I began practicing optometry in 1983, and over these past 40+ years I’ve seen the interaction between patients and doctors change. One area that has changed dramatically is how patients purchase their contact lenses. Contact lenses had been viewed as an alternative basic vision correction but have now morphed into a comfort-focused eyecare segment.1
Back then, a soft contact lens fit required measurements of corneal curvature, visible iris diameter (most lenses came in different base curves and diameters), and refractive findings. Then came a trial fit with a diagnostic lens and spherical lens over-refraction.
Next, we ordered a retail lens. Once that arrived, the patient returned for a lens evaluation. If everything looked good, we dispensed lenses to experienced wearers, taught new wearers insertion and removal, and sent them home with their new contacts.
In either case, these patients were charged a global fee for the contact lenses and the professional fees, with no breakdown. Patients then wore this same pair of lenses until they either lost or tore a lens or until they returned a year later, usually with red, irritated eyes. At that time, the concept of getting their lenses from anywhere other than their local eye doctor was never a consideration.
The evolution of expectations
Things have changed; patients have now come to expect instant gratification in all aspects of their lives, including their eyecare. The big change occurred in 1987 when a new contact lens company known in the US as Vistakon introduced the first disposable contact lens, which was then offering “free” trial lenses.2 So, for the first time, patients could go home with their correction versus waiting for their prescription.
Cost and convenience are primary reasons patients purchase contact lenses online,1,3 so the growth of direct-to-consumer lens sales, which began with 1-800 Contacts in 1995, should be no surprise.4
As an optometrist in this landscape, we need to be aware of a patient's expectations and adapt to the market demands to be effective. The intent of this article will be to review the current market trends and offer suggestions for the savvy optometrist so they can compete in this market.
Current market trends
The soft contact lens market is strong and growing. According to Grand View Market Research, the market size as of 2024 was $9.8 billion worldwide, expected to grow to $11 billion in 2026, a compound annual growth rate (CAGR) of 8.1%.1
North America dominates the market with a 37.2% market share. About 70% of this share is within the silicone hydrogel material products, and daily disposable being the fastest-growing segment.1,5
The fastest-growing form of correction in the US is astigmatic correction; therefore, we need to make sure we are correcting low astigmatism and monocular astigmatism with the most comfortable and stable products.
What I find amazing is the fact that according to the Centers for Disease Control and Prevention, only 50% of the US patients with vision-related issues are seeking care; thus the opportunity for growth is staggering.1
Competing with convenience
So, our soft contact lens patient base should be growing if we are offering this form of correction to those who want and need it; great news, but where are our patients buying these products? Optometry is a unique profession as one of the only ones that not only prescribes products but also sells them. As we see in other markets, new vendors cause disruption when unmet needs are identified.
In the case of soft contact lenses, it was cost and convenience that led to the e-commerce industry. In this year’s annual report in Contact Lens Spectrum, Dr. Nichols reported that about 61% of patients purchased contact lenses from their practice, slightly up from 2025 when it was 59%; 28% purchased from online retailers and 8% from a third-party retailer.6
This data differs from Grand View Market Research’s data, which noted 45.2% of sales occurred in the office. Grand View does see e-commerce growing considerably with a CAGR of 9.68%.1 I think the difference in the above data between Contact Lens Spectrum and Grand View is that the Contact Lens Spectrum data comes from doctors’ perception of what’s occurring in their practice versus a market research survey directly from patients.
In either case, the purchase of soft contact lenses via internet sales is increasing; the goals of every optometrist should include being competitive with online sales outlets and providing the best value for their patients.
Preparing a plan of action for contact lens practices
As Doctors of Optometry, we should always put our patients’ best interests at the forefront. Although our patients very often are motivated by the lowest cost, we need to educate them about the value they receive.3 A big part of that value is the professional care they receive.
Purchasing lenses outside the eyecare practitioner's office, including from online retailers, has been associated with reduced adherence to recommended wear and aftercare practices, and the 2023 TFOS Lifestyle report identifies unregulated purchasing and missed aftercare visits as lifestyle choices with adverse consequences for ocular health.7
I recall when I was a student at PCO back in the 1980s, the idea was suggested that we should charge for our professional knowledge accordingly and sell products at cost. This sounded like a rebellious idea, but with today’s changing environment, it may be very wise advice.
In a recent Review of Optometry article, Dr. Joseph Shovlin was quoted as saying, “We learned a long time ago your profit will come from what you know and do—your expertise in choosing the right lens for the right patient.”8
The power of professional fees
So, maybe this idea of charging more for professional fees and less for products isn’t so crazy? Years ago, we bundled contact lens sales; $400 would get you the contact lens fit, follow-up, and a pair of soft lenses.
