In 1976, Scott Brown was born. It was the same year his father Jack founded contact lens supplier Scotlens. In a picture, taken a few years later, of Jack digging the foundations of the building, which the company still operates out of today, Scott and his brother are playing in the background.
Scotlens and Jack’s pursuit of creating quality contact lenses has intrinsically been part of Scott’s life. It would become his own too; the boy in the picture grew up to become an optometrist and take ownership of the company.
‘If you told me I would follow in my dad’s footsteps as both an optometrist and a lens designer, I wouldn’t have believed you,’ Scott tells Optician.
‘Contact lenses in 1976 were in their infancy. They were expensive at about a hundred pounds for a gas permeable lens. People regarded them as a lifestyle commodity and they were highly valued,’ he says.
Disappointed with the quality of contact lens materials, Jack and his business partner Murray McGrath decided to have a go at making contact lenses themselves. The pair would conceive ideas and create sets of contact lenses in Jack’s garage after being in practice all day.
‘It grew from there and he ended up with four guys making lenses,’ Scott explains. ‘The patients that are most keen for contact lenses are often the hardest to fit. Back then, he could spend half a day trying to make a toric lens for an astigmatic patient. He used to crimp them. You would cut a sphere, squash it in between jaws, remeasure, recut it and let it spring back. Hopefully, it would spring back the right amount. About six times out of 10, it did and the other four times, you had to start the whole process again.’
Jack Brown digging the foundations
Experimenting with materials
Scott says it was a time of unregulated innovation for his father and the contact lens industry. An example of this was the use of polymethyl methacrylate (PMMA). The material was used in the windscreens of spitfires so that when they shattered, fragments would not cause sight loss when they get in the pilot’s eyes.
PMMA was classed as safe to use for contact lenses on this basis and Jack started to explore orthokeratology. ‘The principal was very crude because the lathes couldn’t do very much. You basically just fitted a flat lens. There was no topography. It was just suck it and see,’ Scott says.
Jack eventually found success and Scotlens became the first company in Europe to get a CE mark for a gas permeable lens.
In 2003, Scott joined Scotlens with a fresh perspective. He says he was unburdened by the history of how the industry had changed and a dwindling market for gas permeable lenses.
It was thought that gas permeable contact lens patients had simple prescriptions who could move to night lenses and that would be the future of the company to survive. Scott says this view of the future came from a sceptical perspective of running a business.
‘I came at it as an optometrist and thought, “This is such a fantastic product that I want to offer my patients.” Optometrists improve people’s quality of life by giving them glasses or day lenses. But when you fit night lenses, you realise that you totally change the life of the patients in a different way to other correction methods,’ he says.
Scotlens started to offer Nocturnal to other optical practices and 2023 marked the 20th anniversary of the lens.
Since Scott’s involvement in the company, there have been two areas of growth; scleral lenses for keratoconus and irregular corneas, and Nocturnal night lenses. He says Nocturnal had more of an impact on his practice from a practitioner’s perspective than it ever has for the business.
‘The growth was steady, but the graph was not steep enough. I could never understand why more optometrists didn’t want to offer this product. It would be like saying to a patient who is presbyopic, “I can give you two pairs of glasses or I can give you bifocals.” As an optometrist, I know varifocals are the ones that patients get the best enjoyment out of. It makes the biggest difference to their lives. We are talking to optometrists and saying, “Patients love Nocturnal. It totally changes things”.’
The rate of growth, although slow, has been good for business. He notes the market for irregular corneas is limited to the patients that have irregular eyes, whereas the market for night lenses is increasing.
Bespoke design
Nocturnal’s design is custom-made for each patient based on the three-dimensional map from the topography that optometrists send to Scotlens.
‘We are tailoring every lens to the microns of the accuracy of the topographer to give the patients corrected vision. The early systems were fitting set-based. You took your care readings, you picked a lens, you put it on the eye. You had to look at it, then refine the results and get the patient over the finish line.
‘With Nocturnal, we had the topography, the lens design and the patient. We reviewed our design in 2008 after it had been out for five years and looked at the best performing patients. Who were the patients we’d nailed it with? We re-engineered how the lenses were made to get the lens design. It has been relatively unchanged from then until now.
‘It’s harder and more laborious to make the lenses this way because you haven’t got set sizes but it means I’m confident every patient is not just going to get over the finish line. They’re starting from the best possible point,’ he said.
Clinically, Scott is convinced night lenses are the best performing and the number one choice for getting patients into myopia control in terms of efficacy.
‘It’s the easiest modality. People think it must be difficult to test the kid’s eyes but they’re easy because they’re honest. You say to them, “You can have specs” and they think, “Hmm, there’s a kid in my class that wears specs and I don’t really fancy that.” Some of them think, “My best mate wears glasses and actually that would be cool”, but most of them don’t naturally play towards glasses.’
He says day lenses have the same hassles as night lenses but application, removal and adapting to wearing them is easier with night lenses. Children recognise that they do not have to worry about vision correction while at school if they pick night lenses, which Scott says motivates them and improves compliance.
Correcting complications
Scott has also started to use the term ‘night lenses’ instead of orthokeratology or ortho-k. ‘I realised using the term night lenses with my patients didn’t take away anything from the process, but it made the communication better and that made my job easier, clinically. Patients’ understanding improved. Now, I’m of the opinion that we must drop orthokeratology as a term,’ he said.
Scotlens has experienced record breaking growth in new fits of night lenses month-on-month, from existing and new accounts.
‘The practices that are saying “night lenses” are consistently doing more in new fits than everyone else. We’ve helped practices communicate this complicated sounding correction and it’s benefiting them. We are also seeing growth from the practitioners that are fairly long established. A lot of the best practices are the practices that are new to night lenses. Their staff are all trained and they talk about it as night lenses.’
Going forward, Scotlens has gone from being a fairly stable business to a growing business, which Scott says has come with new, but good challenges.
‘The goals for us as a business are not about the manufacture and the selling of our lenses because we could not keep up with demand. We could not manufacture enough lenses for the 98%. We are working with other manufacturers to try and get them to recognise night lenses as a term so the public become more aware of it.
‘Our goal by the end of 2024 is to have the nightlenses.com website being successful because that means the public is becoming aware of it. It’s about educating the public about this visual correction option that is available for them,’ Scott concludes.