SiHy the way forward for daily disposables
Karen Walsh has been practising optometry for more than 20 years. Since 2015, she has worked as a clinical scientist at the Centre for Ocular Research and Education (CORE) in Waterloo, Canada. Contact lenses have always been an area of specialism for Karen, and she will be delivering a presentation at NCLF 2019 on the commercial benefits of Silicone Hydrogel (SiHy) in daily disposable lenses.
How do practitioners around the world currently position Silicone Hydrogel contact lenses?
Karen Walsh: There is a marked difference between the reusables market and daily disposables. The use of SiHy materials in monthlies and other reusables has now almost plateaued. There is little dispute that SiHy is now the lens of choice for most practitioners.
But on daily disposables there has been a significant lag. We’ve really only had exposure to daily SiHy lenses for around the last ten years, due to issues around discomfort caused by too much silicone in the first-generation models. Historically, they have also been expensive to produce, so manufacturers have been slow to make them widely available.
This has led to a reluctance on the part of some practitioners to offer them to patients - even though the latest SiHy daily disposables now offer the same level of comfort and ease of use as regular hydrogel lenses, as well as providing a range of benefits in terms of eye health.
What research has been done on why those practitioners might be reluctant to offer SiHy solutions to patients?
KW: Cooper Vision recently commissioned a big survey in the US, UK and Japan - and asked practitioners what their barriers were to fitting SiHy daily disposables. What is preventing them having those conversations with patients?
More than 80% of the practitioners surveyed said they accepted that SiHy lenses were the best solution for the long-term eye health of their patients, but that they still had concerns in three main areas:
- Potential for silicone allergy
So how do you address those concerns?
KW: On the cost issue, it is true that SiHy lenses are marginally more expensive than regular hydrogel models - but that disparity is coming down as more choice becomes available. Most SiHy solutions are now priced very close to hydrogel. So, this issue is mainly down to the perception that existing customers would be unwilling to try new technologies when they are happy with the lenses they have worn for years.
Comfort levels are now almost identical to those of hydrogel lenses. We did a trial here at CORE where users wore a SiHy lens in one eye and a hydrogel in the other. The vast majority could discern no difference in comfort between the two.
Finally, being allergic to silicone is actually biologically impossible. Practitioners may have experienced patients complaining of redness and irritability - but that is likely to have been caused by mechanical and wettability complications from the first generation SiHy lenses. These problems have been eliminated in later models as the amount of silicone material used in the lenses has reduced.
What do consumers say?
KW: Cooper Vision also surveyed 1500 consumers in the same markets and asked them what they expected of their eye care practitioners.
More than 80% were aware that “breathable” daily disposables were available - and were motivated to find out more about them.
Three-quarters of those people said they were likely to go ahead and upgrade to SiHy lenses if their practitioner recommended them - highlighting how influential a professional recommendation can be. So, there is definitely an opportunity for practitioners to embrace SiHy more readily. Consumers are open to having those conversations - it really just becomes a question of education.
What are some the variables in the take-up of SiHy lenses in different markets?
KW: There are actually big differences to how SiHy - and disposable dailes in general - are being positioned. In the US, for example, the daily disposable market has been some way behind Europe for many years, so it is possibly easier to encourage the use of new technologies. In the Nordics, practitioners and patients have long understood the value of daily disposables - which is great - but it leads to issues of high numbers of entrenched hydrogel wearers who might be difficult to move across.
Sweden is a fantastic, proactive market, but with a large historical patient base comfortable with their hydrogel lenses, the challenge is to shake things up and refit these loyal, happy patients into a new material.
Then you are in danger of running into those cost and comfort barriers - so it is a question of trying to change the mindset of practitioners to make them willing to have those conversations. Just over half of the Swedish daily disposable market is now on SiHy lenses - which is a really strong starting point, but, for comparison, the SiHy reusables market in Sweden is up at 90%, so there is still significant ground to be made.
Practitioners in Sweden - and Europe generally - are doing a great job, and the trajectory is encouraging, but we would like to see a situation where SiHy daily disposables are the default choice for practitioners everywhere.