From daily disposables to increased refractive surgeries, dropout and more
To sum it up, 2020 has been an interesting year of practicing optometry. Optometrists across the nation have stepped up to do their part in helping to decrease unnecessary ocular emergencies from clogging emergency rooms, freeing up space for COVID-19 patients.
In addition to the increase in certain ocular problems seen during the pandemic (such as computer- and mask-induced dry eye, corneal abrasions, central serous chorioretinopathy, and more), there also seems to have been a shift in trends regarding how contact lenses are prescribed and worn. As noted by several optometrists across the nation, there has been an increase in requests for first-time contact lensfits but also simultaneously an increase in contact lens dropout.
Increase in first-time fits
When asking first-time contact lens wearers in 2020 their motivations for wanting to try contact lenses, their reasons often include wanting to minimize the bulkiness of glasses on the face with the mask, the inevitable fogging of lenses, and “wanting another option while on virtual meetings.”
The dreaded fogging of lenses is not enjoyable for anyone. First-time contact lens fit requests have ranged from medical professionals, to chief executive officers (CEO), and office workers on the computer all day to those who had not considered contact lenses before the pandemic. The common goal is to have the option to eliminate the dependency on spectacle correction while performing important work-related tasks.
Note: The COVID-19 pandemic has seen an increase in what some are calling the “Zoom effect.” With millions of people utilizing virtual chat platforms across the world (such as Zoom), there has been an increase in the willingness to undergo cosmetic procedures and enhancements since the pandemic began.1 Although it has not been studied, it is interesting to note that a portion of patients who have requested first-time contact lens training may be doing so for cosmetic purposes to improve their selfie views.
In addition, after time in quarantine to reflect on the importance of good health, many patients have asked about daily disposable lens options after (re)considering the improved convenience, comfort, and quality compared to other extended-wear lenses. Daily disposable lenses have been my preferred choice for new soft contact lens wearers well before 2020; however, an added problem during the pandemic was accessibility to contact lens solutions. Rivaling toilet paper in some areas of the country during the pandemic, contact lens solution supplies were reportedly low and demand high, forcing some optometrists and patients to switch to a daily disposable modality for a period of time in 2020.
Also likely contributing to some of the increase in contact lens fits and sales, many patients have unused insurance benefits and/or excess health savings accounts (HSA) due to remaining at home most of 2020. In some cases, patients may have also been driven to purchase contact lenses from their hometown provider in an effort to support local businesses during this COVID-19 pandemic. Educating patients on their benefits and how to use them in conjunction with available rebates and discounts offered in-office have contributed to this trend of increased contact lens fits for new wearers.
Increase in contact lens dropouts
2020 also simultaneously saw an increase in contact lens dropout of many established wearers. Some reasons that patients reportedly decreased or completely stopped contact lens wear include wanting to avoid touching the face, concern for increased risk of infections, worsened dry eye, and a decreased need for contact lenses since “working from home and none of my colleagues see me.”
Note: Although many patients reportedly discontinued contact lens use due to fear of receiving an infection, there has been no statistical evidence that wearing contact lenses increase risk of COVID-19 infection.2 Interestingly, contact lens compliance and recommended hand-washing before application and removal was significantly improved during the COVID-19 pandemic because people were more cognizant of their hand-washing habits.3,4
Further contributing to contact lens dropout among patients is the increased risk of mask-associated dry eye (MADE) as well as incomplete blinking and decreased blink rate due to excess computer use.5 Millions of people across the world, including many optometrists, have pivoted to virtual events and increased daily digital use. Along with the millions of children now attending virtual school and millions of adults now spending 40 to 60 hours per week staring at multiple digital devices, many patients are at a higher risk for dry eye problems, increasing the likelihood of contact lens dropout.
Adding to the dropout rates, for some, the global pandemic may have meant loss of vision insurance or means to afford an expense such as contact lenses. Unfortunately, COVID-19 has caused widespread financial burdens, and it seems that for some patients, the luxury of wearing contact lenses is sometimes one of the first expenses cut from the budget.
