CONTACT LENS INDUSTRY UPDATE - WHAT'S NEW IN CORNEA & CONTACT LENSES Neil A. Pence, OD, FAAO
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CONTACT LENS
INDUSTRY UPDATE
WHAT’S NEW IN CORNEA &
CONTACT LENSES
Neil A. Pence, OD, FAAO
Associate Dean
CONFLICT OF INTEREST
u No conflict of interest – past 12 months
u Serve on Editorial Board, Contact Lens
Spectrum Journal
Indiana University School of Optometry
GOALS
u Review contact lens introductions
over the last 12 months
u Soft contact lenses
u GP contact lenses (corneal and scleral)
u Review care system introductions / news
u Review CL industry news
u Discuss “On-line Prescribing” of CL
u Review regulatory issues affecting CL
- Look at FTC proposed changes to FCLCA
Indiana University School of Optometry
CONTACT LENS MARKET
u Contact lenses up 5% in US; 4% world
u Numbers of fits and wearers constant
- Increase in the in the sales or money from CL
u ODs said 32% of gross, 27% net from CL
u Daily disposables highest growth segment
- Nearly 38% of worldwide market share is DD
- US closer to 18-20%
u SCL sph 54%, toric 25%, multi 13%,
corneal GP 4%, scleral GP 4%
Indiana University School of Optometry
J&J VISION CARE
u Anticipate at least 2 new products
@ year until 2022
u Newest products in past 12 months:
- Vita Sphere (monthly replacement)
u +8 to -12 powers; 8.4 & 8.8 bc; 14.0 diameter
- 1-Day Oasys for Astigmatism
u pl to -6: -0.75, -1.25, -1.75 cyls ; @ 10 degress
-2.25 cyl +/- 20 degrees around 90/180
u -6.50 to -9 & +0.25 to +4: -0.75, -1.25, -1.75 cyl +/- 20, 90/180
- Vita for Astigmatism – same parameters as above
Indiana University School of Optometry
COOPER VISION
u Introduced the Biofinity Energys
- designed for computer and digital device users
u Avaira Vitality sphere; Avaira Vitality Toric
- slightly modified material from Avaira
u Clarity 1 Day Toric
- extended the range of parameters
- introduced 90 packs (last of Clarity 1 Day line to have)
u Biofinity Toric XR
- custom 6 packs in high cyls; long awaited
Indiana University School of Optometry
COOPER VISION
MY DAY TORIC
u Silicone-hydrogel daily disposable lens
u Same material as MyDay sphere
u Same toric design as the Biofinity Toric
u Would now be the highest oxygen
transmission of any DD toric
Indiana University School of Optometry
COOPER VISION
ANNOUNCED DISCONTINUATIONS
u Biomedics XC Nov 2017
u ClearSight 1 day toric Nov 2017
u Vertex Toric XR Jan 2018
u Avaira sphere May 2018
u Avaira toric Jan 2018
u Frequency 55 toric Nov 2018
u Frequency 55 toric XR Nov 2018
- trials for all end from Feb 2017 to Nov 2017
u ClearSight 1 day; Proclear 1 day; Proclear
1 day multifocal – all discontinue sale
of 30 pack size by November 1, 2018
Indiana University School of Optometry
ALCON
u Air Optix Plus
- Same exact parameters as regular Air Optix Aqua
- Same material, but added Hydraglyde to the lens and package
u Alcon Dailies Total 1 multifocal
- Same multifocal design as Air Optix & Dailies multifocals
- 3 add powers/center near design
- Expanded parameters: +6 to -10
Indiana University School of Optometry
BAUSCH + LOMB
u Ultra for Presbyopia
u & Biotrue for Presbyopia
- same 3-zone progressive design as other B+L multifocals
- low and high add options
- center distance design
