The resilience of contact lenses

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This case study is provided by our SCC Online Series partner Alcon.

By Megan Zabell

Megan Zabell graduated from the University of Melbourne as a therapeutically endorsed optometrist in 2011. She worked in a private optometry practice for 7 years and also taught preclinical optometry at the University of Melbourne for 4 years. Megan has a particular interest in the treatment of dry eye, as well as fitting contact lenses, which is what drew her to join Alcon Vision Care’s Professional Affairs Team late in 2018. Megan also enjoys volunteering her optometric skill, having done so in Vanuatu and Nepal.

The year 2020 has been economically challenging for businesses large and small alike. So much so, the International Monetary Fund (IMF) have titled their World Economic Outlook, updated in June 2020, “A Crisis Like No Other, An Uncertain Recovery” [1]. Looking locally, the Reserve Bank of Australia (RBA) stated in their August 2020 Statement of Monetary Policy that while the economic contraction experienced by Australia in the first half of 2020 was actually smaller than predicted by experts, the pace of recovery is proving to be slower than initially forecast, thanks in part to prolonged recurring outbreaks [2].

In order to understand what lies in store for the optical industry specifically, there is a need for data about the behaviour of the consumers within the industry. Alcon undertook a global survey, conducted through market research group MarketVision to better understand the behaviour and attitudes of contact lens wearers in the current global market. The survey, which was finalised in June 2020, was completed online with a total of 1,511 respondents from 5 countries. The respondents were all adults (aged 18+), contact lens wearers, and were from Australia, France, Germany, Italy or South Korea. The survey was conducted in multiple languages (English, French, German, Korean and Italian). There were secondary goals to understand any reasons behind changes in contact lens wearers’ behaviours and attitudes, the impact of COVID-19 on dry eye, and the impact of COVID-19 on the engagement of eye care professionals [3].

How the Pandemic Changed Contact Lens Behaviours

As the SARS-CoV-2 virus spread internationally, many countries took drastic action in order to reduce the impact of COVID-19 infection on their various populations. This resulted in a large adjustment in the way of life for many people all over the globe. The 2020 Alcon survey of contact lens wearer found that during the COVID-19 pandemic, 43% of the respondents were wearing their contact lenses less. The top reason, across all countries surveyed, for was the habit of wearing contact lenses only when going out, and the reduction of time spent outdoors due to pandemic-related lockdowns. Other lock down-based reasons included finding glasses more convenient for their current situation, or wanting to conserve their current contact lens supply. Some of the change in CL wearing behaviour was due to concerns over contracting COVID-19: wanting to avoid touching the face or eyes, wanting to lessen their risk of contracting COVID-19, or having received recommendations to avoid contact lens wear due to the virus [3]. Although survey respondents have reported receiving recommendations to avoid contact lens wear due to the COVID-19 crisis, there is advice globally from experts, including those from the Centre for Ocular Research and Education (CORE) that there is no scientific evidence that use of contact lenses during the pandemic increases risk of infection. Correct hand and contact lens hygiene habits are essential and should be imparted under all situations, regardless of the COVID-19 pandemic [4].

One possible explanation for the reduced usage when not leaving the house is that perhaps some patients use contact lenses mainly for their improved cosmesis over glasses, and don’t feel that they need to use them working from home – maybe due to their reduced interaction with others. Some patients may benefit from being reminded of some of the other benefits that contact lens wear can provide: increased field of view/peripheral vision [5], less image size reduction for myopes, and more natural-feeling vision [6].

One thing that the pandemic has been effective in doing, where practitioners across the world have been struggling for decades, is increasing patient compliance in terms of contact lens hygiene. Since the beginning of the pandemic, over 70% of contact lens wearers surveyed have reported improving adherence to at least one contact lens hygiene habit – perhaps unsurprisingly, the behaviour most affected by the pandemic was handwashing prior to lens insertion and removal [3]. Other habits that have been self-reported as being improved due to the influence of COVID-19 are changing contact lenses for fresh ones every day/week/month, and being more diligent about not sleeping in contact lenses [3]. Now is the time for practitioners to re-enforce this positive change in behaviour with information for patients – whether this be delivered face to face at eye care appointments or digitally through social media, in order to try and make the changes stick, especially as the survey results indicated that patients have been researching contact lens hygiene and safety due to the pandemic [3].

