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The Rise… and Rise of the Contact Lens: More than a century after its invention, this modern marvel of eye care continues to thrive

The contact lens business is booming, and in the process smashing pundit predictions to pieces. Massive growth is forecasted ahead, and the phenomena fueling it are multifaceted. From the contact lens’ uncanny ability to adapt to the seemingly infinite possibilities in optical designs afforded by modern manufacturing, these little wonders aren’t going anywhere any time soon. We sat down with Dr. Nadia Afkhami of Vision Care Partners to take a look at the staying—and growing—power of the humble contact lens.

Technology is, by nature, ephemeral. The feverish pace of human innovation makes sure of that. Grandparents tell their progeny in shaky voices and hushed tones of the marvels of ages past. The graveyard of obsolescence grows by the day. So when an invention sticks around for a while, something special must be afoot.

The contact lens has been around for a while. We’ve charted the history of the contact lens elsewhere in this issue (insert page number later), but just for fun: The first mass-market disposable dailies were introduced in the mid-nineties. Since then the cassette, the CD and the standalone MP3 player have all been (mostly) consigned to the catacombs of music history.

At the turn of the millennium, most Americans were reading about the adoption of silicone hydrogel—the material used in the vast majority of modern contacts today—using dialup internet. They would have then scheduled their fitting appointment using a hardwired home phone— unless someone was using the internet, of course. Or, if they were among the lucky ones, a fancy flip cell phone could have gotten the job done. So long has it been since the modern form of the contact lens emerged. And odds are, even more seemingly bulletproof technologies will be discarded into the garbage heap of history before the contact lens.

A deepening patient pool

The point is that contacts, in their current and most popular form, have weathered the sands of time well. More than well, actually. The contact lens market is thriving. A recent report from Fortune Business Insights1 has forecasted growth from an estimated USD 10.35 billion in 2023 to an eye-watering 15.4 billion by 2030, an astounding compound annual growth rate (CAGR) of 5.8%. For reference, the human population is expected to grow from 7.89 billion today to 8.5 billion2 by 2030—a comparatively paltry annual growth rate of 1.07%.

All despite the fact that the doom of the contact lens has been foretold by pundits and laymen since its invention. Contacts have been offhandedly dismissed throughout the years as too hard to put in, too annoying to care for, too uncomfortable, unsanitary, and too expensive.

The list of would-be contact conquistadors is long, too: Laser vision correction (LVC), implantables like implantable collamer lenses (ICLs) and other phakic IOLs, as well as low-cost spectacles. All have been touted as the downfall of the contact lens, and yet—here we are.

So, what gives? Well, for starters, the ongoing myopia epidemic means that the total pool of patients needing refractive correction is increasing. When 50% of the world is projected to be myopic by 2050,3 many of them will opt for contacts.

Dr. Nadia Afkhami, an optometrist at Vision Source Oviedo, has seen this firsthand in her busy clinical practice. “We’re doing so much near work lately as a society. People are a lot more nearsighted now, and myopia is growing,” she observed, echoing the consensus on the post-pandemic world.

But the raw increase in numbers cannot explain everything. In this ever-deepening pool, many people will opt for contact lens competitors like ICLs, glasses and laser. Innovation in the device itself has a role to play in driving the industry’s growth. And with myopia, it’s all about the (sort of) new kid on the block: Myopia control contact lenses.

Myopia control: Cleared for takeoff

As it stands right now, the road to taming the axial elongation that causes myopia runs through contacts. Soft dailies that slow or halt the disease have arrived relatively recently. But they are poised for big things. CooperVision’s MiSight® 1 day (California, USA) and Johnson & Johnson’s ACUVUE® Abiliti™ 1-Day (Florida, USA) lenses carry all of the pluses of contact lenses, with the added benefit of stopping axial length elongation in its tracks.

Orthokeratology is also fully onboard this myopia-fueled rocket to the moon. Though ortho-k has been around for a while, it is experiencing a raucous renaissance as of late. Another report by Fortune Business Insights4 has the ortho-k market growing from $763.9 million in 2022 to $2,043.6 million by 2029—a blazing fast CAGR of 15.1%.

Dr. Afkhami sees the simplicity of ortho-k as being one factor behind this astronomical projected growth. “It’s easier, I think, to push [corneal refractive therapy] or ortho-k, because you put them on, you wake up in the morning, and you have perfect vision for the day,” she related.

