Contact lens 2012

Article Date: 1/1/2013
Annual Report
Contact Lenses 2012
The contact lens field was healthy in 2012, with notable growth in
certain lens categories and modalities.
Dr. Nichols is the Kevin Mc-Daid Vision Source Professor at the
University of Houston College of Optometry as well as the editor-in-
chief of Contact Lens Spectrum and editor of the weekly email
newsletter Contact Lenses Today. He has received research funding or
lecture honoraria from Vistakon, Alcon, and Bausch + Lomb.
By Jason J. Nichols, OD, MPH, PhD, FAAO
Each January we bring to you our annual report, which is intended to summarize the
current state of the contact lens field. We place a heavy emphasis on evaluating trends
in the marketplace in terms of what practitioners are using in their practices. We also try
to identify new concepts or highlight any clinical or research trends that are insightful
relative to analyzing the current state of the contact lens field.
While 2012 was a good year with some differences when compared to years past, it
appears that the field may not have changed significantly from 2011 with the exception
of a few data points described below.
Overview of General Market Trends
We generally use several data sources in evaluating trends in the field in terms of
growth and market shares for contact lenses, including our own market research,
industry reports, and discussion with industry and financial analysts. One estimate that
is always difficult to come by is the total number of contact lens wearers. In the United
States market, it has been recognized for several years that growth in the actual
number of lens wearers has been somewhat flat, with potentially as many people
discontinuing contact lens wear as are entering the market. For the past several years,
we’ve believed there to be 34 million to 36 million contact lens wearers in the United
States. This year, we estimate that there are approximately 37 million to 38 million lens
wearers in the United States.
In recent years, we’ve been concerned about a potential defensive nature of contact
lens sales, with the market posting annual growth of 3 percent to 5 percent worldwide
and 4 percent to 7 percent in the United States between 2009 and 2011. Data obtained
from GfK Retail and Technology (Jim Fleckenstein, Vice President Optics-North America)
show a continued healthy upward trend in the sales volume for soft lenses in the United
States in 2012. GfK data showed that U.S. sales grew 4.5 percent for January 2012
through September 2012 compared to the same period for 2011. Similarly, data
obtained from Robert W. Baird (Jeff Johnson, OD, CFA, director, senior research analyst)
show that as of the third quarter of 2012, contact lens trends have been healthy on a
marketwide basis, with U.S. sales growing 9 percent through the first nine months of
the year and worldwide sales up 5 percent after accounting for the impact of recent
fluctuations in foreign exchange rates. With domestic contact lens market growth
accelerating in 2012 to its highest level since pre-Great Recession Days, it’s also
increasingly evident that technology represents an important growth driver for the
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industry, especially across silicone hydrogel, daily disposable, and multifocal lens
categories, among others.
As for the contact lens market size, Baird’s data suggest that the value of the worldwide
contact lens market currently stands at roughly $7.1 billion, with the U.S. market valued
at approximately $2.4 billion at the manufacturer level in 2012. Of this, Baird estimates
that premium lenses such as torics and multifocals account for roughly 20 percent and 5
percent, respectively, of the worldwide market, with spherical lenses accounting for the
majority of the remainder. Further, daily disposable lenses continued to grow in
popularity in 2012, accounting for ~39.5 percent of year-to-date 2012 worldwide sales
through the end of the third quarter versus ~37.5 percent of worldwide sales in all of
2011. We’ll come back to the daily disposable category later in this report, discussing
some other data sources suggesting their continued growth. Finally, Baird estimates that
silicone hydrogel lens penetration continued to grow last year, increasing to nearly 50
percent on a worldwide basis through the first nine months of 2012 versus ~43 percent
in 2011 (with silicone hydrogel penetration rates closer to 65 percent in the United
States according to Baird’s estimates, which is similar to other data source estimates
that we’ll come back to later in this report).