In other cases, established patients are not willing to give up completely on contact lens wear; therefore, optometric practices may be seeing patients switch from an extended-wear lens to a daily-wear lens. Especially in the midst of a global pandemic, it is important for ODs to educate patients that contact lens wear can be an affordable, safe and healthy option.
Increase in requests for refractive surgeries
Some patients have decided that they would rather take a different refractive route, and a global pandemic encouraged them to finally take the leap. In practice, patients have inquired about refractive surgery options more frequently, which has led to more screenings across refractive facilities. I am curious to see the retrospective studies on the general trends in refractive surgery over the next few years after the COVID-19 pandemic.
Incidentally, in my experience more requests for refractive surgery screenings have yielded more undiagnosed keratoconus and other corneal dystrophies that have excluded patients from being candidates for surgery. Instead, we have been able to steer them toward the specialty contact lens route, thus contributing to the rise in specialty contact lens fittings during the COVID-19 pandemic.
Increase in specialty lens fits
If the COVID-19 pandemic revealed anything in the practice of Micaela Crowley, OD, and other specialty lens practices across the nation, it is the impact that scleral contact lenses have on a patient’s quality of life.
In the majority of cases, scleral lenses are medically necessary therapeutic devices that provide comfortable and functional vision for a patient to perform activities of daily living. Per Dr. Crowley, whether it was due to worry of a mishap with a lost, broken, or poorly fitting speciality lens or worry from a news source (falsely) suggesting contact lenses unsafe to wear, she saw an increase in scleral lens fits throughout 2020.
“Scleral lens patients were at the front of our minds early in the pandemic and our office made sure these patients knew that we were there for them,” Dr. Crowley says. “Many telehealth meetings were scheduled with scleral lens patients to ensure best hygiene practices and switching to a hydrogen peroxide disinfection system6 if it wasn’t already part of their daily routine. Depending on the concern, in-person exams were considered urgent for some of these specialty lens patients.
“Despite their undeniably life-changing potential, scleral lenses have the reputation of being time consuming and a logistical nightmare in a busy office setting. Reduced schedule spots and increased demand forced us to evaluate protocols and immediately adapt to remain successful during the COVID-19 pandemic. For scleral lenses in particular, it meant implementing a direct ship-to-patient delivery system, adding members to our scleral lens team, and bringing on new technology such as profilometry to streamline the fit process.”
1. Gelidan AG, Mrad MA, Kattan AE, AlEnazi TH, Bakraa RM, Barry MA. The Public’s awareness and willingness to undergo plastic surgery procedures during the COVID-19 pandemic. Plast Reconstr Surg Glob Open. 2020 Sep; 8(9): e3170.
2. Osborn G, Dumbelton K. Eye care professionals’ perception of the benefits of daily disposable silicone hydrogel contact lenses. Cont Lens Anterior Eye. 2019 Aug; 42(4):373-379.
3. Vianya-Estopa M,Wolffsohn JS,Beukes E, Trott M, Smith L, Allen PM. Soft contact lens wearers’ compliance during the COVID-19 pandemic. Cont Lens Anterior Eye. 2020 Aug 14;S1367-0484(20)30155-7.
4. Vianya- Estopa M, Garcia-Porta N, Piñero D, Mannion LS, Beukes EW, Wolffsohn JS, Allen PM. Contact lens wear and care in Spain during the COVID-19 pandemic. Cont Lens Anterior Eye. 2020 Nov 11;S1367-0484(20)30194-6.
5. Portello JK, Rosenfield M, Chu CA. Blink rate, incomplete blinks and computer vision syndrome. Optom Visi Sci. 2013 May;90(5):482-87.
6. Centers for Disease Control and Prevention. Contact Lens Care Systems and Solutions. Available at: https://www.cdc.gov/contactlenses/care-systems.html#hydrogen-peroxide. Accessed 12/21/20.