Image Source@Visual China
Text | Frontline of Entrepreneurship, Author | Fu Yancui, Editor | Feng Yu
Do your eyes need a rest?
According to the "Statistical Report on Internet Development in China", as of December 2020, the number of internet users in China reached 989 million, with 986 million mobile internet users. On average, netizens spend more than 7 hours a day in front of electronic devices.
Undoubtedly, with technological advancement and changes in lifestyle, the burden on people's eyes is also increasing. Statistics show that 90% of college students in China are nearsighted, and the myopia rate among six-year-old children has been rising year by year. Even some children aged 4-5 suffer from myopia. Thus, eye health care has become the most urgent need for Chinese consumers.
In fact, whether looking at the hundred-billion-level market size or the annual growth rate of over 15%, the eye health market is extremely attractive to most industry players. Data from Qichacha shows that there are currently 50,300 eye health-related enterprises in China, with 3,197 newly added in the first five months of this year alone, a year-on-year increase of 37%.
However, where there are profits, there is chaos, and the eye health industry, situated in a golden track, is no exception.
According to "Frontline of Entrepreneurship", some companies that only seek profits while ignoring safety engage in exaggerated marketing and false information, claiming "remove glasses in three days, cure true myopia in ten days", but then disappear after patients pay. Worse, some unregulated companies use "atropine", which is toxic and not approved by relevant national authorities, to treat myopia, creating immeasurable safety hazards.
When your eyes become a social issue, what new stories will emerge in the industry?
01 The "Forced" Rise of the Eye Economy
A few months ago, a trending topic about "Yang Di's meibomian glands disappearing" left a deep impression. The function of meibomian glands is to secrete normal tears and lipids. Due to daily不离手机和电脑, he "at the age of 30 has meibomian glands of a 50-year-old," and his eyes are in a worrying state. The doctor even直言: "It is impossible to completely recover through conditioning."
Cases of meibomian gland dysfunction are not uncommon; it is a type of dry eye disease. Developing dry eye disease greatly affects work, quality of life, and mood. Mild to moderate dry eye has become a common health issue affecting the quality of life and work efficiency of China's population. Severe dry eye can lead to visual impairment and even blindness, making it a difficult-to-treat ocular surface and corneal disease.
The eyes are the most important sensory organ for humans because approximately 80% of the brain's knowledge is acquired through the eyes. However, related eye symptoms such as blurred vision, fatigue, dryness, and even headaches are often ignored until obvious symptoms appear.
Chen Chen (pseudonym), a post-90s employee working at an internet company in Beijing, has recently been troubled by dry eye syndrome. Due to work, he faces a computer screen all day and uses his phone at night to read novels or browse short videos, spending more than 10 hours a day in front of screens.
Since January this year, he has felt dryness and pain in his eyes, sometimes accompanied by blurred vision and a desire to tear up. "I've tried to control my screen time, but my eyes remain fatigued from morning till night, feeling as if something is pulling on my eyelids and making them heavy." In March, following his family's advice, Chen Chen went to a nearby eye hospital and was diagnosed with dry eye syndrome.
The doctor told him that computer screens consist of small fluorescent dots, requiring the eyes to constantly adjust focus to see clearly. Prolonged periods lead to excessive eye muscle fatigue. When engrossed in computer or phone content, the decrease in blink rate reduces the secretion of lubricants and tears, preventing the cornea from being adequately moisturized, resulting in dry and uncomfortable eyes. Over time, this leads to dry eye syndrome.
"I've been taking traditional Chinese medicine for over three months with no improvement, and I've also tried massage for two months, but it doesn't seem effective." Chen Chen said. He is now using artificial tears as advised and trying eye masks with Chinese herbal ingredients. "Hopefully, the eye fatigue will get better."
In fact, in modern society where electronic products are prevalent, eye health issues affect all age groups – not only adults but increasingly young children.
"Although we only let our child watch electronic products for an hour a day, my 4-year-old already has over 50 degrees of astigmatism," a post-80s parent told "Frontline of Entrepreneurship". She noticed that her daughter often habitually frowns and squints when looking at people. Since both she and her husband have high myopia, the family took it very seriously and took her to an eye hospital for examination.
"The doctor said most people have a few tens of degrees of astigmatism, so there's no need to worry too much." But children's problems are major issues. She now tries to keep her child away from electronic products and also buys eye massagers for her child. Additionally, following the doctor's advice, she increases the child's outdoor activity time to relax eye muscles.
A research report by the World Health Organization shows that by 2020, the number of people with myopia and eye diseases in China reached 700 million. Among them, the number of myopic patients reached 600 million, and the myopia rate among adolescents already ranks first in the world, with the myopia rate among Chinese junior high school students, senior high school students, and college students exceeding 70%. Other data shows that one in five people in China suffers from dry eye disease.
Obviously, the prevention and treatment of eye health cannot be delayed. Eye care seems to have "passively" become a nationwide consumption necessity.