u Ultra for Astigmatism
- similar design as PureVision 2 for astigmatism
- expanded parameters (+6 to –9; 4 cyls @ 10 degrees)
u Biotrue for Astigmatism 1-day
- orientation mark at 6 o’clock
- also small mark at axis location
- peri-ballasted, so no prism in optics
Indiana University School of OptometryMENICON
u Menicon introduced
Miru Monthly
- 8.3/8.6; 14.0; +6.00 to -13
- Similar oxygen to other SiHy monthly lenses
u Miru Daily Disposable
- Added a second base curve - 8.4 (had 8.6 only)
u RoseK2 Soft Lenses
- 4 packs of lenses; aspheric back, toric front optics
- Availale initially from ABB and Art Optical in US
Indiana University School of OptometryVISIONEERING TECHNOLOGIES
u Introduced NaturalVue Multifocal 1-Day
last year (Center Distance; 1 add)
u Just announced a NaturalVue Sphere
1-Day lens
u +4 to -12 sphere powers in 0.25D steps
throughout the entire range
u Toric & Multifocal Toric DD coming
Indiana University School of OptometrySCLERAL LENS NEWS
u Zenlens introduced 28 lens diagnostic set
- Added 4 lenses with toric haptic (2 dia; oblate/prolate)
u Art Optical has Ample Eye
- Scleral with toric periphery standard; & has multifocal
u Blanchard
- Sym-Toric scleral version of Onefit lenses (front toric)
with no prism in the lens, and not toric haptic
- Onefit Med – customizable for highly irregular,
medically indicated corneas (15.6, 16.0, 16.4 dia)
- Onefit A – introduced for Asian eyes
Indiana University School of OptometrySCLERAL LENS NEWS
u SynergEyes – introduced a scleral CL
- SynergEyes VS Scleral
- toric periphery; independent parameter adjustments
- Menicon Z for highest oxygen; 16 lens fitting set
u X-Cel
- Atlantis multifocal (center-distance design, & zone
size can be controlled
- Atlantis 3D-Vault with limbal control technology
u can adjust limbal sag apex; can utilize standard set to begin
Indiana University School of OptometryTANGIBLE HYDRA-PEG
u A treatment to the lens surface that
enhances wetting, resists deposits
u Being marketed by Contamac
u Can be applied to all their materials
u Corneal GPs; sclerals; Synergeyes hybrids
u Recommend Unique pH or ClearCare
u 1 year warranty from some labs
u $15-25 cost to add it, typically
12/17/17 Indiana University School of OptometryMYOPIA: STOP CORRECTING &
START CONTROLLING?
Where Are We Along the Myopia Treatment Continuum?
Correcting Controlling Preventing
Where Are You?
Indiana University School of OptometryMYOPIA STATISTICS
u US myopia in 1907 was 25%
u US myopia today is 42%
u 9.6 million in US are severely myopic
- 4% of US population (-6.00D and above)
u 41,000 suffer myopic macular degen.
- Rate of myopic complications is nearly 2x for women
Willis et al. The Prevalence of Myopic Choroidal
Neovascularization in the United States. Ophthalmology,
2016 DOI: 10.1016/j.ophtha.2016.04.021
Indiana University School of OptometryMYOPIA STATISTICS
u 4 x risk of RD if -1 to -3 vs. emmetrope
u Goes to as high as 10 x for over -5.00D
u Increased risk for glaucoma is 1.65 x up
to -3.00D, and 2.46 x if over -3.00D
u 25% incidence of myopic maculopathy
if over -5.00D
u 52% incidence if over -9.00D
Indiana University School of OptometryMYOPIC RISK FACTORS
IF LESSENING, BUT NOT ELIMINATING THE
MYOPIA – WHY DOES IT MATTER?
