Chris Bennett What does the UK contact lens landscape look like at the moment?
Giovanni Abruzzini Contact lens penetration in the UK remains flat at 14% (versus 23% in USA and 37% in Japan), based on internal research. The UK has about 4.1 million CL wearers, around 5.8 million are actively considering them and a massive 10.4 million have not actively rejected the idea of wearing contact lenses.
This means that the UK market is in a unique position to grow the number of contact lens wearers by reaching out to these considerers.
It’s important to make sure the patient is having a great experience with contact lenses, especially when it comes to vision and comfort. We know that about the same amount of people that start wearing contact lenses are also dropping out which explains why the category has been flat for quite some time.
CB Why is market penetration of CLs so much lower in the UK compared to other countries?
GA That comes down to a few reasons. In the UK, many eye care professionals (ECPs) don’t start fitting patients as young as in other markets. Based on an internal analysis we know that in the US for example, the average age of first fit is 17 whilst in the UK it’s 21, meaning UK practitioners do not always take the opportunity to talk to a younger demographic.
Furthermore, in the UK, patients are respectful of the ECP’s advice. They expect a recommendation from the ECP regarding CL wear suitability and guidance through the first stages of trialling contact lenses. If this conversation doesn’t happen the patient won’t know about contact lenses. In addition, the number of steps in a UK patient’s journey is sometimes higher and therefore less straightforward than in other countries.
Modernising this journey and moving towards a more digital and innovative process on all stages such as booking, following-up and post-trial period assistance will in the long-term help both the patient and the practice as the communication will not only improve in quality but be more efficient and natural.
CB Have wearers’ habits and attitudes changed over the years – what’s different?
GA They continue to rely heavily on their practitioner to initiate the discussion about possible vision correction options and assume that if the ECP does not raise it with them it’s because they are not suitable, especially multifocal contact lenses.
Patients are now more curious and interested in knowing more. They often want a full explanation of lens options available and want to get a detailed understanding of how their vision needs can be met.
At the end of the day they trust and want the ECP recommendation but they want to feel they have been involved with the decision.
CB How have practitioner habits and attitudes changed over the years?
GA With great new lenses reaching the market in recent years, the practitioner knows that innovation and technology in eye care is essential, but we know from research that ECPs now consider the patient benefit as important as the technology. It’s important for them that there’s a direct link between innovative technologies and patient benefits.
The UK has a relatively low take-up of contact lenses but a big potential market
We’ve also seen, however, that they tend to fit patients that bring up CLs in the conversation, assuming those will have higher motivation and success. Less confident patients might not initiate such a conversation with their ECP.
CB What is the big opportunity in the CL market?
GA Even though eight out of 10 of 40-plus years-olds in the UK need vision correction and CL innovation in this area has increased in recent years, just 3% of the existing contact lens wearer population claim to wear multifocal contact lenses.
This represents a massive opportunity for the market to address the significant contact lens drop-out in this age group. When we know that there are 1.1 million presbyopes considering trying contact lenses we should be acknowledging that and offering these patients the opportunity to trial multifocal contact lenses.
CB How are presbyopes’ needs currently met and what options do patients currently have?
GA We know that presbyopes can consistently feel frustrated by not being able to do normal daily tasks as well as they could before and many remain unaware of the options they have available. At the moment, patients can either choose from a combination of spectacles, contact lenses, or refractive surgery.
The patient is very reliant on the eye care professional initiating discussion about possible contact lens use and the ECP could be more proactive
These alternatives should be openly discussed with the patient and made to fit with the patient’s lifestyle and ocular health needs. Research shows that when choosing between spectacles or CLs, the majority of patients do prefer a combination of both varifocal spectacles and multifocal contact lenses.
CB Are ECPs proactive in talking about presbyopia or do they wait for patients to bring it up?
GA Currently a common situation is that the ECP will be prompted by symptoms or findings during an eye test, like the need for an addition or eye fatigue. Only at that time will they talk about the condition and the patients’ options for vision correction, which contributes to the low level of information and awareness currently among patients. If we can educate patients earlier about how their eyes will change as they age, then they will be more prepared when the time comes.
CB What could practices be doing differently?
GA ECPs could be more proactive when talking about presbyopia and when approaching their patients over 40. We know that patients want the information and want to know what to expect. They also want to hear it from the most reliable source – their ECP. The practices that are proactive about it are reaching out to a bigger number of considerers and being mindful of their patients’ needs.
