Advocates for contact lenses in Australia are a committed bunch, but as Insight finds out, they make a good argument that others in their industry may be missing out on a chance to improve not only their patients’ vision but their practices’ bottom line.
It’s one of the great ophthalmic mysteries.
Australia is a country known for its love of the outdoors and the many sports enjoyed in the long, hot sun that bakes the Lucky Country.
But despite this clear leaning towards an active, outdoor lifestyle, the people enjoying it have not warmed to the full spectrum of vision-correction tools that would help them make the most of it.
Contact lenses don’t always get the love they perhaps deserve in the shadow of those flashy, fashionable frames, and appear to be largely consigned to those patients whose optometrists actively suggest them, or to those experiencing very specific eye conditions.
And the experts interviewed by Insight are among many to scratch their heads and wonder why that is, despite Australia’s world-leading research, innovation and education in the area. And, of course, the satisfaction patients can achieve in contact lenses or as a ‘dual wearer’.
Part of the problem lies in traditional barriers to contact lens adoption, including well-documented fears about putting something in your eye, hygiene and the risk of infection, and cost.
These are common issues around the world.
But those experts also highlight the industry’s role in this particular Australian mystery, including some business models that don’t always build in adequate time, resources and capacity to sit down with patients for a contact lens consult.
Let’s get to that later.
Firstly, let’s consider the opportunities in promoting contact lenses.
Depending on what you read, there is reportedly plenty of growth tipped for the global contact lens market.
Reports from international market analysts, including Coherent Market Insights and Fortune Business Insights, value the industry at between US$10.45 billion and US$19.52 b. In Aussie money that’s between AU$16.25b and AU$30.35b.
And they expect that to grow by between 6.5% and 8.7% in compound annual growth (CAGR) in the next seven to eight years.
Despite that global market being worth many billions of dollars, Australia generated just AU$190m in contact lens sales in 2024, according to Germany-based online data-gathering platform Statista.
That suggests there is plenty of room to move if Australia is to realise the full potential of the contact lens market.
Beyond the macro trends, there are many benefits at the practice level too, as pointed out by a number of experts and practitioners.
They believe that investing more time in a patient and discussing options that include contact lenses builds greater trust, increases loyalty and encourages more referrals from friends and family.
They are also less likely to source their contacts online, preferring to deal with the practice. And these practices are finding plenty of ways to get round what others see as barriers with contact lenses.
As Optometry Australia’s 2020 Vision Index confirms, for a number of reasons, contact lenses continue to strike the glass ceiling with patients.
Two-thirds of the 1000 Australians surveyed wore prescription glasses, with just 13% in prescription contact lenses.
But the same survey revealed that 41% of Australians would prefer to wear contact lenses over glasses while playing sport, even if many didn’t end up doing so.
Intriguingly, other figures suggest that might be because they were either discouraged from wearing contact lenses by their optometrist or possibly not offered them as an option at all.
A US study of consumer perceptions by the Contact Lens Institute (CLI), which would be of interest to Australian practitioners, shows among glasses-only wearers, contact lens trials are largely underutilised.
Thirty-two per cent of that patient population said that a free trial would increase their consideration. Yet among the subset who reported that contact lenses were discussed at their most recent exam, only 10% were subsequently offered trials.
CLI says “our profession has inadvertently made glasses and contacts an ‘either-or’ selection, when the real choice lies in having the ability to pick between the two on any given day and time to suit ever-changing environments”.
Another figure hints at an opportunity lost – at least for now.
The Contact Lens Spectrum has been monitoring the market for close to 30 years.
It started in 1996 as a United Kingdom-only initiative but now collects data from 71 countries.
Its figures show that, similar to other nations, Australia’s uptake of contacts surged around 2007, with the evolution and growing popularity of disposable soft contact lenses. That continued over the next decade but once again hit the glass ceiling and plateaued around 2017, leaving Australia possibly lagging behind other countries, and certainly its counterparts in the Asia-Pacific region.
So the opportunity exists, but how can Australia fully realise it?
Stymied by short-sightedness
Associate Professor Tony Phillips knows plenty about the value of contact lenses for patients and practices, and the loss of opportunity in not promoting them to a wider group.
Few have done more in Australia to advocate for the use of contacts, drive innovation of the product and train others in their use than the now-retired A/Prof Phillips.
So significant has his contribution been over almost six decades that he was recently awarded the 2024 Ken Ball Medal by the Cornea and Contact Lens Society of Australia (CCLSA).