Then online retailers offered replacement lenses at a very low price. Optometrists started to unbundle their global fee to compete with online offerings, but we need to do a better job being transparent about what’s included in the professional fee so patients understand the value they are getting.
Competing on box price alone is not sustainable; the edge we have as optometrists is our expertise, convenience, safety, and outcomes. Dr. Sampalis was quoted, “It’s our opportunity as doctors to let the patient know why you fit that contact lens and what you’re doing.”8
So, it appears the best course of action may be to fit quality products, educate the patient on their condition, explain why we are prescribing a particular product, and be transparent on our pricing and how it compares to alternative outlets. This sounds simply like good care to me! I’ll now offer up a few concepts to help do this.
Concept 1: The report card
Educating our patients is the best way to ensure compliance and show the value of our exam. Most patients I find are visual, thus need to see their findings in addition to hearing them. Think about when you do your annual blood test, you get your results in a tabular format with notations if each test is normal, high, or low.
Seeing your results is much more impactful than your primary care physician simply telling you your total cholesterol is high, your LDL is also high, but your HDL is low. Seeing these results allows you to recall the results, so when they put you on a statin and your numbers go down, you see the results and you comply with taking your medication.
So, can we do the same with our contact lens findings? Yes, collect the following and create a scorecard for your patient:
Contact lens scorecard
| Testing | Scoring Goal |
|---|---|
| CLDEQ-8 | Ideal less than 12 |
| FBUT | Ideal greater than 10 |
| NIBUT | Ideal greater than 17 |
| Tear Meniscus Height | Continuous and greater than 0.20 mm |
| Meibomian Glands | Ideal 6 or greater, secreting clear liquid |
| Lid Wiper Epitheliopathy | Negative |
| Tear Osmolarity | Less that 308 mOsm/L and less than 10 mOsm/L difference per eye |
Creating this card with a floating scale of red, yellow, and green could be very impactful for the conversation with the patient and help them understand the value of the product being prescribed as well as the value of your professional assessment.
Concept 2: Side-by-side pricing
Transparency in pricing is key for patients to understand how your office compares to online retailers. No need to let your patient leave and surf the internet for pricing when you could very easily provide them with the data.
Dr. Brad Boyle does this very well on his office website, Advanced Family Eye Care (AFEC). He shows a side-by-side comparison of his prices versus 1-800 Contacts and Walmart.9 Below I’ve copied over his online pricing comparison of 2 Week Acuvue Oasys.
ACUVUE Oasys (1-year supply)
| AFEC | 1-800 Contacts | Walmart | |
|---|---|---|---|
| Retail | $280 | $312 | $286 |
| Rebates | $50 | $40 | $20 |
| Shipping | Free | Free | Free |
| Total | $230 | $272 | $266 |
Table courtesy of Brad Boyle and Advanced Family Eye Care.
Concept 3: Billing for your time
When we get service on our car, we see a breakdown for each service with a charge for labor and materials. In my opinion, we should be doing the same for our yearly contact lens evaluation.
This lens evaluation is an “add-on” to the comprehensive exam and should be billed as such. If you aren’t doing this, I would suggest you consider adding it to your billing with a small adjustment.
Let’s say we charge an additional $25 for this professional service; I would then suggest rewarding those patients who purchase lenses with a $25 loyalty rebate on contact lenses purchased from the practice.
Those who walk away with their prescription obviously don’t get this rebate, but they do pay for the service since you are evaluating their contact lenses and providing their prescription. This allows you to show even greater value of staying with your practice.
If we use Dr. Boyes' side-by-side from above, it might now look like the following:
ACUVUE Oasys (1-year supply)
| AFEC | 1-800 Contacts | Walmart | |
|---|---|---|---|
| Retail | $280 | $312 | $286 |
| Rebates | $50 | $40 | $20 |
| Shipping | Free | Free | Free |
| Loyalty Rebate | $25 | None | None |
| Total | $205 | $272 | $266 |
So, it’s easy to see the great value from buying lenses from Dr. Boyle.
Key takeaways
- The soft contact lens market is strong and growing.1
- Online retail contact lens sales are considerable and growing.1
- Optometrists should be educators, not salespeople. Today, more than ever, it's critical we educate our patients on the value of the exam and the products we prescribe.
- Transparency in our clinical findings and charges is key.
- Develop a strategy on how best to show the value your office provides to your patients in an easy-to-read format that is accessible to everyone.
Conclusion
The profession of optometry continues to evolve; our scope of practice advances and the technologies we use allow us to be more effective and efficient. So, it shouldn't surprise us that our patients' access to products evolves.
As such, we need to make sure we evolve our systems to stay in touch with the ever-changing demands of our patient base. Providing transparent and competitive pricing is one part of this equation, but most importantly, we need to communicate the value of our professional services and products so our patients can make a well-informed decision on their care.
