Contact Lens & Anterior Eye 27 (2004) 83–85 Clinical note Why one million contact lens wearers dropped out  Graeme Young Visioncare Research, Farnham, Surrey GU9 7LW, UK The early 1990s saw a large increase in the number of contact lens wearers in the UK. It is estimated that this figure doubled between 1990 and 1996 to reach approximately three million wearers. The increased uptake of contact lenses during this period is thought to have been due to a number of factors, including the availability of frequent replacement soft lenses, the introduction of daily disposable lenses and the effects of television advertisments [1]. However, in the late 1990s there was a subsequent fall in the number of contact lens wearers (Fig. 1). The decline in the use of contact lens may have coincided with the growing appeal of designer fashion spectacles; however, this seems an inadequate explanation for the loss of nearly a million contact lens wearers. A further worrying statistics is that the UK has one of the highest contact lens drop-out rates in Europe [2]. This cannot be explained by the fact that the UK has a higher proportion of people who have tried contact lenses, because in Italy, where a similar proportion have tried contact lenses, the drop-out rate is relatively low. The reasons for discontinuing contact lenses have been evaluated in a number of studies [3–5]. The most commonly cited reason in all of these studies is discomfort, which accounts for between 43 and 72% of the drop-outs. Poor vision, handling difficulties and cost are the other reasons reported by lapsed contact lens wearers. However, the rea- sons given by patients themselves for their discontinuation of the contact lenses do not provide an adequate explanation of the problem. The patients’ experience of contact lens discomfort may have arisen from a variety of causes, such as contact lens-related dry eye, poor lens fitting or protein deposition. A recent study [6] provided the opportunity to examine some of the underlying causes of contact lens discontinuation and to face up to some of the disappointing realities of contact lens provision in the UK. The study attempted to answer the question: How many lapsed contact lens wearers can be successfully refitted? In a multicentre study involving 15 investigators throughout the  BCLA Presidential Address originally presented September 2002, Royal Society of Medicine, London. E-mail address: Graeme@visioncare.co.uk (G. Young). UK, 236 lapsed wearers were recruited with the intention of being refitted with contact lenses. The findings published at the end of the last year showed that a high proportion of lapsed contact lens wearers can be successfully refitted and usually with relative ease. On initial assessment, only a hand- ful (2%) were considered to be fundamentally unsuitable for contact lens wear. More than 95% were dispensed lenses and of these 77% were considered successful after 1 month’s wear. Particularly given that only half of the patients had given up contact lens wear in the past 5 years, the disparity between their previous and current contact lens experience is perplexing and prompts the question: What went wrong? As a part of the study, the investigators were asked to state what factors they felt had contributed to the patient’s previous contact lens failure. In a high proportion of cases, shortcomings on the part of the previous practitioner were cited. However, it was not immediately obvious from the analysis whether these deficiencies had been the critical factor in failure or whether they were incidental. As a supplementary analysis, I therefore reviewed each of the 236 case histories and made a judgement as to the main cause of previous contact lens discontinuation in order to gain some insight into why contact lens drop-outs are so prevalent. This analysis was based on the patient’s clinical details, previous contact lens history, previous contact lens prescription details, the investigator’s assessment, clinical study findings and the patient’s contact lens wearing success after 6 months. Each case was classified according to one of five possible underlying causes which was felt to be the prime reason for discontinuation: • Eye-related problems • Lens-related problems • Patient-related factors • Practitioner misjudgement • Product non-availability Clearly, some cases of contact lens discontinuation arise due to a series of problems and mishaps and, therefore, some element of subjectivity is inevitable in this type of analysis. However, the process of categorisation was surprisingly easy and on rechecking the cases a second and third time, it was 1367-0484/$ – see front matter © 2004 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.clae.2004.02.006