Pandemic-impacted 2020 led to a backlog of more than 6 million cataract surgeries globally, as procedures declined 25 percent to 22 million, the lowest number since 2010, mainly due to COVID-related shutdowns in elective surgeries.

The amount of time it will take to eliminate the backlog varies by country or region based on the rollout of vaccines, COVID variants, and the health care infrastructure that exists.

Market Scope’s newly published “2021 IOL Market Report” projects only a modest rebound in cataract surgery volume in 2021 to slightly better than the 2019 level, as many countries continue with deal with partial lockdowns.

Market Scope looks for a strong rebound in most wealthy countries in 2022 and 2023, when the bulk of the cataract surgery backlog is likely to be eliminated. The firm sees it taking longer—in some instances up to five years—in less developed countries.

IOL sales are expected to grow from $4.8 billion in 2021 to $7.3 billion by 2026, for a compound annual growth rate of nearly 9 percent.

Growth in cataract surgery and refractive lens exchange (RLE) procedures over the next five years will increase the number of IOLs sold from 22.3 million in 2020 to 37.4 million by 2026, for a CAGR of 9.0 percent.

Market Scope divides the IOL market into commodity monofocal, enhanced monofocal, intermediate-optimized monofocal, presbyopia-correcting, toric and PC-toric, bifocal, trifocal, EDOF, EDOF multifocal hybrid, accommodating, postoperative adjustable, and phakic lenses.

Presbyopia-correcting (PC-IOLs), toric, phakic, and post-op adjustable lenses make up the premium segment of the market.

An increase in the percentage of patients choosing premium IOLs will help fuel revenue growth.

Market Scope projects that premium IOLs will account for $1.7 billion of the $4.8 billion total IOL market in 2021, or nearly 36 percent of revenue. By 2026, premium IOL revenue will account for nearly 43 percent of revenue.

Globally, premium IOLs’ market share in 2021 is expected to reach 10 percent and grow to nearly 13 percent by 2026. In wealthy countries in 2021, market share will typically exceed 15 percent. In the US, for example, premium IOLs’ market share should exceed 16 percent in 2021 and grow to 21 percent by 2026.

Key technologies will help drive premium IOL revenue over the next five years.

In the short term, modest growth will come mainly from enhancements to current PC-IOL and toric IOL technologies, such as variations in EDOF and combination EDOF trifocal models.

PC-IOLs represent the largest premium IOL segment and will account for 20 percent of 2021 global IOL revenue. This group of premium lenses consists of trifocal, bifocal, EDOF, multifocal EDOF hybrid, and accommodating lenses.

Trifocal and EDOF IOLs are the two largest categories and will represent three-quarters of PC-IOL revenue in 2021. Resurgent growth in phakic IOLs will help sustain healthy premium IOL growth.

Longer term, Market Scope expects premium IOL growth to accelerate, when next-generation optic shape-changing accommodating IOLs become available in 2024. Accommodating IOLs are often referred to as the “holy grail” of PC-IOLs because of the belief that they will one day offer patients spectacle independence without optical disturbances. Alcon’s PowerVision FluidVision and LensGen’s Juvene IOLs have yielded promising early clinical results.

Post-op adjustable IOLs are now beginning to impact the US market after RxSight launched its Light Adjustable Lens in late 2019. Expected improvements, including customizable EDOF adjustment, will add a new layer to the PC-IOL market.

Other companies working on next-generation postoperative technologies include Clario Vision, Merck KGaA (LicriEye), and Perfect Lens. Market Scope anticipates significant advances in post-op technology, such as the ability to provide post-op adjustments multiple times during the life of the patient and the streamlining of the adjustment process, over the next several years.

Enhanced monofocal IOLs, including intermediate-optimized monofocal IOLs offered by a growing number of IOL companies, also will help drive overall revenue growth. J&J Vision (Eyhance), BVI/PhysIOL (ISOPURE), Rayner (RayOne EMV), and Santen Pharmaceuticals (XACT ME4) have recently launched these new monofocal IOLs, and Market Scope expects others to follow, creating a new higher-priced monofocal IOL category.

Market Scope’s 20th edition "2021 IOL Market Report” was published in April. For more information, visit market-scope.com or contact Matthew Douty at matthew@market-scope.com.

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