Of course, it also pays to be the only act in town. Contact lenses are currently the only FDA-approved treatment modality for myopia control. Atropine must still be used off-label, and the drug’s push to join the club has been hamstrung by poor performance in a recent study.5

Myopia control spectacle lenses have similarly stumbled out of the starting gate. Despite Essilor’s Stellest™ lenses (Charenton-le-Pont, France) receiving a “Breakthrough Device” designation by the FDA in mid-2021, full approval has proven to be elusive. The same goes for Hoya’s MiYOSMART (Tokyo, Japan) offering and the countless others waiting in the wings.

“It’s all about patient preference, and everyone’s a little bit different,” Dr. Afkhami commented on the myopia control landscape.“I think that it’s nice that we have some treatment options available for myopia,” she concluded. And the fact that the FDA-approved options are all contact lenses just means adding more fuel to the on-fire contact lens market.

Contact cornucopia

Myopia control options are just the tip of the iceberg in terms of what the modern contact lens can do. Though the basic form and materials used to manufacture contact lenses haven’t changed since the days of Napster and AOL Instant Messenger, advances in manufacturing processes and clever optical designs have yielded other wonders.

One of these is disposable multifocal contact lenses. The world’s population is getting older, 6 and with age comes the inevitability of presbyopia. Enter multifocals, whose share of the contact lens market is projected to grow1 as the world collectively succumbs to Father Time at higher rates.

“It’s kind of hard to wear contacts and then have to throw on the readers, right? The point of contact lenses is not having to wear glasses in the first place,” Dr. Afkhami commented on the rise of multifocal contact lenses. “Now with current technology, I think with everyone coming to that age, we try to give them a shot with multifocals,” she continued.

“We may have to tweak it a few times, but in the long run I think they’re willing to compromise a little bit so that they don’t have to carry around reading glasses,” she concluded. And, of course, a little bit of old-fashioned denial goes a long way. “Maybe they also don’t want to feel old by needing the little extra help from reading glasses,” she added.

Astigmatism is another area where the modern contact lens has entered fertile ground. Traditionally the preserve of glasses, patients with cylinder now have spectacle-free options—thanks to the ingenuity of modern optical design. Extendedwear soft torics are another massive driver of contact lens growth,1 and as flaws like rotational instability are overcome, toric versions of the market’s most popular lenses are finding their way more and more into mass use.

Myopia, presbyopia and astigmatism aren’t the only diseases that contacts can help overcome, either. Scleral contact lenses (though purists might argue they are not true ‘contact’ lenses because they don’t touch the cornea) are also a force to be reckoned with in the staying power of the modern contact lens.

The use cases for scleral lenses are expansive and growing more numerous by the day. Patients with nearly any corneal disease, dystrophy, defect or irregularity can be corrected with scleral lenses nowadays. And if, heaven forbid, a patient’s laser vision correction needs a tuneup, scleral lenses have their back.

Dr. Afkhami especially likes sclerals for patients at the more extreme end of the astigmatism spectrum, further cementing their role in the contact lens pantheon.

“I try to put higher cylinder patients into a scleral lens because sometimes the comfort’s not there with a soft contact lens,” she said. And when patients with both high and low astigmatism are added to the wide range of patients who can be fitted comfortably with contacts, the mystery behind the projected growth of the contact lens market lessens even more.

Spectacular sans spectacles

Speaking of comfort, one large stone in the contact lens growth landscape remains unturned. Yes, contact lenses have expanded their use cases to include the vast majority of the planet’s eyes. But the original appeal of contacts, and arguably the reason for which they were invented, is perhaps the greatest contributor to the device’s longevity: Lifestyle and aesthetics.

The need for spectacle independence has and will always be a driving force in eye care. From IOLs to LVC to, yes, contact lenses, freedom from glasses will always be big business. There are many professions that require or advantage glasses-free employees, but the kind of growth forecasted must ultimately find its sources in new users.

Dr. Afkhami sees a lot of growth coming from the self-confidence market, especially among younger demographics. “I think teenagers are more prone to ask about contacts because this is a time for confidence and this is a time for growing into yourself. And sometimes they think that glasses can hold them back,” she said.

This attachment to contact lenses and wanting to be spectacle-free are not new. “We had those old Acuvue commercials where the twins would wear them—one had glasses, one was in contacts, and the point was that the one in contacts looked so much better. These kinds of marketing techniques have always been passed down, and especially over the last couple of years with social media,” she noted.

Lonely at the top?

Contact lenses are obviously not the only way to correct vision without glasses. But competitors in the spectacle-free realm have their own issues, ensuring there will always be a space for contacts.

