Though a major theme throughout the recent CooperVision-supported online Virtual Perspectives conference was myopia management (see Optician 24.03.23), Marcella McParland (pictured), senior director for professional affairs, EMEA, CooperVision, was keen to emphasise that the agenda reflected many other hot topics of relevance to those in contact lens practice.
Trends in CL Practice
Zoe Bull (pictured), director of category management, EMEA for CooperVision, is becoming the go-to expert when it comes to digging into data to concerning trends and growth opportunities in contact lens practice.
Describing some of the latest market analysis figures, Bull first of all highlighted some patient-specific (or consumer-specific) trends. Notable of these were that 53% of consumers regularly use social media, that 65% were worried about climate change and 72% would prefer ‘environmentally friendly’ contact lenses. Surely, denial is no longer an option for eye care professionals (ECPs). As our patients want to ‘live sustainably’, then it is essential for practices to be transparent about this, to communicate their values effectively, to educate patients on all available choices and to be proactive when it comes to sustainability.
The most obvious practice-focused trend is the rise of myopia management, and this offers a clear opportunity to encourage discussions about contact lenses to patients of all ages. Less welcome trends include increasing staff shortages, the challenges of patient retention and drop-out, and the impending changes to legislation. With regard to the impact of the UK leaving the EU and proposed changes to contact lens regulation, ‘regulatory changes are creating headwinds,’ said the speaker.
Contact Lenses for Life
Next up, Karen Walsh, director of global professional affairs at CooperVision, led a session looking at the challenges and benefits of contact lens correction for patients at all stages of life, from the very young through to the elderly. Much of the content was previously covered in a recent article in this publication (see Optician 01.07.22), but what made this session useful was the inclusion of a panel of leading contact lens practitioners who were able to offer their first-hand experiences from everyday practice. Scottish optometrist Craig McArthur joined Swedish practitioner Alexandra Skjöld in the studio, while Riccardo Cano joined in via a glitch-free live link with Italy where his practice is based (figure 3).
Figure 3: Left to right: Alexandra Skjöld, Craig McArthur, Karen Walsh and Riccardo Cano
Walsh began the session showing the changes in fitting practice over the past two decades, changes which clearly demonstrate a major shift towards daily disposable lenses (DDs) and silicone hydrogel material (figure 4). The move to DDs means patients are better able to adhere to compliant practice, having to follow fewer steps than are required for reuse lenses. Studies also reflect the facts that DDs have the lowest risk of inflammatory complications, avoid problems relating to care systems and cases, and also encourage wearers to replace their lenses when advised.
Figure 4: Fitting habits over time
Myopia management is driving the fitting of contact lenses for patients of younger age, while advances in design and materials now offer correction options for presbyopes at the other end of the age range.
With regard to optimising eye health, Walsh repeated figures from research showing how wearers do not always behave as advised by their ECPs. Between 23 to 50% have admitted to unplanned overnight wear on occasion, while 35 to a massive 87% are thought to nap with their lenses in.
Cost is not everything. Reassuringly, Insight research figures show how seven out of 10 consumers expect their ECP to recommend lenses that provide 100% of the oxygen that their eyes need: regardless of cost. Also, three-quarters of consumers would be likely to follow ECP advice regardless of cost. This is good to hear, as cost is often cited as a reason for not fitting either DDs or Si-Hi material.
Reasons for drop-out of lens wear are ‘well understood,’ confirmed Walsh. For established wearers, the main reasons for stopping are ‘dryness and discomfort,’ though patient satisfaction is also well correlated with handling and vision as well as comfort. Despite the importance of vision, there is still scope for improvement in the correction of cylinder. Improved acuity with toric correction of astigmatism is ‘clinically meaningful’ according to recent research, with 0.6 to 1.1 line acuity improvement typical after toric correction when compared to the spherical equivalent.
Also, there is no evidence of reduced comfort with toric lenses. Insight research again supports toric fitting, with 86% consumers agreeing that ‘they expect their ECP to make a recommendation for the soft contact lenses that provide the best possible vision correction for their eyes, regardless of cost.’ Assuming that comfort is the same, 57% of consumers would be willing to pay a premium for best clarity of vision.
Presbyopia
Presbyopia affects nearly two billion people worldwide, and has a major impact on their lifestyle and self-perception (figure 5). As Walsh outlined, presbyopia ‘makes patient’s lives more difficult, and they wish they could see more clearly like they used to.’ Many presbyopes report feelings of sadness, anger and fear, while a whopping 90% wish their vision had not changed. Importantly, 73% of presbyopes who were previously corrected with single vision soft lenses feel they are no longer able to enjoy the same lifestyle.
Figure 5: Lifestyle and visual demands remain after 50 years
Insight research has found that nearly three-quarters of multifocal CL wearers over 55 years ‘feel more attractive when wearing lenses.’ I think I do, but would be scared to say. Of more importance, certainly to my mind, around 80% of all contact lens wearers agree that ‘they see better in contact lenses than spectacles,’ including those wearing presbyopic contact lens corrections.
Riccardo Cano reminded delegates of the importance of maintain high motivation when fitting presbyopes. ‘Keep trial times down,’ he said, ‘as trials can be boring for both the patient and the ECP.’
Alexandra Skjöld advised: ‘Don’t talk about compromise but about adjustment. Also remember that even a small cyl correction helps and this is now possible with modern multifocal contact lens options.’
Two points that all panel members agreed with: always use the fitting guides and always avoid negative language.
One final thought about presbyopia was raised in a later session on the subject, this time chaired by the ubiquitous contact lens expert Dr Byki Huntjens of City University, London. Awareness of presbyopia among the general population remains low (figure 6), with 86% of 40 to 65-year-olds yet to require a refractive correction unaware of presbyopia and stating that they would want this explained to them during an eye examination. Nearly half of this group would also want to try multifocal contact lenses.
Figure 6: Public awareness of presbyopia and options for its correction remains surprisingly low