u If can reduce myopic progression by:
- 33%, (seen in most all studies), will reduce the
number of High Myopes (>5D) by 70%
- 50%, will reduce high myopia by 90%
from Noel Brennan
u Consider the lifetime risk of high myopia
(RD; myopic macula effects) to the risk of
getting a CL related corneal ulcer
- Risk for a -4D to -6D myope 6x the risk of an ulcer
Indiana University School of OptometryMYOPIA PROGRESSION:
ENVIRONMENTAL EFFECTS
u Effects of bright lightEYE GROWTH AND PERIPHERAL RX
u Retinal processing – 90% of retinal
ganglion cells are found outside the fovea
(Azzopardi and Cowey, Neuroscience ,1996)
u Off-axis refraction may be more or less
hyperopic or myopic in the periphery
u Myopes have more relative peripheral
hyperopia (Mutti, IOVS, 2000; Millodot, OPO, 1981)
u Increase this with most myopic corrections
12/17/17 Indiana University School of Optometry“CREATE A MYOPIC DEFOCUS OVER A LARGE AREA OF THE RETINA” - EARL SMITH 12/17/17 Indiana University School of Optometry
MYOPIA CONTROL OPTIONS
EXPECTED EFFECT ON PROGRESSION
u Studies using soft multifocal contact
lenses tend to reduce myopic
progression in the 33-40% range
u OK studies commonly have effects in
the 40-50% range reduction
u Atropine has shown the ability to slow
progression in the 45-70% range
Indiana University School of OptometryATROPINE STUDIES – ATOM; ATOM2 12/17/17 Indiana University School of Optometry
MYOPIA CONTROL
u Brien Holden Vision Institute
has a Myopia Calculator online
- Enter age, Rx, and shows expected effect of various
treatment options on the final myopic correction
- https://calculator.brienholdenvision.org
u Paragon has videos and resources for
discussing myopia control with parents
u Where are you when it comes to myopia?
Controlling progression or contributing to it?WHAT’S NEW WITH SOLUTIONS?
u 2 products have now been introduced for
filling the bowl of scleral contact lenses
u LacriPure from Menicon
u ScleralFil from B+L Specialty
Indiana University School of OptometryCLEAR CARE PRODUCTS
u ClearCare Plus with Hydraglyde
- wetting agent added
u ClearCare Rinse & Go
- saline product to rinse after
soaking or if drop lens
Indiana University School of OptometryPEROXICLEAR BY B+L
u Taken off the market, at least for a time
u Some patient reports of irritation upon
insertion in the morning
u Was approved for a 4 hour minimum soak
- wanted this for mainly a marketing claim of “fastest”
u This may not be enough time for everyone
- leaves some residue (50-100 parts/ million)
u No damage to eyes caused by this
u Was a voluntary recall; future unknown
Indiana University School of OptometryINDUSTRY MERGERS – J&JVC
u J&J Vision Care purchased AMO
- Mainly adds an ophthalmic surgical business that J&J
did not have any role in before
- Believe the surgical side will remain much as it is –
as a division on it’s own
- Contact lens care business will likely be
absorbed by other J&JVC divisions
u gives an entry into the solution market
u OxySept, Revitalens for SCL; Total for GP
u Revitalens now being marketed as
“Blink Revitalens”
12/17/17 Indiana University School of OptometryINDUSTRY MERGERS – J&JVC
u J&J Vision Care purchased TearScience
- Lipiscan & Lipiview diagnostic instruments
- Lipiflow treatment device
-
Indiana University School of OptometryINDUSTRY MERGERS – J&JVC
u J&J Vision Care purchased Sightbox
u Sightbox is an online contact lens direct
to consumer subscription service
u Allows patient to make monthly payments
on their yearly supply of CL
u In 2016, estimated that 18% of contact
lens purchases were sold on line
u Why does J&JVC want to get into direct
to consumer sales? Indiana University School of OptometryJ&JVC STATED GOALS FOR
SIGHTBOX PURCHASE
u Online purchases are lost to professional
