Taking stock of the UK contact lens market
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In 2003 in this journal,1 I presented a ‘health check’ on the UK contact lens market and, six years on, it seems appropriate to review the state of the market in light of the changes in lens availability over the intervening period.
Precisely how we measure the health of any contact lens market is open to some debate, but a logical approach which is widely adopted is to estimate the number of contact lens wearers within a country or region as the ultimate indicator of the success of this form of vision correction. Of course, a simple absolute number on a country-by-country basis is of limited value on its own and, typically, this parameter is expressed in percentage terms as the proportion of the adult population who are contact lens wearers. This is the ‘wearer base’.
Estimation of the size of the wearer base is a challenging and potentially expensive exercise. One approach is to adopt conventional market research strategies and approach a large population via the post, web, email or with street surveys. The market research companies that undertake this form of analysis work carefully not to bias their sample with these methods it is likely, for example, that the demographics of the population who volunteer for verbal questioning on a high street are different to those responding to a web-based poll.2 Further to this, with contact lens wearers representing a relatively small minority of the total population, a very high number of people need to be surveyed to provide a good level of detail about the types of lenses worn.
A second approach is to access information about the number of contact lenses sold in the market and derive information about the number of wearers from that dataset. This method is dependent on the distribution of the lenses sold being well controlled and the geographic area being well demarcated. This is the case for the contact lens industry. Because lenses are sold to practitioners who then supply patients, there are no complicating effects due to multiple levels along the supply chain furthermore, contact lens companies are generally readily able to identify the number of lenses supplied into the UK, even if the company and/or distribution centre is based overseas.
Another factor is the requirement to capture information about all (or almost all) of the lenses supplied. We are well served in this regard by the Association of Contact Lens Manufacturers, which coordinates an assessment of lens sales in the UK each year, with its 15 contributing manufacturers accounting for more than 95 per cent of lenses sold.
Although the lens sales information from this source is likely to be highly accurate, deriving data about the number of lens wearers requires a series of assumptions about lens consumption. For example, lens consumption for a daily disposable wearer is estimated to be 350 lenses per year. This figure, which indicates that the average wearer uses their daily disposable lenses on a half-time basis, is derived from surveys of lens prescribing and usage. A full analysis comparing estimations of wearer numbers from this lens sales analysis compared to standard market research techniques has been previously reported and suggests that the assumptions related to lens consumption are generally robust.3
Total number of wearers
Figure 1 shows the estimate of contact lens wearers in the UK since 1992, based on applying a range of lens consumption estimates over this period. The assumptions have remained the same over this period although new values have been brought into the model with the launch of newer lens types and modalities. A recent analysis has indicated that the frequency of lens wear has remained similar for a range of lens types over the past 10 years in the UK.4 Between 1992 and 2008, the number of contact lens wearers increased from 1.56 million to 3.44 million. The reason for this rise is not directly revealed by sales data of this type, although presumably the wider range of lens types which were launched throughout this period (eg daily disposable lenses and silicone hydrogels), the improvements in toric and multifocal lens designs, coupled with consumer price reductions and increased availability in the market, have all affected this growth to some degree.
The number of wearers equates to 7.2 per cent of adults in the UK, a value which is half the wearer base of Japan (14.6 per cent)5 and the US (14.7 per cent),6 although the UK market is generally greater by this measure than most other European markets.7
Given the number of new contact lens fits that are conducted each day in the UK (about half of all contact lens fits are to people with no previous experience of lens wear),8 the rise in the number of wearers in the past 17 years is perhaps slower than might be expected. This observation is, of course, explained by the number of wearer discontinuations. In 2002, Sulley and colleagues reported that there were about 1.2 million ex-contact lens wearers in the UK9 on the basis that this figure will have increased in the intervening period, the number of former contact lens wearers is probably about half the number of current wearers. Young and colleagues have reported that patients who have dropped out of contact lens wear are very successful when re-introduced to the modality, with a majority of wearers who are refitted still using lenses after six months.10
Lens types worn
In the ACLM dataset, each lens type is categorised into one of five options, and the number of wearers calculated for each. The change in the number of wearers of each option is shown in Figure 2 and the number of wearers in 2000 and 2008 is shown in Table 1.
