lens care when using a rub-and-rinse regimen as compared to a rinse-alone regimen, which omits the rubbing step.” Of course, research has long demonstrated that the rub step is an essential part of contact lens care to improve the cleaning and disinfection efficacy of multipurpose solutions for all lens types.2,3 Today, there are no recommended no-rub multipurpose lens care regimens, and the rub-and-rinse regimen has become the standard of reusable soft lens care with multipurpose systems.4,5

A notable acquisition that occurred in 2009 was that of Advanced Medical Optics by Abbott. Advanced Medical Optics became a wholly owned subsidiary of Abbott and was renamed Abbott Medical Optics (AMO). AMO was subsequently acquired by Johnson & Johnson in 2017.

TODAY AND TOMORROW

Bringing us back to the present day, a number of events and innovations that occurred in 2019 will have an impact on the contact lens industry in 2020 and beyond. Here we will discuss some of the highlights.

Myopia Control Myopia control is a drum that we have been beating for several years, and with good reason. Myopia’s ever-increasing global prevalence6 and its accompanying risk of ocular complications and vision loss, particularly with higher levels of myopia,7 demand attention. Add to this that we have years of scientific evidence demonstrating that myopia progression can be slowed through the use of atropine,8 contact lenses (orthokeratology and soft multifocals),9 or a combination of both,10-11 and it seems that there is no good reason to not take action and incorporate myopia control into practice.

What is a little shocking and somewhat disappointing is that despite the weight of this evidence, clinical practice is lagging far behind. A recent global study reported that most practitioners (80%) generally did not consider single-distance under-correction to be an effective method for slowing myopia progression, but 64% ± 22% prescribed single-vision spectacles or contact lenses as their primary mode of correction for myopic patients. When asked why they did not adopt specific strategies, their primary reasons for not prescribing alternatives to single-vision refractive corrections were increased cost (21%) and inadequate information (18%).12

This is also apparent in the data reported in the “International Contact Lens Prescribing in 2019” article that also appears in this issue; this article reports that overall, only 5% of GP lens fits and 1% of soft lens fits globally were prescribed for myopia control. Philip Morgan, PhD, MCOptom, notes that when the soft lens data is considered only with respect to patients 17 years old and younger, the value increases to 6%—a significant jump, but still low overall.

Surprisingly, among the respondents of the Contact Lens Spectrum Practice Profile Survey, 42% reported that they actively practice myopia control. However, as readers of a clinical publication on contact lenses, it is likely that they tend to have a greater interest in and to fit more contact lenses in general.

In the United States, no doubt part of the reluctance has resulted from the fact that up until very recently, there were no soft or GP lenses that were indicated for myopia control. This changed with the Nov. 15, 2009 FDA approval of CooperVision’s MiSight daily disposable lens to slow the progression of myopia in children between the ages of 8 and 12 years old at the initiation of treatment. This approval will open the door for other contact lenses to receive clearance or approval for this indication, and it hopefully marks the turning point for a real change toward making myopia control the standard of care.

We also saw continued activity from organizations and industry coming together in an effort to find a solution for and to educate practitioners about solving the myopia problem in addition to raising awareness in the general public about this condition. It is for these reasons that we once again named the myopia initiative as our Contact Lens Event of the year.

Dry Eye Did you notice all of the activity in the dry eye space in 2019? On the technology side, two new thermal-based devices to help clear blocked meibomian glands entered the market. A third device applies localized heat therapy in-office when the current medical community recommends the application of a warm compress to the eyelids, such as for meibomian gland dysfunction, dry eye, blepharitis, stye, or chalazia. Furthermore, a U.S. patent was issued for a commercially available microblepharoexfoliation device.

In pharmaceuticals, a higher concentration of cyclosporine was approved by the FDA and recently launched; this formulation is also delivered using new nanomicellar technology. We have also reported on treatments that are currently under investigation and have novel mechanisms of action to help manage dry eye in different ways from what is currently available.

On the consumer side of the dry eye market, three new hypochlorous acid formulations launched in 2019. In addition, at least five new nutritional supplements became available that target dry eye or digital eye strain. Several innovations were also launched in artificial tears and lid hygiene. At least one new dry eye mask and one new punctal plug became available.

In the contact lens space, a polyethylene-glycol (PEG)-based coating that helps improve lens wettability and reduce lens deposits was expanded to be available for many more GP materials. And, two daily disposable contact lenses that feature a modified version of this coating entered the market.

In short, there has never been a better time to do more to help manage our dry eye patients and our contact lens wearers who struggle with wearing discomfort. More innovations are sure to come in this sector through 2020 and beyond.

Contact Lenses A new technology that entered the contact lens space last year that bears mentioning is a photochromic contact lens that adapts to changes in lighting conditions. This lens is reported to have benefits for patients in unintuitive areas such as night driving and in indoor conditions such as fluorescent lighting and glare from computer screens in offices and classrooms. It will be interesting to see what future developments arise from this technology.

Finally, much activity continues in scleral lenses, from the launch of a 200-Dk GP material to innovations in scleral lens designs, corneal profilometry, and fully customized scleral lenses that match the exact shape of the eye. In addition, caution continues to be advised due to potential concerns with hypoxia and increased intraocular pressure with scleral lens wear. We published close to 20 features and columns on scleral lenses in 2019, illustrating the interest and the momentum behind this modality. We expect to see that continue into 2020 despite the fact that our survey data and the International Prescribing data in this issue indicate that scleral lens prescribing represents a relatively small segment of the market. CLS

REFERENCES

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