Room for growth

However, experts believe there is a vast opportunity still to grasp – whether in understanding patient attitudes, enhancing contact lens designs, or improving support in the practice room.

Painting a picture of the scale of this group of potential patients, Dimple Zala, professional affairs manager, UK/Ireland & Nordics, for Bausch + Lomb, shared that almost 50% of the European population falls within the presbyopia candidate age range. ^1,2,3

“83% of our patients will have some stage of presbyopia by the age of 45,” Ms Zala said.⁴

With research suggesting contact lens wear drop-out between the ages of 45 and 55 coincides with the onset of presbyopia^5,6, Ms Zala added: “This clearly shows that we have a huge opportunity still to tap into and serve the unmet needs of our presbyopic patients.”

Manufacturers agree that a key group of patients to approach for multifocal contact lenses (MFCL) are those already wearing contact lenses.

Sarah Weston, senior marketing manager, UK and Ireland for CooperVision, said: “There is a familiarity with the benefits of contact lens wear, together with experience of wearing and handling.”

But research also revealed a need to speak to patients about presbyopia early – before the onset of symptoms. The target group shared an interest in their eye care professional (ECP) informing them of presbyopia and advising them if MFCL would be an option, to enable them to make informed decisions in the future.

CooperVision head of professional services, UK and Ireland, Krupa Patel, highlighted a study by Hutchins and Huntjens (2020) which showed that pre-presbyopic contact lens wearers were generally more open to the idea of contact lenses for presbyopia, but reported not having received any information on this.

“It feels like a huge opportunity to support these patients,” Ms Patel said.

Exploring prescribing trends, insights from Johnson & Johnson Vision suggest that eye care professionals are more likely to fit a mature, or older presbyope, with a multifocal contact lens, but the manufacturer has identified three groups of younger presbyopes who would be open to trials.

The first group are existing contact lens wearers, agreed professional affairs manager for Johnson & Johnson Vision, Ian Pyzer, followed by, “The nine million emmetropes who, newly presbyopic, would be looking for alternatives to glasses – the ‘Ex-2020 Visioners.’”

The largest group, at 2.5 million patients, are those who find their spectacles inconvenient at times.

Mr Pyzer suggested: “An ‘optical wardrobe’ approach offers practices an opportunity to provide a variety of vision correction solutions to meet their presbyopes’ everyday needs.”

Untapped potential

Research suggests this is a growing segment of the market, with insights from the International Contact Lens Prescribing in 2019 report in Contact Lens Spectrum indicating that multifocal contact lenses accounted for 22% of soft fits in the UK.

The share of weekly or monthly soft multifocal contact lenses has continued to grow in the UK market over the last five years, from 5.6% to 9.8% at the end of 2019 (according to GfK Jan-Dec 2019).

“The number of presbyopes is steadily growing. Yet there is still an enormous amount of untapped opportunity,” Ms Zala shared.

“The number of potential presbyopes in the UK is around nine million people (people aged 45-54 years; ONS 2017) and with around 77% of this group requiring vision correction (Vision Needs Monitor 2013), this means there is the potential to fit around almost seven million people with multifocal contact lenses,” she said.

Menicon professional services director for Europe, Neil Retallic, too, saw a vast space in which multifocal contact lens prescribing can grow.

He outlined, “Although prescribing of soft multifocal lenses has increased over the years, it is estimated that globally around half of presbyopic soft fits are with a non-presbyopic lens, revealing the extent of market opportunity that still exists.”

The increasing trend in soft multifocal prescribing is one expected to continue, he suggests, particularly with the introduction of more daily disposable products.

This clearly shows that we have a huge opportunity still to tap into and serve the unmet needs of our presbyopic patients

CooperVison’s Ms Weston also identified “significant growth” in the segment, sharing, “our data shows that MFCLs are the fastest growing segment across the UK and ROI, and indeed, Europe.”

The trend towards silicone hydrogel daily disposable products across the wider contact lens category in particular, is set to continue as more manufacturers develop products to meet the demand.

Much of the growth can be attributed to wearer movement, Ms Weston suggested, from existing single vision contact lens wearers progressing to multifocal, or monthly wearers switching to the daily disposable variant.

“Growth for this segment of the category is also coming from new wearers, but is currently a less popular route, possibly as their ECP has not mentioned them as an option,” Ms Weston said. “Interestingly, our research has picked up on the ‘COVID-effect’ with one of the top reasons for consumers moving to MFCL being they are fed up with their glasses steaming up.”

