Most trends in the worldwide contact lens market are universal. The four major manufacturers—Alcon, CooperVision, Vistakon and Bausch+Lomb—operate in numerous countries that span the globe. Despite this worldwide reach and coordination of strategy, some notable disparities between the US and international markets exist. From fitting patterns to available products to consumer attitudes toward lens wear preferences, some of these differences can be staggering.

Being aware of successful prescribing trends and new products available worldwide can help to improve not only patient care, but also your practice’s profitability—offering a winning situation for both you and your patients.

Product Availability
While there are many similarities across the various contact lens markets around the globe, it is the disparities between them that are most interesting—and the most bewildering. One such point of interest is the difference in products available overseas vs. products available in the United States. Numerous countries outside of the US generally tend to see contact lenses, solutions and surgical treatments hit the market long before they reach US shores.

A recent example of a product that debuted abroad before receiving the green light from the FDA is Alcon’s Dailies Total1 lens. The manufacturer’s “water gradient” daily disposable lens released initially in late 2011, but only in Nordic countries.¹ The product didn’t reach US shores until June 2013, a lengthy gap in release dates that doctors in the US find frustrating but now commonplace. But US doctors can benefit from the insights gleaned in such early product rollouts.

Bo Lauenborg, an optometrist in Denmark where the first Dailies Total1 launch took place, considers the product “a revolution” in achieving all-day comfortable lens wear. “When I first apply the lens, I have patients telling me they think something is wrong, because they cannot feel anything in their eye.” Dr. Lauenborg also says the lens “opens a whole new world” to patients concerning improved lens comfort at the end of the day.

While the Dailies Total1 lenses are an example of a product approved for patient use internationally before gaining US approval, there are many other products that are already available and being used overseas still awaiting the go ahead from the FDA. For example, recently Novaliq’s NovaTears OTC was marked for approval in Europe in July 2013.² As of now, NovaTears is awaiting FDA approval in the US.³

Myopia control lenses have become increasingly popular in several Asian countries, according to Mark Willcox, PhD, professor of optometry and vision science at the University of New South Wales. He says Singapore, Malaysia and Hong Kong—areas typically associated with high myopia rates—have all more readily adopted contact lenses that assist in correcting myopia physiologically.⁴ CooperVision’s MiSight line, an orthokeratology lens option designed for myopia correction prevalent in these regions, has yet to obtain FDA approval for distribution in the US.

While the health ministries of every nation obviously have the best interests of their citizens at heart, the FDA can be notoriously stringent. Why do so many products hit the international market before reaching the United States? What makes getting a product passed in the US such a difficult task? FDA regulations often pose a difficult hurdle for emergent pharmaceuticals and medical devices to surmount, but what is it that makes FDA approval so difficult?

Nathan Efron, PhD, professor of optometry and vision science at Queensland University of Technology in Australia, believes that fear of potential litigation may be the culprit.  “The notion of wanting to protect the health of citizens in a nation is a universal, but this is perhaps stronger in the USA than elsewhere,” Dr. Efron says. “This may relate to the greater propensity for US citizens to exercise their rights in terms of litigation if anything goes wrong.”

Perhaps past lawsuits over previously released products have caused the FDA to be more conservative in its approval of new drugs and devices.

Whatever the reason, an extensive amount of new products for sale outside of the US are still seeking FDA approval. The differences in the available drugs, contact lenses and other treatments may also be the cause for differences in prescribing patterns between various nations.

International Prescribing Patterns
The differences between contact lens markets worldwide only begin with products. One of the largest and most perplexing differences between US and foreign markets is the greater prevalence of daily disposable (DD) lenses internationally vs. the relatively low adoption rate in the US.

What makes DD lenses more popular in markets outside of the US? Why isn’t the demand in the US for this modality as strong as it is internationally?

There are numerous benefits when using DD lenses vs. reusable lenses—they are more convenient, more sanitary (when proper compliance and replacement frequency are followed) and more comfortable than lenses with a longer recommended replacement frequency. With the added convenience and health benefits when compared to two-week or monthly replacement options, DD lenses would appear to be the obvious choice for contact lens wearers. In Europe and other international markets, this is increasingly becoming the case, but the US is significantly lagging behind in the DD market.

According to Dr. Willcox, the percentage of new daily disposable fits in the US is only 13%, a number that pales in comparison to the 38% of new soft lens fits in the UK. Denmark is far and away the leader of the DD market, Dr. Willcox says, with 58% of their new soft lens fits being daily replacement lenses.

What is causing this notable discrepancy between new DD fits? It’s perplexing that the US—one of the world’s leaders in health care and generally a culture that adopts new technological advances wth gusto—lags so far behind other nations in new DD fits. While DD lenses are generally more expensive on average than two-week or one-month options, Dr. Efron doesn’t believe economics have much effect on the inability of the US to gain ground on the DD lens market.

