An interesting mental game to play on a quiet evening during lockdown is to consider the changes to contact lenses that might have the greatest positive impact on the overall industry. A radical new lens design for presbyopia could further unlock that part of the contact lens market and would certainly open up lens wear to new patients. Developments to soft lens materials to diminish further corneal infiltrative events or infections would be welcomed and perhaps would encourage some additional lens fitting in some quarters. Or maybe a new contact lens solution would be of interest to the few patients who have struggled with care systems in the past. All such developments would no doubt be helpful to the market, but a different change to the market would have the most dramatic impact, and unlike the options listed above, it is one that is principally within the influence of eye care practitioners worldwide: the elimination of contact lens dropouts.
Dropouts (patients who are prescribed and fitted with contact lenses but who later discontinue) are a key issue across the contact lens industry. By definition, such an eventuality is a failure for the wearer. Such wearers have expressed a desire to use contact lenses for their vision correction, but some aspect of the process has fallen short of their needs or expectations. Beyond this, though, contact lens dropouts also represent a commercial hit to both the contact lens practice concerned and to the industry more widely.
Eurolens Research data 1997-2020 - all markets, all lens types
Two outstanding recent papers looked at the dropout rates in hundreds of patients who were fitted with contact lenses for the first time and determined annualised rates of 22% and 26% depending on the methodology used [1,2] whereas the rate across all contact lens wearers (i.e., a typical mix of new and established wearers) has been estimated at 17%. [3]
Despite these relatively high rates of discontinuations, the market worldwide is generally considered to be growing slowly, and industry estimates indicate that new wearers each year equate to about 25% of the existing wearer base that is, overall growth is due to 25% of new wearers entering the market and 17% dropping out each year. On this basis, a contact lens practice that currently has 1,000 lens wearers will grow to 4,600 wearers over 20 years.
A key question, then, is the cause of these dropouts. Assessments here can vary, but the two main reasons are generally poor comfort [4] and poor vision. [1,2] These are both areas that can be addressed by eye care practitioners. Soft lens comfort appears to relate to on-eye movement [5,6] as well as to characteristics of the lens surface such as friction and lubricity [7,8] and also the form of the lens edge. [9,10] As such, a change in lens brand or lens fit can be instigated to attempt to improve wearer comfort. Vision is, of course, closely related to lens power, and any dissatisfaction here can be readily addressed by the eye care practitioner. In short, careful questioning about these two key reasons for dropouts should be initiated at all contact lens aftercare visits, and if any issues around comfort or vision are identified, positive patient management in the form of a change of lens parameters or brand should follow.
The impact of better management here is profound. If the current estimate of 17% dropouts per year is reduced only slightly to 15% per year, the projected number of wearers over 20 years increases to 6,700 from the expected 4,600 - almost 50% more. If there are only 13% dropouts per year, this number rises further: to almost 10,000 wearers. In other words, careful consideration of contact lens dropouts and their management by eye care practitioners can lead to a significant and sustainable improvement in the clinical success of lens wearers and to a dramatic impact on the overall contact lens market.
