Article

DAILY DISPOSABLES—A LOOK BEYOND 2020

The pros outweigh the cons when looking at this contact lens modality

New developments in the contact lens industry are coming faster than ever in response to the increasing demand from patients. As consumers, the bar of patients’ expectation for innovation and value is set higher and higher in our world of technology. Eyecare practitioners (ECPs) need to be on the leading edge of industry to offer the best possible care to their patients. As the daily disposable modality continues to gain more dominance in the current market, let’s consider what makes this modality so powerful and what developments we can expect to see in the near future.

BENEFITS OF DAILY DISPOSABLES

From a practitioner perspective, daily disposable contact lenses hold a myriad of benefits over more traditional two-week, monthly, and planned replacement schedule lenses.

Safety In addition to providing exceptional vision, safety is one of the most important considerations when prescribing contact lenses. With any form of contact lens wear, there is always an inherent risk for which both ECPs and patients are responsible; daily disposable lenses offer an effective way to minimize that risk.

Most contact lens complications result from improper wear schedules and lackadaisical hygiene. Daily disposable wearers are significantly more compliant with lens replacement.1 Lens cleaning and storage cases are taken out of the equation. Relative to reusable lenses, daily disposable lenses decrease the risk of infiltrative events.2,3 Improved safety outcomes with this modality can help mitigate fears of adverse events for new wearers and provide a better option for habitual wearers who have a history of noncompliance or lens-related complications.

According to respected clinician Thomas G. Quinn, OD, MS, many contact lens complications are due to dirty lenses.4 He points to studies indicating that daily disposables, regardless of whether they are hydrogel or silicone hydrogel, are much less likely to induce corneal inflammatory events compared to lenses that are re-worn.2,3 In his opinion, those safety findings, combined with increasing parameter availability, improved recycling strategies, and lower costs, will lead ECPs and patients alike to more fully embrace the daily disposable option.

Regulators’ lack of enforcement action encourages the increase of direct-to-consumer contact lens companies. Therefore, the responsibility of protecting patients from these harms lies on industry to stem the tide of online contact lens availability and to provide the necessary practitioner-to-patient resources.

Comfortable Wearing Time/Fewer Dropouts The other major consideration for ECPs in prescribing contact lenses is to provide adequate comfort for their patients. Contact lens dropout remains a primary concern for practices, and strategies must be devised to combat it. Visual dissatisfaction and discomfort drive contact lens discontinuation and negatively impact both practitioners and the contact lens industry.5 Switching from a reusable to a daily disposable modality improves symptoms of dryness and can increase the number of hours of comfortable wearing time in symptomatic patients, especially those who have ocular allergies.6

Convenience It is important to remember that patients are consumers who care about more than just the safety and comfort of the contact lenses that they purchase. The convenience of wearing daily disposable lenses is undeniable when compared to reusable contact lenses. No longer does a patient have to worry about contact lens solutions and storage cases. The hassle of properly cleaning a lens can easily be avoided. Time is valuable, and anything that can help consumers get through their daily routine more efficiently in this fastpaced world should inherently sell itself.

Particularly appealing is simply the novelty of daily disposable lenses. While they have been on the market for a while, their birth is still relatively more recent compared to other modalities of reusable soft lenses. Many habitual wearers initiated contact lens wear during a time when daily disposables did not exist; presenting this new alternative not only excites them but also lets them know that their health and lifestyle are being considered.

BUT WHAT ABOUT...

Cost Daily disposable lenses are an attractive option for practitioners due to increased comfort and safety profiles compared to reusable lenses. And while ECPs agree that daily disposable lenses—particularly silicone hydrogel lenses—should be the standard of care for their patients, current prescribing practices do not reflect that sentiment, primarily due to cost.7 As we look to the future, the increased demand for daily disposables will drive improvements in manufacturing and encourage companies to develop strategies that will make cost less of a hindrance in fully embracing this modality. While providing great vision, safety, and comfort are of utmost importance to ECPs, profitability must also be a priority. After all, practices need to generate the revenue to keep the lights on and to take care of the next patient.

Wearers of reusable contact lenses are often guilty of extending the lifespan of their contact lenses and thus purchase less. Extending wear time also decreases the frequency of visits to their ECP. Not only are daily disposable lenses more profitable in the short term, they also foster greater compliance with wear schedule and increase the likelihood that patients will return in a recommended time frame for their routine examination.

