The Dynamics of Contact Lens Dropout

The soft contact lens market worldwide is currently estimated at about 140 million wearers and growing, with an estimated 6% growth rate in 2026.¹ The US specific market is estimated to be 45 million wearers.²

This sounds impressive but only represents about 2% of the patients who could benefit from this mode of correction.³ Delving into how to expand this market has been discussed many times but in my opinion the topic of discontinuous wear or dropout is the major concern.

Consider the fact that contact lens dropout is a clinical failure; a patient who was interested in contact lenses and one who the office had invested a significant amount of time and resources in has failed.³ This fact deserves more attention. Defining the impact of dropout as well as how to identify the at-risk patient and a protocol on how to avert this issue is the aim of this paper.

Contact lens dropout: An underestimated problem

When asked about dropouts many of the doctors I’ve talked to believe very few of their patients have discontinued wear. I believe that they are grossly underestimating this group as many of them are “silent” dropouts; meaning they simply stop wearing and seek care elsewhere.

The basis of this opinion is based on data from a comprehensive review paper by Pucker on dropout, noting the published dropout rate in PubMed.gov papers is between 12 to 27.4% with the pooled mean being 21.7%.²

This means one out of every five contact lens patients in a practice could be at risk of being a dropout. In my opinion that’s alarming. Dropout rate does vary based on the complexity of the lens with spherical wearers being affected 19%, toric lens wearers 25% and multifocal wearers 31%.²

Thus the amount of dropouts per practice will vary to some extent based on the mix of patients they have but it’s clear that dropouts occur at all practices and are probably higher than most doctors estimate.

Cost of contact lens dropout

The successful contact lens patient represents a significant revenue stream for the practice, in a prior article I’ve noted these patients have more frequent office visits, make additional purchases such as sunglasses and backup glasses, and often refer friends and family.⁴ It’s been noted the revenue from these patients to be about 17% of the total practice revenue.¹

The cost of a dropout patient has been estimated to be $21,695 over the lifetime of the patient.² Doing the math, one sees that $21,695 times 22% of the practice's contact lens base is a tremendous income loss for a practice. These numbers should motivate all doctors to minimize dropouts and maximize the successful patients.

This could be accomplished by developing and executing a plan that includes:

Understanding the reasons for dropout
Identifying those at risk
Diagnosing the issue
Mitigating the underlying cause

Causes of contact lens dropout

The leading causes of dropout have been noted by several authors and have been consistent and interesting. Amongst the established wearer, contact lens discomfort and dryness have been regularly noted as the leading causes.

In Pucker's review paper, he noted the seminal paper by Pritchard from 1999 where discomfort was the leading cause of dropout from the 1,444 subjects in his work and Dumbleton in 2013 noted discomfort accounted for 24.4% and dryness 19.9% of dropouts in the 4,207 subjects she surveyed.²

You may be thinking that the introduction of SiHi lenses would decrease this rate and cause, but the data tells us that’s not the case. Pucker’s review noted that there is no association of gender or age to dropout rate and no consensus of material (hydrogel or SiHi) to the dropout rate.² Thus, everyone can and is affected.

What is noteworthy is that the neophyte patient is different. The leading cause of dropout of the new-to-wear group is vision at 57% and discomfort at 28%, so discomfort is still an issue but more importantly optimizing vision for this group is critical.²

Identifying those at risk

Following the strategy of collecting patient subjective and objective data allows the optometrist to easily identify those at risk as well as the underlying issue.

Subjective
- CLDEQ-8 (Contact Lens Dry Eye Questionnaire-8): Validated questionnaire. Values of 12 or greater are correlated with comfort and/or vision issues that put patients at risk of dropout.⁵
- SPEED (Standardized Patient Evaluation of Eye Dryness): Assesses ocular dryness but not vision and to date there is not an accepted cut off number.⁶
Objective
- Tear Meniscus Height: Aqueous deficiency is associated with <0.20mm.⁶
- Meibomian Gland Expression: Optimal is six glands or greater per lid yielding clear liquid expression. If less, consider meibomian gland dysfunction (MGD) and intervention.⁶
- Meibography: A very good visual metric to help educate the impact of MGD.
- Fluorescein Breakup Time (FBUT): Goal is 10 seconds or greater.⁷
  - Successful patients: 10.7 + 6.4
  - Dropouts: 7.5 + 4.7
- Non-Invasive Breakup Time (NIBUT): Goal is 17 seconds or greater.⁷
  - Successful: 17 to 22.7
  - Dropouts: 12 to 14.9
- Lip Wiper Epitheliopathy: Sign of inflammation and associated with discomfort.⁶
- Tear Osmolarity
  - Reading over 308 mOsm/L indicates ocular dryness.
  - An inter-eye difference of more than 10 is significant.⁶

Developing a standardized exam protocol

Now that the subjective and objective data is available, the optometrist should be able to determine the underlying cause of concern and develop a plan of action. Dryness and discomfort could be associated with meibomian gland dysfunction, aqueous deficiency, lid wiper epitheliopathy, or an issue with the wettability or edge design of the lens.

The remedy of these conditions are easily within the realm of the optometrist and might include the initiation of an ocular surface treatment plan or changing the lens material, modality, or design.

Vision-related issues could be addressed by:

Revisiting the refraction
Doing a red/green balance
Avoiding over-prescribing the add
Evaluating for any binocular abnormalities, such as an induced vertical prismatic imbalance in the monocularly corrected astigmatic patient

Based on the instrumentation at each office the optometrist could very easily use the above information to create a standardized exam protocol for both new and existing patients. Creating a summary of these findings could make presentation of this information to the patient very easy so the optometrist could then explain their treatment plan if needed and their contact lens recommendation.

By educating the patient in this manner they will enable them to make a well-informed decision, increase their opinion of the optometrist, and encourage them to be more open to premium products.

Conclusion

Contact lens dropout is a major concern for all practices and can have a devastating effect on the financial health of an office. Age, gender, and the use of SiHi lenses have not been noted to be correlated to dropout rate as such the optometrist needs to assess both new and existing patients constantly to determine who might be at risk.

By leveraging existing validated questionnaires and instrumentation available at all offices optometrists could very easily create a customized “report card” for each patient to summarize their unique ocular health and vision.

Such a tool will make the patient/doctor communication more effective resulting in a more informed patient thus allowing the doctor to initiate treatment and or make contact lens changes in advance of the patient exhibiting adverse symptoms which would lead to dropping out of lens wear.

Dropout is a major issue, but with a coordinated plan the successful practice can reduce this rate considerably.

Key statistics and takeaways

Soft contact lens dropout rate in 2026 is between 12 to 27.4% with the pooled mean being 21.7%.²
The leading causes of dropout in existing wearers are discomfort and dryness.²
The leading causes of dropout in new wearers is vision followed by discomfort.³
The cost of dropout in the US is estimated to be $21,695 over the lifetime of the patient.²
Dropout rates have not been correlated to age, gender or the introduction of SiHi material.²
There are well documented validated questionnaires and objective clinical data points that could be leveraged to determine who is at risk for dropout and help diagnose the underlying causes.5