When we imagine a first-time contact lens wearer, many of us probably picture a young, somewhat timid teenager. They may struggle to see distant objects clearly without their glasses, but they are hoping to reduce their spectacle dependence, perhaps for sports or personal appearance preferences.
While these patients certainly exist, this article explores the significant gap in contact lens recommendations and how we can overcome it. Data suggests far more people are interested in contact lenses than currently use them. These potential wearers aren't hiding though; they are right in our exam chairs.
A bit of background
As the Myopia Epidemic continues, more children are requiring vision correction at earlier ages. With their active lifestyles and years of potential prescription progression ahead, these children and their parents often seek contact lenses as an alternative to traditional glasses.
CooperVision’s MiSight soft contact lens is approved in the United States to slow the progression of myopia in children as early as 8 years old.1 There are also a number of orthokeratology designs that are FDA-approved to reduce myopic progression including Paragon CRT and ACUVUE Abiliti, with more options sure to follow. Some parents and providers may squirm at the thought of a young child working with contact lenses, but others will seize this opportunity to slow myopic change and reduce glasses breakages.
The Contact Lenses in Pediatrics (CLIP) study looked to compare the safety and effects of fitting younger patients in contact lenses.2 This trial demonstrated the young demographic had very similar ocular health results to their older cohort.2 They had comparable, low risks of complications from lens wear, and children reported better feelings of their self-image, confidence, and had higher rates of participation in activities.
A deeper look into contact lens market trends
On the other end of the spectrum is the growing population of presbyopes. The American Optometric Association (AOA) reported the number of presbyopes in the United States in 2024 to be roughly 130 million strong.3
Every practicing eyecare provider likely has experience with patients who are hesitant about transitioning to progressive lenses, or need vision correction following refractive surgery, or even those that “never needed glasses until readers.” All of these age ranges have landed the average age for patients to begin wearing contact lenses at 34 years old according to a 2024 international report.4
A 2024 report from the Contact Lens Institute (CLI) looked to examine the recent divide in contact lens recommendations for patients.5 They surveyed over 1,000 adults that used vision correction, of whom over half had no previous use of contact lenses.
According to the results, nearly 50% of spectacle-dependent patients state they were very interested in using contact lenses and only 20% had little to no interest at all. This feedback suggests nearly 80% of these patients were at least moderately interested in contact lens use, but only a meager 10% of participants received a recommendation for them by their eyecare provider.5
How we got here
There may be many explanations for the vast recommendation gap that we see with this data and in our clinics. There are a large number of misconceptions about contact lenses that exist, especially when it concerns inexperienced wearers.
Miscommunication may occur during the exam when a patient does not currently wear contacts, but they are unsure when to discuss their desire to begin using them. Additionally, providers may neglect to mention contact lenses as an option for those interested in using them on a less frequent basis such as for social events or sporting activities. Contact lenses do not have to be a daily driver for patients, but should fit their lifestyle.
Other times, a patient may have preconceived notions that they are not good candidates because of their astigmatism, their use of reading glasses, or dry eyes. Some patients feel that if lenses have never been brought up to them that means they are not a good candidate.
New wearers can be intimidated by the information load that comes with caring for contact lenses and they may be unsure about the procedure for inserting and removing the lenses.
Pearls for closing the contact lens recommendation gap
Closing the recommendation gap will not happen overnight for any office or the profession as a whole. While several steps can narrow this margin, the simplest approach is: Every patient can be a contact lens wearer until proven otherwise.
The designs, materials, and technology incorporated into modern contact lenses have never been more advanced. Silicone-hydrogel lenses provide fantastic all-day comfort, and soft lenses can incorporate high amounts of cylinder or even simultaneously correct astigmatism and multifocal optics.
Custom designs are available for irregular corneas and other ocular surface disorders. A number of brands can be found at nearly every price point and there are multiple replacement schedules from daily, weekly, biweekly, monthly, and onward.
These advancements open the door for so many patients who may be under the previous misconceptions about their lens candidacy. It may have been some time since they’ve brought up using contacts and they may be unaware of these new options.
Practical workflow for discussing contact lenses in the ofice
When it comes to contact lenses discussions and flow in an office setting, there are a few areas we can ensure the option is being presented. Lenses can be asked about or referenced at nearly each point in the patient experience to ensure ample opportunity is given to each person to discuss their interest.
History and intake questions from the appointment scheduler, technician, and provider can all ask if the individual is a current lens wearer. If the answer is no, a simple follow-up question is to gauge their interest in using contact lenses or being less reliant on their glasses.