Environmental Impact The goal and the challenge of the contact lens industry is to find new and creative ways to improve the patient experience, not only in materials and designs, but also in how packaging and patient engagement innovations can solve problems and deliver unprecedented value. One of the major arguments against daily disposable lenses, from a consumer standpoint, is the amount of waste produced compared to a reusable lens. As sustainability becomes more of a topic of concern on the forefront of society, the ramifications of this modality must be considered. The amount of waste generated by the use of daily disposable lenses is insignificant relative to a consumer’s total personal everyday waste.8 Furthermore, the carbon footprint of all other modalities far outweighs the environmental impact of a new daily pair of lenses and their packaging.9

Even still, contact lens companies are attuned to the environmental impact of these lenses and are making efforts to minimize that impact while still providing consumers with the healthiest option for their eyes. Continued research into lens packaging may drive cost downward and lessen the burden on the environment. Biodegradable blister packs and flat packs may particularly attract the new generation of more socially conscious lens wearers.

It helps to remind patients that the outer cardboard packaging can be recycled with their everyday recyclables and that contact lenses should not be thrown down the drain. Special recycling programs have been developed that make it easy for patients to mail in the blister packs, foils, and even the lenses themselves to be recycled. Or, patients can simply bring their contact lens waste into a participating ECP’s office to be recycled.

EXPANSION OF PARAMETERS AND MATERIALS

Following the trends of the past few years, contact lens parameters are expected to increase for the daily disposable modality. This includes higher sphere powers in the plus and minus ranges, higher around-the-clock cylinder powers, and the release of a daily disposable toric multifocal. As manufacturers continue to improve in their technologies and efficiency, a much wider proportion of our patient population can be more readily served.

With the exploration of more rigorous fitting techniques and by cross-referencing the applications used to fit specialty contact lenses, practitioners are looking beyond base curve and diameter and focusing on sagittal depth.10 Industry may consider following suit by listing additional parameters on their packaging, because it will allow practitioners to better select which lens will work best for their patients.

Given the introduction of photochromic contact lenses into the marketplace, it can only be speculated that similar innovations in a daily disposable modality are on the horizon. Protection against ultraviolet light will likely become standard in all lens modalities. As more research is being conducted in the realm of blue light and computer fatigue syndrome in this increasingly digital age, contact lens innovations to combat these issues are coming in the foreseeable future.

Finally, continued research into new materials will especially benefit daily disposable wearers. The benefits of oxygen transmission, accompanied by surface treatments/coating technology, will reduce the risk of complications even further.

The Future of Daily Disposables

“As the companies that produce daily disposable lenses continue to innovate, our patients will be the beneficiaries of more parameter availability and even more improved comfort levels. In five years, I predict that in the United States, three out of four contact lens wearers will be in daily disposable lenses.” –Mile Brujic, OD

“Over the past 10 years, we have seen a surge of [daily disposable] lenses; I do not anticipate that changing anytime soon. Companies are currently working on new materials that are better than the ones we currently have. Regarding fit, I anticipate that we will start looking beyond base curve and diameter and start focusing on sagittal depth. With this knowledge, we will better be able to properly select which lens will work best for our patients.” –David Kading, OD

“In the next three to five years, we will see more direct-to-consumer contact lens companies come to market. When they see the lack of enforcement action of regulators, more companies will see [in-office eye exams] as a nuisance to be side-stepped. It will be up to [us] to stem the tide of disruption and to protect our patients from harm.” –Jeff Sonsino, OD

“Over the next five years, I predict that daily disposable contact lenses will continue to demonstrate the fastest growth in the category, eventually becoming the dominant modality in the United States. This will be bolstered by decreasing product costs as well as by a new generation of patients moving into contact lens wear who default to disposable consumer products. Myopia control is yet another factor that will contribute to growth in the younger population. I believe that we will see many new manufacturers and commercial distributors enter the U.S. daily disposable market, enabled by both product and business model innovation on a global scale.” –Vic McCray, MD (Tangible Science)

“As the industry as a whole becomes more comfortable prescribing one-day disposable lenses, I see a continued effort to provide more parameter options to better serve our patients. Higher powers in the plus and minus ranges above +8.00D and –12.00D, higher toric powers above –2.25D cylinder, and the release of a toric multifocal in a one-day disposable are what I believe will be next in our near contact lens future.” –Shalu Pal, OD

“Our challenge, in an increasingly commodified segment, is to find new and creative ways to improve the patient experience. We need to look at advanced lens materials and designs but also think about how packaging and patient engagement innovations can solve problems and deliver unprecedented value.” –Scott Orphanos (Menicon America)

