Contact lens commoditization: Looking forward and back

Contact lenses are increasingly viewed as a commodity, not a medical device, especially in recent years with pressure through legislation from online retailers.

In business literature, commoditization means a lack of meaningful differentiation in goods. Commoditized products are largely sold on the basis of price, not brand. This process would create the perception that all contact lenses are created equally in the eyes of the consumer.¹ 

Our job as eye care professionals is to provide our patients with the best possible options for their personal visual demands. Contact lenses are one of the primary correcting options and, the desire to wear them spans centuries (see box, “History of contact lenses”).

Medical devices are not commodities

Contact lenses have been and are considered a medical device. The Food and Drug Administration (FDA) functions “not only as industry regulator and consumer protector, but also as scientific advisor and consumer educator regarding medical devices, drugs, foods, cosmetics, and veterinary medicine. Medical devices are regulated within the Center for Devices and Radiological Health. Contact lenses are regulated under the authority of the medical device amendments.”²

Most contact lenses that are removed daily fall within Class II medical device category. They are in this class as they “provide a reasonable assurance and safety and effectiveness”. Other things regulated in this category are x-ray systems. Extended wear contact lenses are regulated as Class III medical devices because they pose a higher risk of injury. This is the same category as heart valves and pacemakers.³

I challenge this contact lens commoditization concept in that these medical devices are equal-very far from it. Many eyecare professionals will use everything in their contact lens toolboxes on a given day in order to take care of their patient’s visual needs. Contact lens practitioners today are able to choose from a variety of new contact lens materials, lens care solutions, moisturizing eye drops, and prescription therapies to help with various contact lens-related needs.

For example, a 49-year-old female patient presented looking to wear contact lenses again due to blurred vision at near. She had LASIK 10 years ago and was happy with the results until recently when she had needed to wear her readers more and more often. Her refraction was slightly hyperopic (+0.50 D OD, +0.75 D OS) at distance and required a +2.00 D add. It is difficult to maintain stable vision in LASIK patients because of the altered corneal architecture. The central flattened cornea can be difficult for soft lenses to conform to and will, at times, lead to the lens vaulting the cornea. This will inherently result in visual instability between blinks.

If the patient could choose any multifocal contact lens she wanted, her visual success would be extremely unsatisfactory. She would most likely not wear contact lenses and never try them again, thus contributing to fewer contact lens wearers in the market. This patient ultimately needed a flatter fitting contact lens which did not vault her altered cornea, resulting in better visual acuity at distance and near.

This patient’s success was achieved through my knowledge of and experience in fitting contact lenses. Choosing the lens with the lowest price would not have netted a similar outcome.

Many outside forces can challenge contact lens comfort during long days in front of visually demanding tasks, such digital device usage. Innovation continues strong with many new daily disposable lenses, multifocal and toric designs, which can enhance our patient’s lives. These products are constantly evolving to address these needs of our patients, including lenses to improve ocular surface health, better eyesight at multiple distances and most importantly to improve the comfort.

Optometrists have been closely involved in the development of this technology from its early beginnings to where we are now with nearly 41 million contact lens wearers in the U.S.⁴

Contact lens legislation

Online contact lens retailer 1-800 Contacts has been aggressive via legislation in the past year to increase its contact lens sales.

However, the fight to commoditize contact lenses has been ongoing for more than a decade.

Let’s take a look at four pieces of legislation that affect contact lens prescribing.

1. 2003 Fairness to Contact Lens Consumers Act

This act deals with the availability of contact lens prescriptions to patients. There are many aspects to this bill, but primarily states that there are rules for the prescriber and the seller of contact lenses.⁵

In short, the prescriber:

• “Shall provide to the patient a copy of the contact lens prescription”

• “Shall, as directed by any person designated to act on behalf of the patient, provide or verify the contact lens prescription by electronic or other means.

While the seller “may sell contact lenses only in accordance with a contact lens prescription for the patient that is:

• Presented to the seller by the patient or prescriber directly or by facsimile; or

• Verified by direct communication.

The grey area happens in a couple of areas. First, the prescriber has eight business hours to communicate with the seller after receiving a request. Many requests come in at times when the prescriber does not have an opportunity to respond within that time frame, such as over a weekend or holiday. Additionally, a seller may not alter the contact lens prescription in any circumstance unless that same contact lens by the same manufacturer is sold under multiple labels. The seller can sell that lens under any of the available labels.