It is typically believed that the North American market is the largest global contact lens
market. GfK released data in October 2012 for the period from July 2011 to June 2012
showing continued growing demand in various contact lens markets, with Asia leading in
terms of the fastest growth (http://www.gfk.com/news-and-events/pressroom/press-
releases/pages/contact-lens-marketacross-asia-europe-and-the-us-continue-to-expand-
with-asia-being-fastest-growing-region-gfk.aspx). The Asian countries tracked showed
growth of 7.4 percent, while the United States and Europe showed growth of 4.8 percent
and 3.2 percent, respectively. Of the six Asian countries tracked (including China,
Malaysia, South Korea, Taiwan, Hong Kong, and Singapore), Korea showed the most
growth at approximately 15 percent, making up 38 percent of the overall region’s
market share.
Looking to market share of the four largest lens manufacturers, Baird estimates that
market shares were fairly stable in 2012, although CooperVision remained the fastest
growing company of the bunch last year and thus likely picked up a small amount of
share relative to the competition. Specifically, with the market growing roughly 5
percent on a worldwide basis after accounting for foreign currency fluctuations, and
Vistakon and Alcon (formerly Ciba Vision) both growing 4 percent to 5 percent through
the first nine months of 2012, it appears likely that both companies maintained their low
-40-percent and mid-20-percent worldwide market shares, respectively. For
CooperVision, Baird estimates that with the company growing its worldwide contact lens
revenue 11 percent through the first three quarters of 2012, its share of the worldwide
contact lens market may have increased roughly a point to just approximately 17
percent to 18 percent last year, with Bausch + Lomb (B+L) likely maintaining close to
the 10 percent market share that the company had entering the year.
When practitioners were asked in November 2012 about product “innovation” associated
with the four major contact lens manufacturers, Baird data showed that Vistakon had
regained the No. 1 position, having lost this position in 2010. Vistakon scored the
highest at 3.85 on a scale of 1 to 5 (1 = Not innovative at all and 5 = Highly
innovative), followed closely by Alcon (3.80), and CooperVision (3.56), with B+L
continuing to lag behind (3.00). According to Baird (and as reported in previous years),
CooperVision was associated with the highest perceived product innovation in 2011,
while Alcon (Ciba Vision) held that title in 2010. B+L has consistently been ranked
fourth in perceived product innovation since 2009.
Current Practice Trends
Contact Lens Spectrum also conducts market research, whereby we ask our readers
about their practice trends and patterns both generally and as they relate specifically to
contact lens practice. Our questions cover a variety of topics including characteristics of
the practice patient base, practice business and financial aspects, fitting and prescribing
trends, and care solution trends. This year, we had 467 respondents who accessed the
survey link, with 428 completing the entire survey and 39 answering a portion of the
survey. As I proceed ahead in discussing trends and observations about the contact lens
field, I will draw on information provided through this market research in addition to

that acquired from the Baird and Co. research group and from GfK, as mentioned
previously.
Practice and Business Trends Table 1 summarizes trends in practice and business
characteristics from 2009 to 2012. Most of our respondents were optometrists, followed
by opticians, contact lens technicians, and ophthalmologists. Modes of practice varied,
but the most common was solo private practice, followed by group private practice and
retail corporation. In 2012, the typical practice saw an average of 127 patients per
week. The patient base of the typical practice was made up of approximately 34 percent
contact lens wearers, and the average number of contact lens fittings and refittings in a
typical week was about 26. Correspondingly, most respondents felt that about 32
percent of their gross profit and about 27 percent of their net profit was derived from
the contact lens portion of their practices. Sixty percent of practitioners believe that
they will see an increase in their overall contact lens practice in 2013, while 38 percent
believe it will stay the same and 2 percent believe it will be decreasing further.
Much to the dismay of many eyecare practitioners is the growing trend of online
eyeglass and contact lens sales at the expense of office-based transactions. An April
2012 report from IBIS World listed online eyeglass and contact lens sales as one of the
top 10 fastest growing industries of the next several years
(http://www.ibisworld.com/Common/MediaCenter/FastestGrowingIndustries.pdf).