“In practice, I find that more and more patients are failing the cookie cutter method of soft contact lens fitting. Where does that leave patients who desire use of contact lenses only three to four days a week? Likely in a modality that is open to noncompliance with care and handling.” –Stephanie Ramdass, OD, MS, MBA

“It is an exciting time for eye care, influenced by dynamic demographics and the changing digital world we live in. I know that we can expect to see a continuous increase in the investment of contact lens and lens care research and development to help improve the overall lens-wearing experience of patients.” –Rhonda Robinson, OD

DISEASE MANAGEMENT

The utility of contact lenses extends far beyond just correcting refractive error. In the future, contact lenses will play a much larger role, not only in managing ocular disease but systemic disease as well. Those applications of contact lenses are already being explored, and it is only a matter of time before they become mainstream.

Myopia Management The recent introduction of the first U.S. Food and Drug Administration (FDA)-approved contact lens for myopia management paves the way for major growth and opportunity in the contact lens sector. In many parts of the world, myopia is already a large public health concern, and both patients and practitioners alike embrace the necessity of managing the progression of myopia and axial length growth in children. Projections indicate that myopia will only continue to grow as a global health concern and emphasize the significance of planning comprehensive eyecare services.11 As more ECPs in the United States recognize the importance of myopia management, the FDA approval of this contact lens immensely highlights both the problem and its management. Advertising and awareness through patient education is only expected to increase, and ECPs must be prepared to accept myopia management as standard of care and must be able to meet the needs of an increasingly myopic population. This approval provides opportunities for growth for all contact lens manufacturers as the demand for myopia management increases.

Drug-Eluting Contact Lenses Continued research into the use of contact lenses as a drug delivery vehicle will allow for better management of chronic ocular diseases. Current challenges with chronic topical medications include short contact time, difficulties with instillation, poor compliance, and side effects. By using drug-eluting contact lenses, there is a potential to better control and sustain delivery of topical medications to the eye.12 Indications may include patients who have glaucoma, ocular surface disease, and chronic allergic conjunctivitis.

Smart Lenses for Glaucoma, Diabetes, and More With the development of smart lenses, the potential for applications is endless. Researchers are merging contact lenses with microelectronics used for detecting certain biomarkers in the tear film. By measuring glucose levels in the tear film, the blood glucose level could be estimated; thus, patients who have diabetes could be alerted to adjust their medications and diet accordingly.13 Technology is even being developed to detect changes in corneal curvature secondary to fluctuations in intraocular pressure, giving ECPs diurnal pressure measurements to better manage their patients who have glaucoma.14

As observed with new lenses designed for correcting refractive error, strict research, development, and studies are necessary before a lens can reach the market. For a lens that has applications for more than just vision correction, this process will be even more laborious. Despite these obstacles, the potential for use of contact lenses in the management of ocular and systemic disease will revolutionize patient care and outcomes.

THE FUTURE

Time and time again, extensive research has proven the benefits of daily disposables, with corroborating testimonials from practitioners and the industry alike (see “The Future of Daily Disposables”). It is an exciting time, influenced by dynamic demographics and the changing digital world. We will all witness the growth and transition of the daily disposable market in which innovative technology has become an expectation rather than a luxury.

This article explored the future of daily disposables for “normal” corneas. The neglecting of specialty soft contact lenses was not purposeful, as industry has much to consider, such as the cost of raw materials and labor, transition of delivery in vials to blister packs, and increasing volume and demand. The struggle to convert from a conventional to a monthly modality remains, let alone to a daily disposable.

As we all patiently await the “next big thing” in the world of soft contact lenses, the words of noted contact lens leader Glenda Secor, OD, are quite prophetic: “The next few years will be the golden years of daily disposable contact lenses. The ability to offer premium technology in a daily format is appealing to practitioners and patients. We want it all: visual excellence, exceptional comfort, enhanced safety, predictable fitting, affordability, and a range of colors. Addressing material composition, surface treatments, and designs will differentiate future technology from today’s daily disposable lenses. Diabetic and glaucoma detection, treatment, and drug-eluting capability should become mainstream. Patient lifestyles seek convenience and value. Practitioners want safety and clear vision. Daily disposable technology fulfills both.” CLS

Acknowledgements: Erik Anderson (Art Optical); Ed Bennett, OD, MSEd; Mile Brujic, OD; David Kading, OD; Victor McCray, MD (Tangible Science); Scott Orphanos (Menicon America); Shalu Pal, OD; Tom Quinn, OD, MS; Stephanie Ramdass, OD, MS, MBA; Rhonda Robinson, OD; Glenda Secor, OD; Jeff Sonsino, OD.

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