Deserved or not, laser vision correction has always had a stigma of danger attached to it. This has only worsened as of late with the FDA’s controversial draft guidance for LVC. The Jonas Brothers’ recent plug of ICLs aside, the fear of going under the knife and life-altering complications will always limit the appeal of surgical alternatives for those looking to correct refractive error. On top of this, both procedures are considered to be cosmetic in the United States and elsewhere, placing them firmly outside the realm of insurance coverage and, thus, affordability for many.

Dr. Afkhami sees the eye’s natural changes as it ages as another factor constraining the mass adoption of surgically-based refractive correction as well.

“If someone is in their 30s and they’re asking me about LASIK, I say ‘Hey, listen—realistically, in 10 years you’re going to need reading glasses. Is this worth the time and money when you’re just gonna throw glasses on again?’” she related. “The answer is usually no.”

Speaking of spectacles, logic would dictate that their rising popularity would be a prime candidate for pulling the air out of the contact lens party. Dr. Afkhami believes that glasses are timeless and aren’t going anywhere.

“I do think that the numbers with glasses have gone up in the last few years—they’re trendier, they’re more stylish,” she admitted. “In the eye care industry, we’ve been pushing [glasses]. It’s part of your style—it’s an accessory now,” she concluded.

The important thing to notice here, however, is that the contacts vs. glasses battle is not a zero-sum game. “Most contact wearers I see, they wear both,” she said. “Like a lot of my patients, I just supplement one with the other.”

Glasses these days are also significantly faster, cheaper and easier to obtain than ever before, but this could actually be a hidden boon to contacts in some markets. As Dr. Afkhami explained, insurance in the United States only covers one form of vision correction. Because contacts are significantly more expensive, patients are inclined to charge this more expensive option to their insurance when a cheap and effective pair of glasses can be had for a few bucks in a matter of days.

Here for the long haul

Ultimately, there are many reasons why contact lenses are taking on a more significant role in refractive error correction. Their detractors, however, are not wholly wrong about the issues with contact lenses. Dry eye rates are rising. Contact wearers are more prone to infection. Compliance is low. And specialty contacts like those for myopia control can only be used by a restricted group of patients who need them.

But in the end, the contact lens will never go out of style for one reason: Ultimate flexibility. As reports from experts like Dr. Afkhami and industry insiders have noted, this wonder device’s ability to adapt to society’s changing needs is its ultimate insurance against what the future will bring.

References

  1. Contact Lenses Market Size, Share & COVID-19 Impact Analysis, By Modality (Reusable and Disposable), By Design (Toric, Multifocal, and Spherical), By Distribution Channel (Ophthalmologists, Retail Stores, and Online Stores, and Regional Forecast, 2023-2030. Available at https://www.fortunebusinessinsights.com/industry-reports/contact-lensesmarket-
  2. Accessed on September 4, 2023.
  3. Population. Available at https://www.un.org/en/global-issues/population#. Accessed on September 4, 2023.
  4. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.
  5. Orthokeratology Lens Market Size, Share & COVID-19 Impact Analysis, By Type (Overnight Lens and Daytime Lens), By Age Group (Children and Adults), By Application (Myopia, Astigmatism, and Others), By End-user (Optometrist Offices, Hospitals & Ophthalmology Clinics, and Others), and Regional Forecast, 2022-2029. Available at https://www.fortunebusinessinsights.com/orthokeratology-lens-market-103110. Accessed on September 4, 2023.
  6. Repka MX, Weise KK, Chandler DL, et al. Pediatric Eye Disease Investigator Group. Low-Dose 0.01% Atropine Eye Drops vs Placebo for Myopia Control: A Randomized Clinical Trial. JAMA Ophthalmol. 2023;141(8):756-765.
  7. Ageing. Available at https://www.un.org/en/global-issues/ageing. Accessed on September 4, 2023.

Editor’s Note: This article was published in COOKIE magazine Issue 13.

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Dr. Nadia Afkhami

graduated from the Western University of Health Sciences College of Optometry in Pomona, California. She grew up in Central Florida, earned her Undergraduate Degree at the University of Central Florida, Orlando Campus, and later pursued her Master’s Degree at Barry University in Miami, Florida. In 2022, she received the Eyecare Business Magazine Game Changer Award. Dr. Afkhami started her social media journey as a student and has continued to grow her online presence through her Instagram, EyeAmDrNadia, allowing her to work with many industry professionals over the years. In her spare time, she is passionate about community outreach for young women and children who have an interest in science, and she enjoys spending quality time with friends and family.

[Email: nadiaafkhami@gmail.com]

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