According to the report, between 2002 and 2012, online eyeglass and contact lens sales
grew 28.2 percent. The report also indicated that the 2012 revenue from these online
sales is estimated at approximately $350 million. The report further estimates that by
2017, online dispensing revenue will be approximately $530 million, which suggests
almost 9 percent growth per year in this time period.
TABLE 1
Trends in the Business Portion of Practice
2009 2010 2011 2012
Patients seen each week 108 116 107 127
Contact lens-wearing patients 37% 36% 35% 34%
# CL fits/refits per week 27 27 24 26
Estimated % gross practice revenue from CLs 35% 34% 37% 32%
Estimated % net practice revenue from CLs 29% 28% 26% 27%
Lens Dispensing and Mode of Wear Trends As we have reported in years past,
silicone hydrogel materials dominate the fits and refits being conducted today (Figure
1). However, in 2011, we saw a definite slowing of the growth in the silicone hydrogel
category. In 2012, we noted an apparent small decline in the silicone hydrogel category
in that 64 percent of lens fits and refits were conducted with a silicone hydrogel
compared to 67 percent in 2011, whereas 24 percent were conducted with a hydrogel
material (24 percent in 2011). Thus, as noted last year, our data suggest that the
silicone hydrogel category has indeed slowed in terms of any further growth. Similar to
years prior, 9 percent of fits and refits were conducted with GP materials—we noted that
respondents indicated 8 percent of fits and refits were done with GP materials in 2011.
Figure 1. Distribution of material classes used in fittings and refittings.

Figure 2 shows that most of the reported fits and refits are with soft spherical lenses (51
percent) and in full time daily wear (59 percent), followed by soft toric lenses (22
percent), soft multifocal lenses (12 percent), spherical GPs (6 percent), and multifocal
GPs (3 percent). Most of your patients are using monthly replacement (45 percent)
schedules as shown in Figure 3. Twoweek replacement was down to 30 percent this
year, again losing share in the replacement schedule sector of the market. When Baird
asked practitioners about their preferences regarding spherical lenses, silicone hydrogel
monthly lenses led the pack (36 percent), followed by silicone hydrogel two-week
replacement (24 percent), and hydrogel daily disposable (17 percent). Data provided
from GfK for the January through September 2012 time period (compared to the same
time period for 2011) show that the two-week replacement category is down 6 percent,
while the monthly category is up about 12 percent (for 2012). There were little changes
in quarterly and annually replaced contact lens fittings and refittings when comparing
2012 to prior years.
Figure 2. Distribution of lens modalities used in fittings and refittings.
However, as noted elsewhere in this report, daily disposable lenses once again trended
up in 2012. In fact, it was one category that showed big changes again in 2012
compared with 2011. Our data indicate that daily disposables were used in just over 17
percent of fits and refits in 2012 (Figure 3), which is up from 11 percent in 2009, 13
percent in 2010, and 14 percent in 2011. Further, data from GfK show daily disposable
growth between January and September 2012 at nearly 19 percent in the United States,
compared with the same time period for 2011. As noted previously, data from GfK also
show that overall, the most growth in any one region of the contact lens market appears
to be occurring in Asia. However, data from GfK also showed that within the daily
disposable category, most 2012 growth occurred in the U.S. market (again about 19
percent overall comparing 2012 to 2011) compared with Japan at about 2 percent
growth and five prominent European countries averaging about 4 percent growth. Data
obtained from GfK also show that within the daily disposable segment in the U.S.
market, daily disposable toric sales growth was 81 percent, whereas daily disposable
spherical growth was about 15 percent and daily disposable multifocal growth was
nearly 5 percent.

Figure 3. Distribution of replacement schedules used in fittings and refittings.
When asked about the contact lens design or modality with the greatest growth
potential over the next year, 58 percent of respondents in our market research chose
daily disposable lenses, followed by soft multifocals (34 percent) and soft torics (8
percent). When asked in our survey about anticipated use this coming year, 64 percent
of respondents in our market research anticipate using silicone hydrogel daily
disposables, and 52 percent anticipate using traditional hydrogel daily disposables at a
greater rate in 2013.