offices, and not going to go back
u Want to disrupt the “renewals”, and
send them back to the doctor
- Hope is they might then be fit in updated lenses
- Sightbox will contact doctor, and agree to pay them a
“usual & customary” exam and CL services fee
- Doctor then gives the CL Rx to Sightbox
- Patient expects to pay $0 at their visit
u Contend if patient not happy, will go to an
online exam and CL Rx next time
Indiana University School of OptometryINDUSTRY MERGERS
u CooperVision purchased Procornea
- Netherlands based specialty CL manufacturer
- Adds the DreamLite orthokeratolgy lenses
- Believed to fit in with CV efforts in the area of
myopia control
- Lab and offices to remain in Europe
u CooperVision purchasing Paragon Vision
Sciences
- The CRT lenses fit with the myopia control emphasis
- Also gives CV a family of GP materials and GP button
manufacturing capability
Indiana University School of OptometryOTHER INDUSTRY NEWS
u Alcon
- Added AlconODMarketing.com
u A site to assist ODs with their digital media marketing
- Heavy rebate program to encourage daily disposables
u $200 rebates to make it more affordable & attractive
- Changed packaging on Air Optix Aqua
u Added insertion and removal instructions
u J&JVC
- Heavy effort into advocacy support
u Vision to Action site; Advocacy Academy site with many
resources to help with advocacy
Indiana University School of OptometryOTHER INDUSTRY NEWS
u B+L
- #ONEbyONE recycling program (with Terra Cycle)
u In office, and patients can download shipping lables
- Close to EW approval for Ultra material
u B+L Specialty Vision
- FDA approval for Therapeutic use of Boston XO/XO2
u May see scleral lens products developed to utilize this
- Offer Boston materials guarantee
u 6 months, if not 100% satisfied (wetting; breaking), replace
u Contamc
- FDA approval for HEXA 100 material,& with HydraPeg
Indiana University School of OptometryGPLI RESOURCES
u gpli.info
u Much new information
u Fitting programs
u Medical CL billing information
u Case examples
u Staff training modules
u Searchable lens database
u Much more
Indiana University School of Optometry12/17/17 Indiana University School of Optometry
SCLERAL LENS SOCIETY
u Offering educational opportunities
u Excellent lectures and workshops
u Resources available on their site
u Big presence at the GSLS @ January
(Global Specialty Lens Symposium)
u Scleral workshops and numerous
lectures at the Am. Academy meeting
in San Antonio in November
Indiana University School of OptometryCL INDUSTRY DATA
u 38% of CL are sold by OD, OMD office
u 19% by retail chains (Lenscrafter; Pearle)
u 25% by mass marketers (Walmart;
Costco; Sam’s Club)
u 18% on-line sellers
- of these, 2% through distributors for OD offices
- 16% by 1-800 and all the others combined
u 96% of patients satisfied with their CL
purchase options
Indiana University School of OptometryNEW ONLINE ACTIVITY
u Hubble Contacts – hubblecontacts.com
u Their own DD lens
u 30$/month subscription
u Trying to sign up ODs
u Lenses are made by
“St. Shine” in Taipei, China
u Toric DD coming soon
u Not compliant with FCLCA?
u Left Harry’s Razors to found Hubble
Indiana University School of OptometryTHE BROKEN STATE OF CL VERIFICATION CONTACT LENS SPECTRUM 11/2017
OTHER NEW MARKETERS
u Simple Contacts – wear your CL, enter
CL data, take an online test
u Within 24 hours “World-Class Doctors”
will give you a CL Rx
- all OMDs in New York and possibly other East Coast
u Company received $8 million in venture
capitol funding from Notation Capitol
extolling this innovative, game-changing
technology breakthrough
Indiana University School of OptometryOTHER QUESTIONABLE
MARKETERS
u VisionPros.com
- Advertise “No Prescription Needed” or
“Buy your contact lenses without a Dr.”
