Contact Lens Business
Staying the Course
Despite downward trends in many areas, contact lenses stood their ground in 2002.
By Christopher Kent, Senior Associate Editor

Tough times (economically speaking) are a mixed blessing: On the one hand, staying in business becomes a much greater challenge. On the other hand, these times force us to eliminate waste and get down to the heart of the matter.

In 2002, several contact lens trends that began with the recession in 2001 continued, with political and technological shifts also having an impact. Here, I'd like to review some of the statistical data relating to contact lens sales and use during 2002, to help paint a clearer picture of how contact lenses and dispensing M.D.s have been doing in the midst of all of this change.

The numbers discussed in this article are based on Vision Information Services: The Contact Lens Report and The Annual Consumer Eyewear Study.

The Contact Lens Report data are collected every quarter by Health Products Research, Inc. (HPR), a division of Ventiv Health, Inc. HPR tallies detailed responses regarding more than 18,000 patient visits from more than 500 contact lens dispensing locations, including private ophthalmology and optometry practices, independent retail outlets and national chains. The figures given here are projections based on that collected data, weighted to compensate for factors such as region, and practice size and type.

The Annual Consumer Eyewear study is issued to 2,200 households screened for eyewear use from a base of 60,000 households nationwide; the data include responses from more than 2,900 individual eyewear users.

In 2002, a slow, general decline in contact lens wear that was evident in 2001 continued -- with a few notable exceptions in specific categories. The overall number of contact lens wearers grew 3% to 4% a year during 1999 and 2000, but declined by 1.4% during the recession of 2001. During 2002 the total number of contact lens wearers continued to shrink, dropping another 1.5%.

However, not every type of contact lens wear declined. The number of soft contact lens wearers in 2002 stayed about the same as in 2001 (about 31 million wearers). Just as in 2001, the overall drop in wearers was largely the result of the ongoing decline in RGP wearers, which has been evident for several years. In 2002 the number of RGP wearers shrank nearly 14% -- the biggest drop yet.

At the same time, the number of people wearing only spectacles (no contact lenses) for vision correction increased by 2% during 2002, suggesting that some patients have decided to forego contacts (especially RGPs) in favor of the more traditional alternative, at least temporarily.

Bruce Koffler, M.D., past president of the Contact Lens Association of Ophthalmologists, says he sees a number of reasons for the drop in RGP popularity. "First of all, RGPs have been used for astigmatism and presbyopia; now soft lenses are competing with them. Second, soft lens companies send reps to promote their lenses and train staff; we hardly ever see reps from RGP companies. Third," he says, "the RGP industry hasn't had a major breakthrough to provide the 'wow factor.'" (Dr. Koffler points out that the Menicon Z lens might qualify, but it's not well promoted in the United States.) "Fourth, everyone is moving toward disposable lenses, and this option hasn't been offered with RGPs, so far.

"The one bright spot for RGPs," he adds, "is the Corneal Refractive Therapy lens, which has great potential. This is the kind of creativity this part of the industry really needs."

M.D. Dispensing

Unfortunately, the number of M.D. practices dispensing contact lenses continued to decline in 2002. After a dramatic increase in the number of dispensing practices during '99 and 2000 (a 44% total increase), the number dropped by 11.6% in 2001 and another 21% during 2002. At the same time, private practice O.D.s had a slight increase in soft lens-related visits (less than 1%), but the top 100 independent chains showed an increase of 5%.

Dr. Koffler points out that the large increase in M.D. dispensing in 1999 and 2002 could have been a "bump" whose downside is disguising an overall upward trend. "I know it's an optimistic way to view the situation," he says, "but even after the recent drop, the number of M.D.s dispensing is still greater than at the beginning of 1999."

Soft Spherical, Toric & Multifocal

Perhaps the brightest spot in 2002 was a dramatic increase in multifocal soft lens wearers -- an increase of 47% over 2001. (Note: This includes patients wearing monovision.) This increase in multifocal wearers was the primary reason the overall number of soft lens wearers stayed constant from 2001 to 2002; although multifocal wearers are still a smaller segment than toric or spherical wearers, their increasing numbers offset a 6% decline in wearers of spherical soft lenses, and a 2.6% decline in soft toric lens wearers.

Frequency of Replacement

In 2002, replacement modalities were prescribed as follows (based on the number of office visits that resulted in dispensing of each type of lens, not the number of lenses dispensed):

• traditional/reusable contact lenses: 17% of office visits
• 1-Day disposables: 3%
• 2-Week disposables: 60%
• Planned Replacement Monthly: 16%
• Planned Replacement Quarterly: 4%.

These numbers were very similar in 2001; the only notable changes were:

• a drop in visits for traditional lenses (from 21% down to 17%)
• an increase in the percentage of visits resulting in monthly planned replacement lenses (from 13% to 16%).

These changes were reflected in the number of soft lenses actually dispensed (not counting telephone or Internet sales) in 2002:

• Traditional/reusable contact lenses dropped from
  7.2 million to 5.4 million.
• 44 million monthly planned replacement lenses were sold, up from 34 million the year before.

It's also worth noting that 141 million 1-day lenses were sold, a 19% increase over the 118 million sold the year before. Nevertheless, Dr. Koffler believes 1-day lenses are still being held back by the perception that they're expensive. "Once the industry gets the cost down under a dollar a day, this modality will surge in popularity," he says.

Overnight Wear

In 2002 only 9.1% (one out of 11) office visits resulted in dispensing lenses intended for overnight wear (down slightly from the year before). Of these:

• Lenses for up to a week of overnight wear were prescribed about half of the time. (Dr. Koffler notes that the preference for weekly replacement is probably a holdover from what practitioners were taught about extended wear in the 1980s.)
• Lenses were prescribed for 2-week continuous wear about 11% of the time.
• Lenses were prescribed for 30-night wear about 19% of the time.

Overall, despite the increasing popularity of 30-day extended wear lenses, the number of visits to any eye doctor that resulted in dispensing extended wear lenses dropped 9% from the year before. This may seem strange, but it undoubtedly had a lot to do with the injunction against Bausch & Lomb's PureVision lenses as a result of CIBA Vision's patent infringement lawsuit in the United States. This eliminated access to what had been the previous standard in this category, and reduced the category's overall success in 2002.

The Best is Yet to Come?

It's clear that it will take more than an economic downturn to undermine the popularity of contact lenses. How big a part of this ongoing drama M.D.s will play in the future remains to be seen, but it's important to note that the decline in the number of dispensing M.D.s doesn't reflect how well dispensing M.D.s are doing. "2001 and 2002 were very good contact lens years for us in every respect -- sales, returning patients and new patients," says Dr. Koffler.

Maybe optimism should be the word of the day.