The state of the CL industry

The past couple of years heralded the fifth revolution in the 120-year history of the contact lens. The first was the introduction of the corneal PMMA lens. The next came with the introduction of hydrogel lenses in the 1960s and 70s, improving the comfort and further widening the number of people able to wear lenses.
The introduction of the disposable lens in the 1980s marked the third revolution, changing for ever the way contact lenses were manufactured and fitted, and reducing the problem of long-term deposit build-up for the patient. A mere 10 years later the fourth revolution was the development of the daily disposable lens. Daily disposables eliminated the need for solutions and simplified the wearing regime of patients. More recently, the fifth revolution was the introduction of silicone hydrogels. As a family of materials they have eliminated the problems of hypoxia.
Yet, despite the significant benefits to the patient of daily disposable and frequent replacement lenses the number of lens wearers in the UK remains stubbornly flat with just 2.5 million out of the 17.2 million 16-64 year-olds requiring vision correction wearing contact lenses. Now as we stand on the verge of the sixth revolution our question should be: how can we use the new material benefits of silicone hydrogel lenses to bring safe and totally comfortable contact lens wear to a new generation? Our profession and the contact lens industry have both great opportunities but also some significant challenges. In this article I will provide a personal perspective on many of these changes in the context of the UK contact lens market in 2005.

The Comfort Challenge
Delivering comfortable contact lens wear has been a goal of the contact lens practitioner since the days of the scleral lens.
Millions of pounds of research money has gone into improving designs, reducing thickness, increasing oxygen permeability, increasing water content, decreasing lens life and a myriad of other changes all with the objective of improving the comfort of the contact lens wearer. Yet despite this, discomfort has remained the single biggest cause of contact lens discontinuation. There are those patients who can successfully wear pretty well any lens, but many more report increased discomfort towards the end of the day, discomfort in challenging environments and a gradual deterioration in comfort towards the end of the lens replacement cycle. These people, the 'successful wearers' all say the same thing, 'I don't complain because I assume that this is what contact lenses do'. Patient folklore is of contact lenses hurting and these patients just assume that discomfort is normally something to be put up with - namely, it's the price to pay for wearing contact lenses.
But these people represent the tip of an iceberg that I believe is the single biggest issue we face in the industry today. These are the people who persevere; the travesty of the contact lens industry today lies beneath the surface - the silent drop-outs.
Today there are 1.3 million people in the UK who previously wore contact lenses but have now dropped out. Perhaps the most compelling statistic is the high number of dropouts who stop wearing contact lenses in the first three months of wear. This runs at approximately one in five. In many cases they never even return to the prescribing practitioner who often mistakenly believes that, when they fail to return for further supplies, they have bought their lenses elsewhere.

New regulations
The new changes to the Opticians Act will bring benefits for the profession in terms of the increased potential to expand scope of practice and the introduction of compulsory continuing education and training.
Receiving less publicity, but equally significant, are the rules on changes to the supply of contact lenses. Following consultation, common sense prevailed and plano cosmetic lenses are to be classified in the same way as any other contact lens. Of perhaps greater significance is an opening of supply channels for contact lens replacements such that the patient can obtain lenses from non-optical suppliers with an up-to-date prescription. The legislation makes clear the need for the supplier to ensure that provision is made for aftercare and that a registered eye care professional is responsible for the sales of the lens. The explicit wording around the provision of aftercare is good news, particularly when the influence of the practitioner is so critical in ensuring safe and comfortable wear.

The Crystal Ball
So what of the next 120 years for contact lenses in the UK? At the heart of the future is the practitioner. The role of the practitioner is probably more important today than at any stage in the past.
As contact lens materials become more sophisticated, the interactions between the lens, the care system and the eye make the importance of initial evaluation and aftercare so much more important. I believe that the time is ripe to look again at the fee structure for contact lenses; to start to progress to an economically viable fee for fitting and aftercare, rather than relying on the mark-up on product sales.
The London Business School model developed by the Association of Contact Lens Manufacturers showed how profitable contact lenses can be to a practice. So perhaps now is a good time to revisit the model in the light of the changes.
The supply of contact lenses will change over the next five years as they become more accessible to the general public. I believe, however, that the biggest threat to the growth of the market is less from the 15 per cent of patients who want to buy their lenses from mail order and more from the fifth of all contact lens wearers who drop out each year. Dealing with the factors that are associated with this should be a major priority for practitioners and the industry alike. As we anticipate the sixth revolution in contact lens technology, ultra comfortable lenses will become a reality. Existing direct debit and lens by post schemes provide the patient with the convenience of supply that they are looking for.
In its 2004 report, Mintel estimates that the contact lens industry in the UK will grow by 38 per cent in value over the next five years. This is a very conservative view. Improvements in materials, in training (with compulsory CET) and solutions should all reduce the drop-out rate of contact lens wearers. There is no reason why CL penetration should stay at 8 per cent when it sits at 25 per cent in the US and Japan.
By working together, the industry and profession can proceed with great confidence about our ability to provide our patients with contact lenses that really can make a transformational change to their vision and to their life.