Evolving designs

The visual and wearing comfort of MFCL has improved over time, with advances in design making the contact lenses a more appealing option for first-time wearers.

“Manufacturers have evolved multifocal designs to keep pace with the changing lifestyle and visual needs of presbyopes,” Mr Retallic said.

With a range of patients affected by presbyopia, from pre-presbyopes to the more advanced, the company has worked to adapt to their differing needs. Mr Retallic explained: “Our Menicon multifocals can provide visual benefits for anyone needing support with near vision, and our designs differ to match the usual progression of presbyopia.”

Ease of handling is an area that Menicon is particularly focused on, with a survey of presbyopic wearers revealing 92% had experienced handling issues. Solutions, such as the company’s Smart Touch technology, aim to address this, Mr Retallic said, “Especially for daily disposable lenses which we hope to launch in 2021.”

To address high levels of drop-out identified in MFCL wearers, Johnson & Johnson Vision worked on a design that accounted for the natural variation in pupil size, due not just to age but also refractive error.

“With the introduction of Pupil Optimised Design used in 1-Day Acuvue Moist Multifocal, for the first time, ECPs were no longer fitting hyperopes, who typically have smaller pupils, with the same optical design as their myopes with naturally larger pupils,” Mr Pyzer said.

The optical design incorporates the difference in pupil size for each 0.25D step as well as for each ADD.

Manufacturers have evolved multifocal designs to keep pace with the changing lifestyle and visual needs of presbyopes

Bausch + Lomb, too, has explored designs that go beyond the use of refractive error or pupil size alone. The company’s 3-Zone Progressive Design takes in additional factors including higher order aberrations, pupil diameters, corneal curvatures, axial lengths and residual accommodation, across nine distances in the optical design development.⁷

“In doing so, we found two adds addressed both near and intermediate needs of the patients, without compromising the distance,” Ms Zala said. “The design provides three distinct zones, a particularly wide intermediate zone, each with consistent power.” ⁸

Combining this design with its OpticAlign design, the Bausch + Lomb Ultra Multifocal for Astigmatism boasts an optimised ballast design with <5 degrees of rotation for 95% of patients.⁹ With a smaller axis indicator to help identify whether the lens is sitting at the desired axis of astigmatic power, the lens is designed to make for a simpler fit.^10,11

Manufacturers also pointed to comfort as a key issue, with innovations in design aimed to address issues with compromised tear film that can be common for presbyopic patients. Bausch + Lomb, for example, utilises its Moistureseal Technology which uses a proprietary two-phase manufacturing process to fuse water-loving PVP (polyvinylpyrrolidone) into a silicone hydrogel matrix for moisture retention.^{12,13,14,15,16}

Creating a positive story

The consulting room conversation and experience are all-important for engaging presbyopes in the possibilities that MFCL could offer, and manufacturers have developed a variety of tools to support practices.

Addressing barriers to fitting MFCL, CooperVision plan to deliver education and training programmes through the online Learning Academy and also include the topic at a CooperVision virtual conference as part of this year’s Virtual Perspectives clinical conference in April.

“ECPs have a key role in communicating to patients the benefits of contact lenses and in addressing consumers’ concerns, so building a positive story around presbyopia and MF contact lenses is the key to success,” Ms Weston added.

Research has shown that retention for MFCL wearers is lower compared to sphere and toric wearers, Ms Weston noted, adding that this is a focus area for CooperVision to address through new wearer retention programmes.

CooperVision launched its ‘My Lens Life’ programme in 2020 to reduce the number of new contact lens wearers that drop out in the first year. The programme is set to incorporate a multifocal element later this year.

The company also has campaigns and initiatives planned for the year ahead regarding multifocal contact lenses, including two, new pieces of ECP and consumer research into the communication and understanding of presbyopia. It is hoped that this insight will help to identify new ways to address barriers to wearing MFCL, Ms Weston suggested, “Growing the segment of the category as we go.”

CooperVision’s Biofinity toric multifocal contact lenses will become available in April, aiming to keep wearers that are astigmatic in contact lenses as they become presbyopic. The contact lenses combine the designs of CooperVIsion’s Biofinity toric and Biofinity multifocal products.

Discussing the product, Ms Patel explained: “With a 93% success rate on initial fitting and more than 200,000 unique prescription options, Biofinity toric multifocal will soon be a valuable tool for addressing patients’ evolving vision needs.”

