Commentary: Evolving trends in contact lens practice in India — Insights from a decade-long experience at a tertiary eye care center

The field of contact lenses (CLs) is constantly evolving with the latest developments in CL materials, designs, and solution formulations. This has led to the dramatic evolution of CL practice over the last few decades, from being a refractive aid to a therapeutic and rehabilitative tool in modern ophthalmology.[1,2] We conducted a hospital-based observational study to evaluate the prescribing trends of CLs among the CL users at a tertiary eye care center in eastern India between January 2013 and December 2022. Of a total of 5138 subjects, 2936 (57.1%) were females, and 2202 (42.9%) were males. We observed a steady increase in the number of CLs dispensed for refractive error from 2013 to 2019, potentially reflecting a growing awareness of this treatment option and a desire to achieve spectacle-free vision. We noted a declining trend from 2020 to 2022, which can be attributed to the COVID-19 pandemic, during which hospital visits declined for non-emergency conditions. The common indications for prescribing CLs were visual rehabilitation (89%), cosmesis (10.1%), dry eye disease (0.5%), and comfort (0.3%). Among patients prescribed for vision restoration, refractive error (55.4%) was the most common indication, followed by keratoconus (24.1%) [Table 1]. There was a statistically significant association between diagnosis and lens type prescribed (P < 0.001). Soft CLs were the most dispensed (55.8%), followed by corneal gas permeable (CGP) lenses (35.3%), prosthetic soft lenses (4.2%), Boston Sight scleral lenses (3.3%), mini scleral lenses (0.7%), cosmetic lenses (0.3%), and Rose K (0.3%) lenses [Fig. 1]. CLs were also prescribed after ophthalmological procedures (21%) such as collagen cross-linking, keratoplasties, corneal tear repair, and limbal transplantation. A higher prescription rate of CGP, BostonSight scleral, and Rose K lenses was observed in males than in females (P < 0.05). Previous studies have proven that keratoconus is more prevalent in males, and these corneal lenses are the primary modality of treatment in such conditions.[3]Figure 1: Change in the trend according to the type of contact lens from the year 2013-2023Table 1: Indications of various lens prescriptions according to clinical condition in the study populationThe preference for traditional yearly replacement lenses from our study contrasts with Western prescribing trends, where daily disposables are preferred.[4,5] This observed disparity emphasizes the role of socioeconomic considerations while choosing lenses. Replacement schedules are substantially affected by patient compliance, availability, and cost factors. In such situations, the “cost-per-wear” concept gains significance, highlighting the need to consider local economic factors when interpreting prescribing patterns rather than comparing them with those of high-resource nations. Advancing technology and awareness among ophthalmologists and patients have boosted early detection of corneal pathologies and a better understanding of the therapeutic use of lenses in patients with ectasia and ocular surface disorders. We also witnessed an increase in BostonSight scleral lenses from 2018 to 2023, following the establishment of a local manufacturing unit in 2017 in collaboration with the Boston Foundation for Sight. This has led to cost reduction and an increase in the availability of scleral lenses in India. With the availability of these specialized lenses in India, we anticipate a rise in the therapeutic use in the future. Nevertheless, patients should be thoroughly counseled about proper handling, maintenance, and judicious follow-up to avoid unwarranted complications.