For GP lens wearers, most practitioners in our market research indicated that their
patients replace GP lenses yearly (38 percent), followed by every two years (29 percent)
and every three years (18 percent).
When asked about estimates for types of wear schedules for contact lens patients,
respondents to our survey indicated that most of their patients are in the full-time, daily
wear soft (59 percent) wear schedule, followed by part-time, daily wear soft (12
percent), occasional overnight wear soft (9 percent), full-time daily wear GP (9 percent),
full-time overnight wear soft (7 percent), part-time daily wear GP (2 percent), and full-
time overnight wear GP (1 percent).
Relative to toric soft lenses, our estimates show relatively no change in soft toric lens
fittings and refittings in 2012 (approximately 22 percent of all lenses fitted) compared
with 2011 (23 percent). Nearly 64 percent of respondents to our survey anticipate
greater use of silicone hydrogel toric lenses in 2013, while only 15 percent of
practitioners estimate greater use of traditional hydrogel torics in 2013. When Baird
asked practitioners about preferences in terms of toric lens fittings, 48 percent
responded that they would first choose a silicone hydrogel monthly replacement design,
followed by a silicone hydrogel two-week replacement (24 percent), hydrogel monthly
replacement (9 percent), and hydrogel daily disposable design (7 percent).
For presbyopic patients who wear contact lenses, most practitioners indicated a strong
preference for multifocal lenses (69 percent) compared with monovision (19 percent)
and over-spectacles (12 percent). In practice, indeed more of your contact lens-wearing
presbyopic patients are prescribed a multifocal (46 percent) compared with monovision
(31 percent). Soft multifocals (38 percent) and soft monovision (27 percent) make up
the bulk of the presbyopic contact lens correction modes, following by soft lenses with
over-spectacles (18 percent), GP bifocals/multifocals (5 percent), GPs with over-
spectacles (5 percent), GP monovision (4 percent), and hybrid and scleral multifocals (1
percent and 2 percent, respectively).
Forecasting into 2013, most respondents thought that nearly all options in silicone
hydrogel materials, including silicone hydrogel multifocals (73 percent of respondents),
silicone hydrogel torics (64 percent of respondents), silicone hydrogel daily disposables
(64 percent of respondents), and silicone hydrogel monthly lenses (49 percent of
respondents), would be increasing further in their practices. This is interesting in that,
as noted above, data for the silicone hydrogel material category as a whole suggest that
growth in this material sector has stopped. Most respondents (52 percent) felt that
hydrogel daily disposables would also be increasing in their practices in 2013, compared
with staying the same (37 percent of practitioners) or declining (3 percent of
practitioners), whereas most respondents felt that daily wear monthly hydrogels would
be staying the same (51 percent of practitioners) compared with increasing (13 percent)
or decreasing (36 percent). For every other lens option asked about, including daily

wear one- to two-week replacement silicone hydrogels, all other toric and multifocal
options, extended and continuous wear, cosmetic/colored lenses, orthokeratology, GPs,
hybrids, and sclerals, practitioners generally felt that these modalities would all be
staying the same in terms of utilization in their practices in 2012 compared with
increasing or decreasing. However, when asked specifically which specialty lens design
has the greatest potential for growth in 2013, respondents indicated the following:
custom soft lenses (49 percent), hybrids (24 percent), sclerals (19 percent), and
orthokeratology (8 percent). Interestingly, while many practitioners are very vocal and
passionate about scleral lenses and their perceived “growth,” these data seem to
suggest that scleral lens growth may not be quite as strong as some believe.
Figure 4. Practitioner perceived patient compliance associated with lenses of
various replacement schedules.
Contact Lens Wear and Care Compliance
As shown in Figure 4, practitioners indicated that only 48 percent of their patients who
use one- to two-week replacement lenses were compliant with the replacement
schedule, whereas practitioners indicated that 67 percent of their patients who use
monthly lenses were compliant and 78 percent of their patients who use daily disposable
lenses were compliant. Generally, respondents indicated that about 71 percent of the
contact lens patients in their practice properly comply with replacement per instruction.