This should come hand in hand with the focus on the overall eye health of these patients. For patients over 40, it’s known that not only are their vision correction needs more likely to change, but the risk of developing dry eye increases with advancing age, which represents again an opportunity for the practice and the ECP.
CB Is emerging presbyopia one of the reasons for patients to drop out of CLs? If so, why do you think that’s happening?
GA One in four of all contact lens wearer drop-outs is due to presbyopia. However, there is no doubt that presbyopes are interested in contact lenses. According to a poll in Review of Cornea and Contact Lenses (2010), eight in 10 lens wearers over the age of 50 said that they were interested in bifocal or multifocal contact lenses. Most patients who wear contact lenses are highly motivated to stay in them.
The main two reasons why a presbyope would drop out of wearing CLs are vision and comfort. Fortunately, with new technology, we are now able to better meet the presbyope’s visual and comfort needs. It’s also important for the practices to be mindful of how the process unfolds for the contact lens patient.
There are many critical points along the journey of trialling contact lenses (before, during and after fit). If the patient feels supported during the journey, they’re more likely to feel increasingly comfortable with this vision correction option and it’s more likely they will continue to wear them.
CB Do they know contact lenses for presbyopia exist?
GA Not only do most patients not know what presbyopia means, most of them also don’t know multifocal contact lenses are an option and associate their symptoms with old age and reading glasses. There’s a definite need to raise awareness on both the condition and on their vision correction options.
CB Do ECPs recommend and fit them?
GA Many ECPs recommend multifocal contact lenses but it’s still not widespread or routinely introduced to patients. One way the ECP could do that is to always assess the patient’s lifestyle and discover more about them, whilst uncovering their day to day vision needs. By doing that, the conversation about multifocal contact lenses will happen naturally and it might help the patient ask questions they wouldn’t proactively ask.
CB What is the scale of the opportunity in the presbyopia market for practices?
GA For practitioners, there is a broad opportunity in the multifocal contact lens market. The category is not limited to contact lens wearing myopes and hyperopes who have become presbyopic, but also all of the emmetropes and latent hyperopes who first experience the need for vision correction around the age 40.
CB Why should ECPs talk to patients early in the journey?
GA There’s a general feeling among presbyopes that failing vision means old age and most of these individuals don’t feel ready for it. They are usually active, at the peak of their careers, with a young family and social life and they want to stay that way for as long as possible.
You might have seen our recent successful consumer campaign where we bring to life the everyday struggles of living with presbyopia, including difficulty reading a food menu in dim light, reading texts on your mobile or applying make-up. This creates more awareness around presbyopia.
This is based on the consumer insight that the most common reactions are denial and frustration. They don’t know what it is and don’t think there’s a solution for them. It’s highly emotional.
The task of informing them and preparing them for what will inevitably come is a challenging one, but a necessary one. It could potentially eliminate the feelings of frustration and would prevent them from resorting to coping mechanisms whilst their eye sight continuous to decline.
CB What product does Johnson & Johnson Vision Care have and how does it meet those needs while creating business opportunities for practices?
GA 1-Day Acuvue Moist brand Multifocal contact lenses are J&J’s latest multifocal innovation. The development of the unique pupil optimised for multifocal vision technology used in these lenses addresses the natural variation in pupil size due to both age and refractive error, by optimising the optical design across all three additional powers (Adds).
It was clear when developing the lens that pupil size changes not just with age, but with refractive error too. Whereas the former is commonly addressed by creating a different design for each of the available Adds, multifocal contact lenses failed to account for the fact that myopes have larger pupils than hyperopes. Using the same design across the prescription range could inevitably lead to visual compromise.
The great news is that despite the technical advances in the lens design the fitting of the lens is very simple, there are only three steps to the fitting process and it can be done in five minutes.
CB How can ECPs attitudes and behaviours be changed?
GA The ultimate goal for the ECP is to provide the best possible management for their patient. Part of that is choosing the best vision correction tool they have at their disposable, and most importantly provide them with all options, so that they are catering to their patients’ lifestyle needs.
Johnson & Johnson Vision is here to support the ECPs and to help raise awareness with consumers to help improve the discussion about presbyopia.