Daily disposable lenses were first recorded as a separate category in 1996 and the number of wearers has risen approximately linearly to the current number of 1.3 million wearers (38 per cent of all lens wearers). Frequent replacement hydrogel lenses accounted for the largest number of contact lens wearers (46 per cent in 2000) until a decline in recent years (23 per cent in 2008) as the number of silicone hydrogel lens wearers increased (1 per cent of wearers in 2000 and 26 per cent of wearers in 2008). The rise in silicone hydrogel wearers accelerated from 2004 when the lens manufacturers started to promote this material as a daily wear option previously, silicone hydrogels were typically prescribed for extended wear.
The number of rigid lens wearers has seen a modest decline over the period of the ACLM data collection, from 399,000 in 2000 to 324,000 in 2008.
Predicting the future
For the past 14 years, with colleagues from Eurolens Research, I have also collected data relating to contact lens prescribing trends in the UK8,11 and it seems reasonable to assume that there must be a relationship between how lenses are prescribed and how many are sold, albeit with a time ‘offset’ between the two sets of data. For example, if a new lens type is launched in any one year and widely fitted, lens sales for this lens (and the number of wearers) will lag behind the prescribing data. The magnitude of this lag is dependent on many factors such as the frequency of lens wear and the likelihood of discontinuation. While these are difficult to quantify, it seems that a one year lag between prescribing popularity and the number of calculated wearers gives good agreement.
Figure 3 shows the change in the proportion of rigid lens wearers in the UK market in terms of both values derived from ACLM sales data and the predicted number of wearers from Eurolens Research prescribing data with the later data set offset by one year. The agreement between 1998 and 2008 appears quite robust, suggesting that the predicted number of wearers for 2009 and 2010 is also likely to be reasonably accurate. This information suggests a small rise in the proportion of wearers who use rigid lenses which in turn could be used to predict the number of rigid lenses that will be sold this year and next.
Perhaps a more dramatic example of these future predictions is that for silicone hydrogel lenses (Figure 4). Again, the number of wearers predicted from prescribing data appears reasonably accurate for 1999-2008. This model suggests a significant rise in silicone hydrogel wearers for 2009 and 2010. Specifically, it is predicted that the number of silicone hydrogel wearers in the UK in 2010 will be about 1.3 million.
The UK is a mature contact lens market which is one of the more successful in Europe although it is rather smaller in terms of the proportion of people who use contact lenses compared with Japan and the US. It seems highly likely that there will be an increasing number of silicone hydrogel contact lens wearers, although most of these will be people switching into this material from other lens types rather than new wearers coming to the market. The change which will see the most significant rise in the number of wearers is probably a lens type or associated product which will reduce the number of lens drop-outs.
- Morgan PB. Healthcheck on the contact lens market. Optician 2003 226 (5908): 32-33.
- McDonald H and Adam S. A comparison of online and postal data collection methods in marketing research. Marketing Intelligence & Planning 2003 21: 85-95.
- Morgan PB. A healthcheck on the UK CL market. Optician 2002 223 (5854): 14-16.
- Efron N and Morgan PB. How often are contact lenses worn? Contact Lens and Anterior Eye 2009 32: 35-6.
- Kato Y, Saito H, Nishizaki R, Shiota T, Matsuda T, Mizuki, N and Okada E. Contact lens user statistics in Okada Eye Clinic. Eye and Contact Lens 2005 31:231-237.
- Barr JT. Contact Lenses 2005 Annual Report. Contact Lens Spectrum 2006 21(1) 20-26.
- Morgan PB. Comparison of soft contact lens markets in Europe. Optician 2005 230 (6026) 24-25.
- Morgan PB, Efron N. A decade of contact lens prescribing trends in the United Kingdom (1996-2005). Contact Lens Anterior Eye 2006 29(2): 59-68.
- Sulley A, Rogers J and Griffin P. Lapsed wearers – a bigger problem than we thought. Poster at the British Contact Lens Association Clinical Conference 2002.
- Young G, Veys J, Pritchard N and Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthal Physiol Opt 2002 22: 515-527.
- Morgan PB. Trends in UK CL prescribing 2009. Optician 2009 237(6205): 20-21.
? Dr Philip Morgan is director of Eurolens Research and a senior lecturer in optometry at the University of Manchester. He is an honorary member of the Association of Contact Lens Manufacturers