Building a positive story around presbyopia and MF contact lenses is the key to success

As well as offering patient retention programmes, the company has upgraded its OptiExpert app to make contact lens selection easier, including an upgraded ‘smart prescription’ calculator.

Tools like fitting calculators are simplifying the selection of contact lenses, also helping to reduce the time spent in the practice room – particularly important in the pandemic.

Last year, Menicon launched its Multifocal Calculator to improve the possibility of achieving first fit success, something that can be particularly challenging when a patient might be approaching multifocal contact lenses for the first time.

The calculator offered an “instant starting point” to increase the chances of selecting the best lens, and with the lens’ Hi-Add design and decentred near zone, the company suggested the combination could offer high patient satisfaction, supporting loyalty.

The company has also recently launched educational tools for practices. Mr Retallic explained that the e-learning modules help ECPs to ensure their staff have all the information they might need about Menicon’s lenses, facilitating those conversations in the practice.

Supporting eye care professionals through continuing education and development has also been on the agenda for Bausch + Lomb in supporting the UK launch of its Ultra Multifocal for Astigmatism, including CET webinars exploring patient’s needs, tips and advice on fitting, and reviewing case scenarios.

Outside of this, the company has created practical tools for optometrists, Ms Zala said, “We are supporting practices throughout their patient journey by providing tools, like social media content and imagery, patient email templates, bundle deals with lens care solution, as well as a subscription and home delivery service.”

Meanwhile, Johnson & Johnson Vision has been working to support greater understanding of presbyopic patients’ needs, Mr Pyzer explained.

“We have always tried to make reaching out to their patients as easy as possible for ECPs, so we have created a range of digital materials that they can use to engage their presbyopic patients,” he said.

“During the last couple of years, we also invested to raise patient awareness about multifocal contact lenses and how they can improve their vision experience,” Mr Pyzer said, “We will continue to drive consumer awareness into 2021 with our new media campaign and PR activities.” 

References

1. Demographic outlook for the European Union 2020, EPRS (March 2020) European Parliamentary Research Service.
2. Population structure indicators, Eurostat (3 July 2020).
3. Population change, Eurostat (10 July 2020).
4. Holden BA, Fricke TR, Ho SM et al. (2008) Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol 126: 1731-1739.
5. Understanding the needs of pre-presbyopes and emerging presbyopes. (05/2014) Points de Vue. International Review of Ophthalmic Optics.
6. Vision Needs Monitor (2013).
7. Schafer, J., Steffen, R., 2019. Early clinical experience with Bausch + Lomb ULTRA Multifocal for Astigmatism Contact Lenses. Review of Optometry 15 June 2019, pp32-35. (14)
8. Reindel, W., et al., 2015. Ergonomic Utility of Progressive Multifocal Contact Lenses: A Comparison of Power Profiles Across Near, Intermediate and Distance Zones. AAO Poster Presentation. (23)
9. Bausch + Lomb ULTRA® Multifocal for Astigmatism stabilisation study. (REF-UMT-0031) (2)
10. Hovinga, K.R., 2016. Summary of Ultra for Astigmatism Orientation and Axis Markings (#LDR168019). (28)
11. Bausch + Lomb., 2016. A study to evaluate the product performance of two designs of soft toric lenses (#ROC2-16-016). Rochester (REF-UMT-0033) (4)
12. Results of an online survey with patients who wore their lenses for 7+ days and on average, spend 3 or more hours a day on a digital device (n=465). Survey questions were top 3-box scores (% Strongly Agree, Agree, Slightly Agree) on a 6-point agreement scale, with a margin of error ±2.4%. 2014.
13. Schafer J. et al., 16-Hour, bilateral, dispensing clinical evaluation of methacrylamide lenses as compared to Air Optix Aqua, Acuvue Oasys and Biofinity Lenses. 2013.
14. Gradient of PVP from surface to bulk Bausch + Lomb X-ray Photoelectron Spectroscopy analysis of samfilcon A of PVP gradient from surface to bulk. 2013.
15. R. Steffen, O.D., M.S., D. Hook Ph.D., J. Schafer, O.D., M.S., FAAO, I. Nunez, Ph.D., New Technology Yields Dehydration Resistance.
16. Katarzyna A. Wygladacz, Anthony Taddei, Daniel J. Hook, Surface and Bulk Poperties of a Novel Inherently Wettable Silicone Hydrogel Material.