While the economic recovery from COVID-19 lockdowns seems slower and more protracted than predicted by experts [12], the return to regular contact lens wearing behaviours for those whose behaviour has been affected seems to more rapid. The survey indicated that 90% of wearers who reported a reduction in their contact lens wearing routine expected to return to their regular wearing habits – 69% within the next two to three months or even sooner, in fact [3]. This is positive news as it means that the increase in contact lens consumption as wearing schedules return to normal should help to support businesses as they begin to reopen as lockdowns end and healthcare and eyecare needs begin to return to normal levels.

Brand and Practitioner Loyalty Amongst Contact Lens Wearers in Times of Change

The survey results indicate that contact lens wearers have maintained loyalty to both their prescribed brand of contact lenses and their practitioners during COVID-19 [3]. Not only do the wearers largely remain loyal to their brand, with 94% of respondents sticking with their current brand, but 75% of respondents are open to talking to their eye care practitioner about upgrading their contact lenses in order to improve their wearing experience. 71% of respondents also indicated that they may be open to paying more for an innovative contact lens that could increase their wearing times, and improve comfort, and vision.

The study found that over three quarters of respondents have continued or would continue to purchase their contact lens supply directly from their ECP during the pandemic, although some may shift to an online channel offering from their ECP rather than in person [3] – this is why having a prominent online presence is so important. The respondents also indicated that most would be receptive to use their ECP for all of their eye care needs [3].

Dry Eye Symptoms in a COVID-19 World

41% of respondents in the survey, excluding those respondents from Germany, indicated that they had experienced an increase in symptoms of dry and tired eyes during the COVID-19 pandemic [3]. Almost 70% of respondents indicated that they would prefer to visit an ECP to discuss their dry or tired eye symptoms as opposed to trying to treat the symptoms themselves without professional consultation [3]. Roughly two-thirds of respondents agree with the fact that increased screen time during lockdown has had an effect on their dry and tired eye symptoms. The Centre for Ocular Research and Education, CORE, has also postulated a link between the use of face masks, commonly recommended to reduce the spread of the virus, and dry eye symptoms [7]. Now would be a good time for practitioners to be proactive in the discussion of dry eye symptoms with all patients, to ensure that all sufferers of dry eye symptoms are investigated and offered suitable treatment.

Takeaway points from the international survey of contact lens wearers about changes in their behaviour during the COVID-19 pandemic include: As testing and routine care resumes, it would be a good opportunity to ask patients about any symptoms of dryness they may have experienced during the lockdown. It is also a good time to re-educate patients on contact lens hygiene, given that many contact lens wearers improved their contact lens hygiene during the COVID-19 pandemic and were looking to improve their education on contact lens safety. Proactively offering patients an upgraded lens wearing experience through advanced technologies that may improve lens wearing times and/or comfort is likely to be well-received by the majority of patients, who may be willing to pay more for a lens that offers them extra benefits [3].

References

1.         IMF, World Economic Outlook, Update June 2020, in World Economic Outlook, I.M. Fund, Editor. 2020.

2.         RBA, Overview, in Statement on Monetary Policy, R.B.o. Australia, Editor. 2020.

3.         Alcon, Data on File – Global COVID-19 Impact on CL Wearers Survey. 2020.

4.         Jones, L., et al., The COVID-19 pandemic: Important considerations for contact lens practitioners. Contact Lens and Anterior Eye, 2020. 43(3): p. 196-203.

5.         Walline, J.J., M.D. Bailey, and K. Zadnik, Vision-specific quality of life and modes of refractive error correction. Optom Vis Sci, 2000. 77(12): p. 648-52.

6.         CDC. Benefits of Vision Correction with Contact Lenses. 2014  [Accessed: 25/06/2020]; Available from: https://www.cdc.gov/contactlenses/benefits.html

7.         CORE. CORE Alerts Practitioners to Mask-Associated Dry Eye (MADE). 2020  [Accessed: 20/09/2020]; Available from: https://core.uwaterloo.ca/news/core-alerts-practitioners-to-mask-associated-dry-eye-made/

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