A/Prof Phillips moved to Australia from the UK in the early 80s to join SOLA Optical, an Adelaide-based company looking to develop the world’s first disposable contact lens.
“I had to fit rabbits with lenses; all that was done and we went on to the human trials,” he says.
“The case design was all finalised, and we had a really good product that seemed to work extremely well.”
But like earlier, unsuccessful versions of their world-first design, the project began to unravel due to personnel changes and politics and was then shelved.
“The sad thing was that, at that point, we were several years ahead of the rest of the world.”
To this day, A/Prof Phillips struggles with the short-sightedness of that decision.
And he’s equally perplexed about why contact lens penetration is behind where he might expect it to be in Australia.
“I’ve no idea why,” he says. “We’ve got very good practitioners. The training is very good.”
After a little more prodding, A/Prof Phillips suggests that Australia’s largely hot, dry climate might not be ideal for contact lenses, possibly exacerbating any irritation.
But like others, he thinks more could be done to create a framework that supports contact lens prescribing.
“It’s so much easier and less time involved to simply prescribe spectacles,” he says, “and the Medicare fees when involved are very low if they are intended to cover an initial fitting appointment, an instruction session and an average of, say, two after-care follow-ups.
“With many optometrists being pressured to cut the examination time down, this does not leave sufficient time to discuss alternative corrective options such as contact lenses, the types of lens available, and the various pros and cons.”
He believes the points noted above have taken the “fun and clinical challenge” out of fitting lenses and that some of this could be addressed by practices charging above the Medicare rebate, to make contact lens visits a more viable financial option.
That would also give professionals more time to discuss lenses and at least give patients an option.
Contact lenses often in the ‘too hard basket’
Mr Gavin Swatz acknowledges that contacts can be a challenge for some businesses and their commercial models.
Swatz is director and chairman of the Abernethy Owens group of optometry practices in Western Australia. He is also the vice-president of CCLSA, a lecturer in contact lens use at the University of Western Australia and is completing a PhD on different ways to improve outcomes in complex keratoconus cases.
He got into optometry because he felt it was the perfect mix of health and physical sciences, but he realises that many businesses sometimes struggle to offer a perfect mix of options for patients with vision issues.
“I think that sometimes there is a lack of time to spend with patients, fitting multifocal lenses and the number of visits required,” he says.
“I think a lot of optometrists might shy away from them, and some environments aren’t necessarily as conducive to spending time on the more complicated cases.”
Frames also appeared to make more cents and sense on the bottom line too.
“There’s certainly bigger margins in glasses than there are in disposable contact lenses, and the internet sellers have really commoditised the disposable lens, where it’s really become a volume game.”
But there remains a major advantage in the contact lens space, especially for independent practices.
“I think that’s when independents need to be looking for their points of difference,” says Swatz.
“If you’re trying to compete with corporates on the same playing field, you’re not going to win, so you need to be looking at service-based offerings that really enhance that care for your patients.”
Beyond those patients for whom contact lenses were the best option, there were potentially many others who may not have thought that they could wear contacts occasionally.
As the Vision Index 2020 figures showed, 41% of Australians would prefer to wear contact lenses while playing sport but some were discouraged from doing so by their optometrists and other perceived barriers.
“There’s certainly a lot of patients who wear spectacles and think that they can’t wear contact lenses, and would like the opportunity to be able to wear contact lenses when they’re going out, going to the gym, etc,” Swatz says.
“So you’re not losing the spectacle business; you’re actually enhancing that and increasing that engagement of that patient in your practice.”
More time spent with these patients on fitting, instruction and follow-up helped to establish a relationship of trust and increase the likelihood they would return for help with other vision issues and spread the word among family and friends.
But that time was valuable in a busy practice with a premium on chair time.
To help with that, Swatz empowers a team member to be the “champion” for contact lenses within the practice.
“They can have insertion and removal instruction sessions booked into a spare room to free up your clinic chair time,” he says.
“It’s always great to ‘pop in’ on these sessions to see how they’re going and offer encouragement, as this gives the patient confidence that this session is under your oversight.”
The practice and the patient have gained even more confidence from the advancements in contact lens technology, which have lowered many of the traditional, troublesome barriers for uptake.
“The advances in corneal topography and the associated software have enhanced our ability to understand our patient’s corneal shape,” says Swatz.
