Silicone Hydrogels - Have we missed an opportunity?

Market research launch data from CIBA Vision, Bausch & Lomb and several other surveys have all confirmed that patients have an overwhelming desire for "permanent vision correction". It seemed that these original lenses were able to deliver what consumers wanted:

1. extended / continuous wear i.e. permanent vision correction
2. good comfort
3. convenience, no solutions
4. healthy eyes
5. comparable costs to daily disposable

They also delivered to practitioners the benefits of:

1. happy patients-fewer complications in continuous wear
2. fewer drop-outs
3. patient loyalty
4. more clinical involvement and use of clinical skills justifying higher fees
5. greater profitability from all of the above.

Yet five years on, penetration of silicone hydrogels is still low and of that penetration the use in daily wear with solutions ranges anywhere between 20 and 65% depending on whose data you read.

So why did it not happen?

Clinically these lenses have produced in general, very impressive results with many indicators of corneal health and contact lens wear improving and although no definitive long-term data on microbial keratitis is available, all the indications are that the risks are significantly reduced and manageable. There seems to be no change in the number of inflammatory events compared to conventional hydrogels and of the mechanical complications, the early problems with superior epithelial arcuate lesions (SEALs) seem to have been eliminated with new design changes, and there is a slight increase in the level of giant papillary conjunctivitis (GPC), also known as contact lens induced papillary conjunctivitis (CLPC).

So can the blame be laid at the door of inadequate clinical performance? Well, perhaps slightly, as we know complications do occur and we still need antibacterial lenses with really biocompatible surfaces if we are to eliminate infection and achieve superior comfort. However for a large majority of patients, these lenses do offer effective continuous wear and that majority is certainly a much higher percentage of patients than the current market penetration. Clearly, there are other factors that are responsible for the lower than anticipated uptake of silicone hydrogels.

To what must be the frustration of the manufacturers, the answer lies with practitioners. Practitioners who because of their previous experience, lack of clinical skills or knowledge, and / or poor marketing and business skills are reluctant to fit and recommend extended wear and have frustrated the development and success of these products. In my opinion the profession has missed an opportunity.

Industry however, is not going to give up on silicone hydrogels that easily. We are now entering the era where silicone hydrogels will be available for a broad range of patients and all wear modalities and we must ask the question “What lessons can be learnt from our recent experience?”.

In 2004, we have seen the worldwide launch of silicone hydrogel lenses from Johnson & Johnson (Acuvue Advance), CIBA Vision Inc. (02 Optix) and the repositioning of Bausch & Lomb’s Purevision in an attempt to grow the monthly replacement daily wear market. Silicone hydrogels for daily wear offer many advantages over conventional hydrogels for daily wear, and will certainly capture this part of the market over the next few years - wiping out the monthly hydrogel lenses, as one industry spokesman put it, “as surely as the combustion engine took over from steam”.

Many patients will achieve an improvement in their wear - longer, more comfortable wearing times, whiter eyes and healthier corneas, but it remains to be seen if the mechanical effects will continue to drive up the rates of GPC and if the incompatibility issues of lens care solutions with silicone hydrogels can be resolved.

The early indications are that many practitioners and chains are offering these new lenses at very little premium, so in the next five years if all we do with silicone hydrogels is replace the current monthly hydrogel lens base at roughly the same cost to the patient, and fail to grow the market by lowering dropouts, fail to increase the penetration of contact lenses to new wearers and don’t deliver on the continuous wear quest, then the investment in silicone hydrogels will have been a poor return on the millions of dollars invested in their development. The lesson from the past is also that just having a good product is not enough and practitioner education on good clinical and business practice will have to improve to achieve these goals.

The long term future of silicone hydrogels must surely be as a first choice lens for all contact lens patients, and we await further material development and a new approach to practitioner education with anticipation.