If the patient mentions previous failure of lens use, gathering the details of that experience can be helpful. Perhaps they were trialing a poor-fitting brand, the prescription was never comfortable for them, or they may have had difficulty with insertion and removal.
Even patients who previously wore contacts may have discontinued use when they began needing reading glasses over them. This demographic can be ideal for discussing multifocal or monovision options.
To download a patient handout on contact lens insertion, removal, and care instructions, check out Contact Lens Care for Patients with Take-Home Instructions.
Adapting treatment plans to match patient needs
An additional, though off-label, approach I have had some success with in this group involves using presbyopia-correcting drops to supplement their distance-prescription contact lens wear. Again, this method is off-label, but it can be an impactful set-up for the right kind of patient.
In the previous scenario of the occasional wearer, daily-disposable lenses can be a terrific option. A one- to three-month supply of lenses can last these wearers much longer than that time frame since they won’t be worn every day. Framing lens purchasing decisions in this light can allow patients to be fit in a comfortable, convenient, and hygienic design that still allows flexibility with their wear schedule while maintaining affordability.
Even if a patient decides not to proceed with a contact lens fitting during their examination, staff at the checkout or optical area may still inform them of their contact lens benefits when reviewing insurance usage. This strategy may not change their mind in the moment, but can serve as an aid to their decision to begin contact lens wear later.
In 2016, a few offices in the US took this last strategy to the next level. They allowed patients who did not currently wear contact lenses to wear a trial pair during the optical phase of their visit. In doing this, they reported patients were nearly 13% more likely to purchase spectacles, spent about 20% more on their glasses, and were much more likely to proceed with a contact lens fitting in the future.6
Implementing contact lenses during the optical selection phase enhanced patient satisfaction and allowed them to visualize the eyewear more clearly. Furthermore, while this approach improved revenue gains during the trial period, the financial benefits would likely continue if patients transitioned into long-term contact lens wearers.
Setting the stage for new wearers
Novice wearers can experience a fair amount of anxiety during their insertion and removal training class. Keep this stage calm, clean, and concise. Patients may need a short break if they are beginning to get frustrated or their eyes are irritated from multiple attempts. Having staff know multiple methods for each step helps patients be more comfortable that they will still find a technique that suits them to accomplish this stage.
Providing new wearers with at-home materials on caring for their lenses can be extremely beneficial. The first day learning these steps can be overwhelming for some and they may have difficulty retaining all of the new information.
Practices can design handouts with insertion and removal tips and tricks, common questions, expectations during the first few days of use, and issues to watch out for. There are also online versions of these resources such as Johnson & Johnson’s ACUVUE LensAssist, which provide videos as well to help demonstrate different techniques.
Samples are a new wearer’s friend; they provide value to the fitting process, ensure they are beginning with recommended and reputable products, and can curb issues before they arise.
Tips for enhancing the contact lens experience for patients:
- Solution and case samples can even be helpful for daily lens wearers in the event a lens falls on a surface and needs to be cleaned or they need to remove the lenses to go for a swim or take a nap.
- Lubricating drops can help improve comfort during the first few days of use if irritation arises, though it’s important to recommend ones that are contact lens compatible.
- Small pocket mirrors are thoughtful inclusions for insertion/removal on the go.
- Specialty lens wearers also appreciate tools such as plungers and filling solutions to get them started.
- Carrying bags or watertight containers allows patients to keep a few small things on hand in case of an emergency while they’re out and about.
Bringing it all together
The distance between the number of patients fit into contact lenses and those who are interested in using contact lenses, but have not proceeded yet, may be considered more of a gorge than a gap. As eyecare providers one of our many responsibilities is to educate our patients on the options available to correct their vision. This includes spectacle lenses, refractive surgery, presbyopia drops, and contact lenses.
Depending on lifestyle, cost, appearance, and their ocular health, one or more of these options may be more appealing to them. However, they are still entitled to know what options exist for their specific situation.
As it pertains to contact lenses, gone are the days of restrictive parameters. Nearly every prescription and eye shape can be fit into a contact lens of one design or another. When patients are unsure how contact lenses will work for them, I tell them that we may never know until we try. Many of them are surprised to find that their prescription is available in a pair of lenses, or that they can indeed touch their own eye, or that they no longer need readers for the majority of their day.
In order for us to shrink this large recommendation gap, we need to rewire our brains to see each patient as a default-contact lens candidate. We should instinctively ask them about their interest in wearing them, even if on an occasional-use schedule. By educating our patients on all of their options we can uncover a new generation of comfortable, confident contact lens wearers who have been eager to be less spectacle dependent.