2. 2004 Contact Lens Rule: A Guide for Prescribers and Sellers

The Federal Trade Commission (FTC) issued the Contact Lens Rule in July 2004 to spell out the Fairness to Contact Lens Consumers Act’s requirements.⁶

The Act increases consumers’ ability to shop around when buying contact lenses and gives consumers certain rights, imposes duties on contact lens prescribers and sellers, and requires the FTC to develop and enforce implementing rules.

3. 2014-2016 Universal pricing policy (UPP) under attack legislatively with bills in various states

UPP is a method by which manufacturers protect the brand of their products. By setting the lowest price, manufacturers prevent that product from being a “discount” product. UPP has been applied in many other markets, including clothing, high-definition televisions, cell phones, sunglasses, and others, notably including Apple products. UPP is usually set on the newest products and/or technologies.

Anti-UPP bills have been supported by 1-800 Contacts, Costco and others; while these bills are generally aimed at eliminating UPP, some have decided to push the envelope further, especially in Arizona.⁷ These bills are attempting to eliminate expiration dates and contact lens brand on prescriptions, prevent eyecare providers (ECPs) from selling contact lenses, and allow online refractions/vision kiosks to prescribe contact lenses without an ocular health examination from an ECP.

These legislative efforts sponsored by online retail sellers attempt to remove the ECP from the equation and drive business directly to their outlets-but they are also extremely bad for patient safety.

4. 2016 Contact Lens Consumer Health Protection Act

SB 2777, sponsored by Sen. Bill Cassidy, MD (R-LA), and currently in the Senate, “amends the Fairness to Contact Lens Consumers Act to require contact lens sellers to provide a toll-free telephone number and email address that prescribers can use to ask questions about a seller's prescription verification request.” Currently, the law is a passive verification process in that the seller can sell any lens if the prescriber fails to communicate within the eight business hours after receiving the request.⁸

If the prescriber communicates a question or concern through the toll-free telephone service or email address within the eight-hour window, this bill would require the prescription to remain unverified until the seller obtains confirmation on the accuracy of the prescription from the prescriber.

Such legislative attacks are taken very personally by ECPs and are often directed at online contact lens retailers’ own financial gains. ECPs want their patients to be safe with contact lens wear and have the best possible visual outcomes.

References:

1. BusinessDictionary.com. Commoditization. Available at:

http://www.businessdictionary.com/definition/commoditization.html#ixzz4AiGMlRkj. Accessed 5/19/16.

2. Lippman RE. The FDA role in contact lens development and safety.

Cornea. 1990;9 Suppl 1:S64-7; discussion S68.

3. Arizona Bioindustry Association. Why Contact Lens Wearers Benefit from Annual Eye Exams. Available at: http://www.azbio.org/why-contact-lens-wearers-benefit-from-annual-eye-exams. Accessed 5/19/16.

4. Centers for Disease Control and Prevention. Healthy Contact Lens Wear. Available at: http://www.cdc.gov/features/healthy-contact-lens/. Accessed 5/19/16.

5. Congress.gov. H. Rept. 108-318 – Fairness to Contact Lens Consumers Act. Available at:  https://www.congress.gov/congressional-report/108th-congress/house-report/318/1. Accessed 6/5/16.

6. Federal Trade Commission. The Contact Lens Rule: A Guide for Prescribers and Sellers. Available at: https://www.ftc.gov/tips-advice/business-center/guidance/contact-lens-rule-guide-prescribers-sellers. Accessed 6/5/16.

7. AZLeg.gov. HB 2523. Available at: http://www.azleg.gov/legtext/52leg/2r/bills/hb2523p.pdf. Accessed 6/23/16.

8. Congress.gov. S.2777 - Contact Lens Consumer Health Protection Act of 2016. Available at: https://www.congress.gov/bill/114th-congress/senate-bill/2777?q=%7B%22search%22%3A%5B%22S.2777%22%5D%7D&resultIndex=1. Accessed 6/5/16.

9. Bowerman M. Study: Bad hygiene a problem for nearly all contact lens users.” USA Today. 2015 Aug 20. Available at: http://www.usatoday.com/story/news/nation-now/2015/08/20/contact-lens-bacteria-eye-infection-blind-cdc/32049205. Accessed 1/3/16.

10. Brujic M, Miller J. Contact lens follow-ups; Point-Counterpoint. Optometry Times. July 2014. Available at: http://optometrytimes.modernmedicine.com/optometrytimes/content/tags/contact-lens/contact-lens-follow-ups. Accessed 6/5/16.