Since the introduction of soft contact lenses over 50 years ago, the number of dropouts each year worldwide has unfortunately remained high. To enhance awareness of the potential lifestyle choices in wearing lenses on ocular health, the Tear Film and Ocular Surface (TFOS) group empaneled a writing committee. The aim was to review critical literature and identify gaps in knowledge to stimulate future direction for novel research.¹ One area of significant interest was lifestyle factors that might impact the number of soft lens dropouts using a systematic review.¹

Sobering Stats

The key factors causing dropouts are discomfort and dissatisfaction with vision, especially in patients with significant astigmatism and presbyopia in particular.^1-4 Additional factors contributing to high dropout rates are the patient’s inability to handle lenses, cost and convenience/disinterest in continuing lens wear.^1-3 Sobering estimates place the rate of contact lens–related dropouts at about 25% of wearers over a two- to three-year period.¹ Other reports estimated the rate to range from 12% to 27.4%.²

The TFOS systematic review attempted to investigate associations between environmental exposures (e.g., climate, temperature, health status, allergies, pollution) and behavioral lifestyle factors (e.g., contact lens handling abilities, wear schedule, adherence, patient motivation, occupation) and the frequency of lens wear dropout.¹ Eligible study designs used for the review were randomized clinical trials (n=15) or retrospective and prospective cohort studies (n=19). The conclusion of the review is a sobering reminder that the rates of dropout are unacceptable. The need exists for future population studies looking at factors for high quality data that might contribute (e.g., lens type/design, material, patient age) to fully capture the reason(s) for dropouts.¹

Dropout Rates by Lens Type and Population¹

Let’s review this startling information. For more detail, refer to the full TFOS report.

• Dropout for multifocal lens wear: 72% at one month, 42% at three months, 20% to 24% at six months and 26% to 54% at one year of follow-up.

• Dropout for children wearing lenses: 9.5% to 17% at three months.

• Dropout for lens wear for myopia control: 11% to 43% at two years, 36% at six years.

 • Dropout for astigmatism patients: 4.5% at one month, 18% at two years.

• Dropout for daily disposable wearers: 2% to 4.3% at four weeks, 11% to 23% at one year, 25% to 29% at two years.

Moving Forward

The question that looms for practitioners: What might we do to reduce this number each year? A joint effort and a shared responsibility among the stakeholders—clinicians, researchers, manufacturers and patients—is essential to reduce the rate of dropouts.⁴ We have to remind ourselves that a good number of these patients can be refitted with new lens options; so a second chance is often in order.^2,4 If offered a chance to resume wear after offering a problem-solving option, the success rate in resuming lens wear was 74%.² 

We certainly welcome new products to help salvage those contact lens patients who have been lost. Practitioners should constantly monitor research, assess new products and be willing to try new options when made available. 

We thank TFOS for taking this “deep dive” into the important questions surrounding contact lens dropouts. We end up having more questions than answers, but many of the missing gaps in knowledge have been identified. They have clearly pointed out that further work employing high level studies is needed to provide quality information. For example, they ask whether there is a significant difference among materials and designs, if there is a difference in the rate of dropouts between males and females and different age groups (presbyopes) and what strategies can be employed to reduce the rate of dropouts. 

The potential role for daily disposable lenses to ward off dropouts to mitigate the lifestyle challenges posed in wear also requires further study. Remember to closely monitor for patient satisfaction. When previously unsuccessful patients who present are motivated, you should remain tenacious in offering additional options and strategies.

1. Jones L, Efron N, Bandamwar K, et al. TFOS Lifestyle: impact of contact lenses on the ocular surface. Ocul Surf. 2023;29:175-219. 2. Pucker AD, Tichenor AA. A review of contact lens dropout. Clin Optom (Auckl). 2020; 12:85-94. 3. Pucker AD, Jones-Jordan LA, Marx S, et al. Clinical factors asociated with contact lens dropout. Cont Lens Anterior Eye. 2019;42(3):318-24. 4. Young G. Why one million contact lens wearers dropped out Cont Lens Anterior Eye. 2004;27(2):83-5.