"Whether it's me or my friends around me, everyone has bought eye supplements, eye massagers, or various eye patches," Zhang Yue told "Frontline of Entrepreneurship". They hope to minimize the damage to their eyes through various physical methods.
Zhang Shilang, founder of Cloud Optometry Vision Restoration, also revealed to "Frontline of Entrepreneurship" that the demand in the eye health industry has always existed. "As long as it's effective, consumers are very willing to spend money to try."
Data also show that China's ophthalmic medical service market is growing rapidly, with the industry size increasing from 73 billion yuan in 2015 to 127.5 billion yuan in 2019, a compound growth rate of 15% during the period, and is expected to further grow to 223.1 billion yuan by 2024.
Over 700 million people with eye diseases are supporting a huge market.
02 Using "Poison" to Treat Myopia
With the continuous upgrading of domestic consumption habits and levels, people are spending more and more on eye health, and companies in the industry are reaping huge profits.
"Major ophthalmic-related institutions are quite profitable. It's no problem to see several listed companies emerge just from the myopia prevention and control business," Zhang Shilang said. If myopia prevention and control can keep adolescents from wearing glasses or even help them remove glasses, parents' willingness to pay and ability to pay would be very considerable.
The performance growth of related companies also proves the potential of the eye health market.
For example, Aier Eye Hospital's 2020 annual report data shows that the company achieved operating revenue of 11.91 billion yuan, a year-on-year increase of 19.24%. Shenyang Xingqi Ophthalmic Pharmaceutical, engaged in the research, development, production, and sales of ophthalmic drugs, achieved operating revenue of 689 million yuan in 2020, a year-on-year increase of 26.96%. Glasses retail chain Bsch Eyewear achieved operating revenue of 656 million yuan in 2020, a year-on-year increase of 0.20%, and achieved a net profit attributable to the parent company of 69.174 million yuan, a year-on-year increase of 10.93%.
In the capital market, the eye health industry is also experiencing an IPO boom.
At the end of July 2020, Liaoning He's Eye Hospital, Huaxia Eye Hospital, and Chengdu Purui Eye Hospital almost simultaneously submitted listing applications. In April this year, ophthalmic pharmaceutical company Zhaoke Ophthalmology listed in Hong Kong. A few days ago, ophthalmic medical service provider Chaoyang Eye Hospital also landed on the Hong Kong stock market.
Amidst the stories of wealth creation, entrepreneurs are flocking to the industry.
Data from Qichacha shows that there are 50,300 "ophthalmology, vision" related enterprises in operation/existence in China, with 10,400 newly added in 2019, 7,684 in 2020, and 3,197 in the first five months of this year, a year-on-year increase of 37%.
But when your eye health becomes someone else's business opportunity, the phenomenon of uneven quality, where some are greedy for profit while ignoring safety, follows.
Driven by interests, some enterprises resort to exaggerated claims and various marketing channels to attract consumers. Some even cross the line, sacrificing consumer health for their own gain.
Liu Wei (pseudonym), an industry insider, told "Frontline of Entrepreneurship" that some institutions even advertise "remove glasses in three days, cure true myopia in ten days." "Lucky" patients might encounter those who disappear after collecting payment, but if unlucky enough to come across unregulated operations, they may lose not only money but also risk having their eyes damaged.
"Previously, a private eye hospital wanted to cooperate with our company for referral, asking us to refer patients to them," Zhang Shilang introduced. Making money in ophthalmic-related companies is not difficult, but similar to the medical aesthetics industry, there is much chaos in many places. Therefore, Zhang Shilang rejected such cooperation.
He said there are also many newly established vision correction brands in the industry, some of which may have no effect at all and just make money by recruiting franchisees. "Franchise fees are generally tens of thousands of yuan, but some charge 200,000 yuan. However, offline stores usually don't make much profit," Zhang Shilang added.
The industry chaos that he finds most unbearable is the high-risk practice of using 0.01% atropine to treat eye diseases.
"Although 'atropine' is on the WHO Model List of Essential Medicines, it is also a 'highly toxic drug'. 0.1 grams can kill an adult. Moreover, it can be absorbed through mucous membranes or damaged skin, so using this drug to control myopia is very dangerous," Zhang Shilang explained. Eye drop products containing 'atropine' ingredients, although not yet approved by relevant national authorities, are still available on the market.
Clinical and pharmacological studies have also shown that excessive use of "atropine" to treat diseases may cause new symptoms of poisoning.
In fact, media has previously reported that many optical shop staff generally recognize the effect of "atropine" in delaying myopia progression, while also being aware that it is not yet approved for sale. Nevertheless, they still guide consumers to try "atropine" through purchasing agents or hint at illegal sales.
03 Technological Innovation to Rescue Eye Diseases
With so many technologies and drugs for treating myopia and eye diseases, can eye problems ultimately be cured?