“This allows us to better understand potential outcomes and make better lens choices. The improvements in access to corneal tomographic devices like the Cylite HP-OCT means we can have more accurate data on highly complex corneas for specialty lens fitting.”
That technology has also helped in the ongoing competition from online providers.
“These lenses are tailored specifically to meet the needs of our patients and are unable to be offered by online retailers that otherwise treat contact lenses as a commodity, rather than the medical device that they are.”
Also, to help with the financing, Swatz charges a fitting fee that may or may not be covered by Medicare, depending on the circumstances, and he issues 12-month prescriptions for contact lenses, encouraging the patient to return for further check-ups.
Changing a life and powering a practice
Ms Jessica Chi understands the opportunities and advantages that contact lenses can bring – professionally but also on a personal level.
Before she became an optometrist, the owner of Eyetech Optometrists in Carlton, Melbourne; the Victorian president of the CCLSA; and a contact lens specialist, Chi was a young myope who lacked confidence.
“I remember putting glasses on for the first time and thinking, ‘Oh, my God, everything is so clear’,” she says.
That helped her vision, but not her confidence; she was desperate to fit in but couldn’t help standing out because she was overly tall and not many others were wearing glasses back then.
“I hated wearing them,” says Chi. “I thought they made me look like such a nerd.
“So I became quite shy and introverted, and often I would not wear my glasses, which further reduced my confidence because I couldn’t see.
“At 13 I started wearing contact lenses, and I know it sounds really cliche, but they really changed my life, especially with sport and also just self-confidence.”
It’s part of the reason why she has always been so passionate about contact lenses. That passion drove her to specialty contact lenses, with her clinic prescribing a large number of orthokeratology, for keratoconus and irregular cornea and ocular injuries.
Those can be tricky and time-consuming, so much so that a third of the practice’s referrals come from other optometrists.
She understands that time is money in the competitive optometry business, which is why, like Swatz, she will do the main consult and then pass the patients on to other staff.
“I don’t do the tuitions at my practice,” she says. “If you delegate that to one of the other staff, then they can spend two hours with the patients and they’re not eating into the more valuable optometry chair time.”
Neither is she too hung up about selling contact lenses.
“If you charge appropriately for your services, then with the contact lenses, if they buy from you, great; if they don’t, then you haven’t lost anything.
“Look at dentists – they don’t make money on toothpaste and toothbrushes, so why should we make money on contact lenses, right?”
She admitted there was not a lot of money to be made in soft contacts, but the margin on specialty contact lenses was high because they were custom-designed – “and that’s not something that they can buy on the internet”.
Chi thought many optometrists were missing out by not offering contact lenses to complement their patients’ glasses.
“It’s very rarely glasses or contacts, because most people that wear contact lenses will need glasses as well.
“And it might be too difficult to wear contacts and be comfortable all day, but it doesn’t mean that they can’t have something to wear for social occasions or on the weekend or when they’re playing sports.”
That was simply about giving people the option.
Chi’s practice will start doing that from the first interaction with a patient.
“We ask them, when they book in, whether it’s for glasses and or contact lenses. We ask them if they want contacts, if they wear contacts, or if they’re interested in contacts. And our optometrists will always talk about contact lenses during the consult.”
They are also happy to promote themselves as confident wearers of contact lenses. And they have some novel ways to address concerns and fears.
Chi will offer patients contacts lenses to help them choose their frames.
“They think that it’s going to be uncomfortable, that they’ve got something plastic in the eyes, but then if you can get it into the eyes and they can feel it, they can feel actually really comfortable.”
Fear about putting something in the eye can be conquered with practice and support. Even plenty of return visits.
That creates plenty of touchpoints, says Chi, “because you’ll see them for the fitting, you’ll see them for the aftercare, you’ll see them pick up the contacts and all the glasses, and so then they have the familiarity with you, and so it builds patient loyalty, which often can drive referrals.”
A third of the referrals to Chi’s practice are from other patients.
That can also build revenue.
“It’s just plus, plus, plus – you have the glasses, but then you have the contacts as well.
“Then you’ve also got the consult fees. The patient has also had an experience, which they may or may not have thought they could do, but they’re much more likely to refer someone on to you.”
And that’s bound to boost the confidence of even the shyest optometrist.
More reading
New evidence dispels common myths about fitting soft contact lenses
How to stop patients stretching the life of contact lenses
Myopia Profile and CORE join forces