“We know that nations with a higher gross domestic product (indicating the ‘average wealth’ of citizens) have a higher rate of daily disposable lens prescribing,” he says. “However, this cannot explain the lower uptake in the USA, which is an affluent country with a relatively high gross domestic product.”

While financial issues may not be the main cause of lukewarm DD prescribing in the US, compliance among patients deserves some investigation. A 2010 study by Dumbleton et al. examined the compliance of contact lens replacement in the US and Canada. The study found that 18% of Americans—not an insignificant number by any means—reported that they wear their DD lenses beyond the recommended replacement frequency.⁵ More research needs to be done on the relationship between compliance and prescribing trends in the US vs. trends abroad, but perhaps due to poor replacement frequency compliance rates, ODs in the US aren’t as forceful in prescribing DD lenses to patients as a result.

Nicole Carnt, PhD, BOptom, of Moorfields Eye Hospital in London, believes that lifestyle differences may also play a role in daily disposable lens prescribing. “It makes sense to me that in Australia the market share is high, because of the outdoor lifestyle. Practitioners will often prescribe a supply of daily dispoables for holidays, etc., for biweekly or monthly replacement wearers.”

Geography—something that not many ODs would consider a factor in prescribing trends—could potentially play a more significant role in the relatively slow adoption of DD lenses in the US than you may think. Dr. Efron believes that the wide dispersion of practitioners created as a result the vast landscape of the contact lens market may have a significant impact on prescribing trends in the US.

“The UK is a small island nation with short lines of communication and a large, coherent body of contact lens practitioners who regularly attend, and are influenced by, opinion leaders at the annual British Contact Lens Association meeting,” he says. “If a product or category is deemed to be superior, such ideas are quickly and universally adopted.”

The BCLA meetings give practitioners in the UK the opportunity to become educated and more familiar with new trends in the contact lens market, and to share their expertise more readily with each other. Without directly comparable meetings in the US, it is more difficult for ODs to communicate with one another which products and treatment options are more successful than others. Perhaps the shared knowledge exchanged at the BCLA meetings help practitioners in the UK gain more confidence in prescribing certain products.

Such confidence and enthusiasm even trickles down to the optician level. “In the UK, Morgan et al. found that daily disposables were slightly more likely to be recommended by dispensing opticians—maybe they are more retail savvy and are able to communicate the benefits of DD and justify the increased cost more comfortably?” adds Dr. Carnt.

Impact on Your Practice
What effects—if any—will these global trends and distinctions have on your practice? The application of the shared knowledge of ODs from around the world to your practice can help to improve patient care and bring in more revenue for your practice.

One of the first things you can do now is educate yourself on the various products available outside the US. When these products obtain FDA approval, you’ll be better prepared to quickly recommend newly released products to your patients with authority. For example, if you start learning the features of a product now such as the MiSight lens, when it hits the US market you won’t need to spend additional time learning its various features. This will enable you to quickly suggest and prescribe it as another option for your patients with myopia, while at the same time increase your practice’s profitability.

Another important area to address is that of patient compliance. Discuss with your patients the importance of following recommended contact lens replacement schedules. You can use this conversation as a framework for suggesting DD lenses to your patients. Explain the convenience of DD lenses with your patients, while also outlining their added health benefits. This should help to reduce patient dropout, which will guarantee you more repeat customers.

Lastly, see if the European experience offers any lessons about patient engagement that might shed light on missed opportunities here. The move to daily disposable lenses has been embraced elsewhere. Americans are no less open to the benefits of this modality when presented in a way that demonstrates the health and convenience benefits.

You have a unique position as an OD—with the dual obligations to protect the health of your patients while also offering them a full suite of contact lens products from which to choose. Educating yourself on what’s successful internationally as well as domestically will improve both the patient care and profitability of your practice. 

1. Dailies Total1 Background Information page. Ciba Vision Web site. http://www.cibavision.dk/pdf/DT1-Backgrounde_v2.pdf. Accessed August 20, 2013.
2. Novaliq GmbH Announces European Market Approval for NovaTears OTC. Novaliq Web site. http://www.novaliq.de/inrel_pr.html. Accessed August 20, 2013.
3. NovaTears – Reviews & Brand Information page. LegalForce Trademarkia Web site. http://www.trademarkia.com/novatears-85858687.html. Accessed August 20, 2013.
4. Foster PJ. Myopia in Asia. British Journal of Ophthamology. 2004;88(4):443-444. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772076/. Accessed August 20, 2013.
5. Dumbleton K, Richter D, Woods C, et al. Compliance with Contact Lens Replacement in Canada and the United States. Optometry and Vision Science. 2010;87(2):131-139.