Further, practitioners indicated that they believe that approximately 75 percent of their
contact lens patients wash their hands prior to handling their contact lenses, but only 60
percent of patients rub their lenses as indicated and 62 percent rinse their lenses as
indicated.
Lens Care Trends
According to our survey, the vast majority of our survey respondents reported using
chemical care systems (74 percent) with contact lens patients, followed by hydrogen
peroxide-based systems (25 percent), which has been trending up over the last several
years (Figure 5). Our data show that you are also recommending care systems to your
contact lens patients—87 percent of respondents recommend specific brands of contact
lens care systems to their contact lens patients, while 13 percent do not. Care solution
recommendations by eyecare practitioners continue to be trending down a bit this year
compared with prior years. According to our survey, the largest factor in your selected
recommendation is lens material/solution compatibility (30 percent), followed closely by
the potential impact on comfort (29 percent), disinfectant efficacy (22 percent), cleaning
efficacy (13 percent), cost (10 percent) and convenience (6 percent).
Other Issues and Looking Ahead
The year 2012 was one marked with further discussion of some key elements associated
with successful contact lens wear. We’ve continued to see a heavy emphasis being

placed on the safety of contact lens wear, with topics such as corneal infiltrative events
being heavily discussed. Several studies have shown at least a two-fold increase in the
risk of an infiltrative keratitis in silicone hydrogel lens wearers compared with non-
silicone hydrogel lens wearers, begging the question as to why (Szczotka-Flynn, 2007;
Chalmers et al, 2011; Chalmers et al, 2012; Radford et al, 2009).
Further, there has been continued discussion about the No. 1 issue inhibiting growth in
the contact lens industry—contact lens dry eye. Several of the larger markets, including
the United States, have shown little, if any, growth in the contact lens market in the last
10 years. In fact, as I noted in the Editor’s Perspective, the Tear Film and Ocular
Surface (TFOS) Society initiated the Contact Lens Discomfort Workshop in 2012, aimed
at developing a contemporary understanding and global consensus on the issue of
contact lens dry eye and discomfort. This new workshop will be concluded in 2013, and
we will be sure to bring you a summary of the results later this year.
Figure 5. Lens care systems prescribed to patients from 2009 to 2012.
These aforementioned issues have led some to question the ultimate success of silicone
hydrogel materials in the market. Are these materials actually safer for patients? Do
they have any role in improving patient comfort? It will be of interest to see how the
field continues to respond to this issue as we move ahead into 2013. Further, in the not-
so-distant future, the Alcon (Ciba Vision) Nicolson patents that relate to silicone
hydrogel materials will expire—September 2014 for the U.S. patents and March 2016 for
international patents. It will be interesting to see how this patent expiration will impact
this material category, in addition to the apparent clinical issues discussed above.
Finally, as I also mentioned in the Editor’s Perspective, we have noted significant trends
in certain material and modality categories that have built on the previous years’
momentum in those categories. We’ve seen continued enthusiasm about scleral lenses,
custom silicone hydrogels, and the daily disposable categories, with continued and
expected growth in some of these areas. But what was most noteworthy this past year
and what we have chosen as the Contact Lens Event of 2012 was the significant steps
forward in the U.S. Food and Drug Administration’s (FDA) guidance and regulatory
outlook on contact lenses and care solutions. In late 2012, the FDA culminated years of
effort by publishing eight papers in Eye and Contact Lens (three of which are editorials).
The papers identify key events and issues that relate to outdated guidance to the
industry, by which materials and care solutions were introduced and subsequently
approved, but then unanticipated issues arose when they were used in practice. Look for
more on this in 2013.
In summary, the contact lens field certainly did well in 2012. There were some healthy
growth-related trends in some interesting material and modality categories, which are
likely to continue through 2013. We continue to be optimistic about the state of contact
lenses and look forward to returning to you in January 2014 to report further on these
trends. CLS

For references, please visit www.clspectrum.com/references.asp and click on document
#206.
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Contact lens 2012

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