u The Lens Butler – subscription service
u Opternative
- online refraction and then can purchase a CL Rx also
u 1 800 Contacts
- many cases documented of changing the type of CL
- pushing legislation to make all SCL “generic”
Indiana University School of OptometryHOW DO YOU COMPETE
u Have your own subscription service,
in addition to ease of ordering from
your website
u Use friendly services
- Lens Ferry S: owned by CooperVision; you control
fees; patient can pay monthly and get lenses quarterly
u all lenses, not just CV; sign them up before leave office
u part of Eye Care Prime; reduced fee based on CV sales
- CL Compare – help do annual supply
- Lensquote.net – to help promote annual supply
- I am sure there are others, but not familiar with
Indiana University School of OptometryOPTERNATIVE
u Opternative and 1-800 Contacts
u Partnership that has resulted in
1-800 putting greater amounts of
money into fighting states that do not
allow a CL Rx to be tested for on-line
u Most recent laws in Georgia, So. Carolina
u IN, MI, AL, MS, Maine, OH, Nebraska all
have laws that limit online in some way
Indiana University School of Optometry1-800 ACTIVITIES
u Introduced legislation in AZ
- would make CL Rx expiration dates 5 years, not 1
- defeated in AZ
u In Utah, introduced legislation to allow
the CL prescription to be based on a
“simple on-line questionnaire”
- defeated for now, but very powerful (i.e. have given
lots of money to) Utah legislators
u In October 20, 2017 federal judge ruled
1-800 practices harmful to the public
- illegal, anti-competitive practices on search engines
Indiana University School of Optometry1-800 ACTIVITIES
u In AZ, have hired attorneys to file over
3,000 formal complaints against over
500 AZ ODs
u Complaints filed with state Opt. Board
- none have been filed by a patient, all by 1-800 att.
- all claim violation of verification rules of FCLCA
- Board must investigate every complaint
- the complaint gives a “date, and claim of failure to
verify” but no patient names; impossible to investigate
- Is NO requirement to verify by OD in FCLCA
Indiana University School of OptometryFCLCA REVIEW
u Fairness to Contact Lens Consumers Act
u Set a 1 year CL Rx expiration date
u Requires online or phone sellers to verify
the CL Rx with the prescriber
u Verified by
- confirm it is correct
- advise it is not correct or correct but expired
- passive verification if no response within 8 business hrs
Indiana University School of OptometryFCLCA REVIEW
u If passive verification, seller can fill it
only that 1 time
u Study found 58% of yearly CL Rxs filled by
1-800 received a notification toward the
end of that year that their Rx was about
to run out & did they want to order more
u They then sold them another year of CL,
meaning they extended the expiration
date to 2 years
Indiana University School of OptometryFCLCA REVIEW
u If a patient gives the seller the numbers
on their box (the websites tell them
where to look for them and what to give)
u They can list a random doctor (not theirs)
u Seller attempts to “verify”
u Likely no response; “Never heard of them”
u This then amounts to passive verification,
and the seller can fill it
Indiana University School of OptometryINFLUENCE ON FTC
u FCLCA under review; staffers took much
information and rendered opinion almost
totally based on 1-800 information or
influence on the office reviewing the rule
u Result is a proposed revised FCLCA rule
that would be very harmful to ODs and
seem to be of little value protecting the
welfare of patients
u 96% of patients who wear CL are satisfied
with their CL purchase options
Indiana University School of OptometryFTC PROPOSED RULE – GIVE CL RX & GET
“ACKNOWLEDGEMENT”
u Must be entitled ‘‘Patient Receipt of Contact Lens
Prescription,’’
u Must state ‘‘My eye care professional provided me
with a copy of my contact lens prescription at the
completion of my contact lens fitting. I understand
that I am free to purchase contact lenses from the
seller of my choice.’’
u Form must include the name of the patient, patient
signature, and the date the form was signed.
u Prescribers are required to maintain the signed
acknowledgments for a period of not less than 3
years.
Indiana University School of OptometryPROPOSED FTC RULE
u https://www.ftc.gov/system/files/documents/
federal_register_notices/2016/12/
contact_lens_rule_published_frn12716.pdf
u Read (just google) the FTC CL prescription
proposed rule (if you do not tend toward
high blood pressure)
u FTC announced a CL Workshop on March 7
on the proposed rule
- Independent estimate of new rule will cost OD $20,000/yr
- https://ftcpublic.commentworks.com/ftc/contactlensworkshop
u stopillegalCLs@aoa.org they will report for youYou can also read
