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This was the 10th Pioneers Conference put together by Nigel Burnett Hodd and his co-host this year was Professor James Wolffsohn who delivered the evening Pioneers Lecture. The programme featured all-British presenters and a panel discussion on contact lens inventions of the past.
The interface between research, practice and manufacturing is one that Britain, and the BCLA, manages particularly well, so it was fitting that the theme for this year’s anniversary event was ‘The best of British’.
Predicting success
Professor Wolffsohn (Aston University) argued that practitioners need to learn about and reflect on the latest science to predict patient success with contact lenses. This would allow more targeted advice, and appropriate lenses and treatments to be prescribed.
Among the research reviewed was a study of soft lens fitting correlates that showed substituting similarly fitting lenses did not provide comparable clinical performance. ‘Lens substitution, from the studies we’ve done, is not acceptable. Lenses don’t perform like for like even if they have similar parameters. It’s much more about the individual person, an individual lens and an individual tear film.’
His predictions were that wettability of the optical surface was the main factor affecting contact lens dropout. Soft contact lens fit was reliant on peripheral topography, and RGP fit on lid position and tear meniscus height as well as topography. Contact lens induced dry eye was likely in the presence of LIPCOF, poor non-invasive tear break-up time and poor Ocular Surface Disorder Index score.
Compliance was poor in young males with a propensity for risk-taking. Infiltrative events in silicone hydrogel lens wear were linked to bacteria on lenses, smoking and limbal redness, and microbial keratitis, among other factors, to poor compliance.
Predicting success in presbyopic correction remained problematical; there was no good information on which lens was going to work.
Independents and multiples
Two speakers presented new data on UK contact lens sales through independent and multiple practices. Dr Trusit Dave (Optimed) had some stunning statistics on new fits: on average, independents were fitting just 13 new patients per year per practice compared to an average of 84 new fits in the multiple sector.
Multiples now accounted for 80 per cent of all contact lens sales, a swing of 6 per cent over the past five years. For Dr Dave, this represented a ‘huge opportunity’ for independents to reverse the trend.
Competition came not only from other practices and the internet but from recent advances in refractive and cataract surgery, such as corneal inlays for presbyopia, more accurate surface-based treatments and piggy-back intraocular lenses.
Recognition that practitioner recommendation was the primary driver of patients’ purchasing decisions was key. Content-driven promotion through practice websites, email blasts and social media allowed practices to work harder on their existing databases.
Since research had shown that patients were most likely to purchase additional spectacles just three months after their eye examination, why not market to your patients three times a year rather than waiting one or two years to call them in?
Professor Philip Morgan (University of Manchester) reported that contact lens patients in independent practices were, on average, older and more likely to be female than nationally. Independents fitted more rigid lenses, fewer daily disposables and more extended wear than the sector as a whole.
Soft torics and presbyopic fits were finding greater acceptance, RGPs were stable at about 10 per cent of all fits but growth in daily disposable and silicone hydrogel lenses was levelling off.
Lenses for new applications such as myopia control and health monitoring still had to be fitted and remained within the contact lens practitioner’s domain. Things happened very quickly in the contact lens market, he observed.
Making a difference
Change was also rapid in the manufacturing industry which had moved from handmade lenses to full automation and from small private labs to global soft lens makers, said William Thomas. Among the developments were improved edge designs, greater reproducibility, aberration-controlled and asymmetric designs.
He predicted the industry would see further consolidation, with just one or two specialist companies and two or three soft lens manufacturers dominating the market.
British ingenuity in instrument design was demonstrated by Douglas Anderson (Optos), who developed the Optomap Retinal Exam system after his son suffered a retinal detachment that was undetected until it was too late to treat.
Leading authority on contact lens materials Professor Bran Tighe (Aston University) looked at the effects of contact lenses on the tear film composition, particularly the lipids, proteins and electrolytes.
Patients often had a strong preference for one lens material over another and material might well make a much greater difference to an individual patient’s successful wear than was previously thought. ?