"There is no reliable technology right now. There are quite a few technologies for restoring pseudomyopia, but the correction of true myopia is still not ideal," Zhang Shilang continued. "Of course, it's not that China's technology is inadequate, but currently, technologies worldwide cannot fundamentally solve the problem of myopia restoration."
It is worth noting that during an hour-and-a-half conversation with Zhang Shilang, he mentioned the keyword "technology" 75 times to "Frontline of Entrepreneurship". In his view, the current opportunities in the industry lie mainly in technological innovation for ophthalmic diseases.
Take myopia correction surgery as an example. Excimer laser treatment for myopia was first clinically applied by American doctors in 1985, was introduced to China in the early 1990s, and has developed rapidly in recent years. However, it has only been about 21 years since its clinical application, and patients often face various sequelae after such surgeries, while those without immediate sequelae still need time for observation.
A patient from Xi'an also shared with "Frontline of Entrepreneurship" that he underwent laser surgery at an eye hospital four years ago. But recently, when a small insect flew into his eye while walking and he rubbed his eye, the world before him turned blue.
"When I went back to the hospital for a check-up, the doctor said my eyes were overstrained," the patient said. Now his vision has deteriorated again, and his eyes hurt severely when he looks at his phone for too long. "But after all, having had surgery inevitably brings some inconvenience to daily life."
At the same time, regarding eye surgeries, none of the current operations fundamentally solve the problem of myopic axial length and ocular fundus issues. Complications caused by myopia, such as retinal detachment, cataracts, and glaucoma, still pose a risk even after myopia surgery.
Zhang Shilang revealed that during a recruitment drive at his company, an optometrist who came for an interview from a well-known eye care company told him that someone had undergone myopia laser surgery at their hospital in their twenties, but later the corneal flap of their eye detached, requiring another surgery to reattach it. "The probability of risk is certainly low, but if it happens to you, you're just unlucky," Zhang Shilang said.
Zhang Shilang gave another example. He knows a young mother who had corrective surgery at the age of eight for right eye esotropia in Xi'an. Twenty years later, after giving birth, she found that her right eye had started to exotropia.
Image / Patient consulting Zhang Shilang
He explained that the reason for strabismus is that there are six muscles around the eye. When strabismus occurs, it essentially means the pulling force of the muscles is insufficient. Western surgical treatment involves cutting off a portion of the tissue to shorten the muscle and restore pulling force. "This really tests the surgeon's skill. If the doctor cuts too much or too little, it can lead to eye problems for the patient."
Surgery carries risks, while physical correction generally has limited possibilities and the correction process is extremely painful.
In fact, physical correction of true myopia is mostly unlikely. However, after cycloplegic refraction, fitting appropriate OK lenses can effectively control the progression of myopia. "But the process of wearing OK lenses is quite painful."
OK lenses are a type of contact lens. They do not have a degree themselves but work by applying a certain amount of pressure to the eyeball. Patients wear them while sleeping at night, and temporarily achieve clear uncorrected vision during the day, while preventing rapid progression of myopia.
After wearing them at night and removing them during the day, 90% of patients with myopia under 400 degrees (about 0.3) can achieve 1.0 vision during the day. However, wearing such OK lenses requires flattening the cornea and is often very painful. "I tried wearing them for just one minute and never dared to wear them again. My eyes kept tearing up, and some people might even feel like 'dying'," Zhang Shilang said.
In Zhang Shilang's view, the treatment methods popular on the market all have certain drawbacks. Therefore, whoever can invent a correction technology that is highly effective, safe, and offers a good user experience will find a very broad market space.
Of course, besides technological innovation, there are entrepreneurial opportunities at any stage of the industry chain.
An investor relations representative from an investment firm told "Frontline of Entrepreneurship" that the firm has investors specifically focusing on the eye health sector and are interested in projects at any stage of the industry chain. For example, regarding myopia-related projects, they could invest in myopia prevention projects, while for those who are already myopic, there are myopia control methods or refractive correction projects.
In fact, various myopia prevention projects are indeed springing up like mushrooms.
For example, online blue light filtering software such as Eye Care, Master Eye Care, and Honey Eye apps; eye care self-training companies like Eye Care Baby, Careful Eye, Eye Care Master, eYenurse; ordinary eye care products like eye washes, eye patches, masks, and creams; and smart hardware for monitoring eye habits and providing warnings such as Cloud Clip, Honey Eye, AKESO smart glasses, Fitkid, etc.
As Aier Eye Hospital recently stated when receiving institutional surveys, the market space for ophthalmic diagnosis and treatment in China is still huge. Whether it's traditional businesses like refractive surgery, optometry, and cataracts, or future growth points like dry eye and presbyopia, there is still enormous market space.
Eye diseases are often irreversible. Although more treatment options will emerge with technological iteration, reducing the use of electronic screens and relieving eye strain will always be the first line of defense for eye care.
