INTERNATIONAL PRESCRIBING

International Contact Lens Prescribing in 2006
Our annual update on contact lens prescribing trends reports on more than 22,000 prospectively conducted fits in 19 countries.
By Philip B. Morgan, PhD, MCOptom, FAAO, FBCLA; Craig A. Woods, PhD, MCOptom, DipCLP, FAAO; Deborah Jones, BSc, FCOptom, DipCLP, FAAO; Nathan Efron, DSc, MCOptom, FAAO, FCLSA, FBCLA, FIACLE; Kah-Ooi Tan, BOptom (Hons), PhD, MBA; Martha Yanneth Gonzalez, OD; Alice Pesinova, Hans-Juergen Grein Dr. med., Dipl.-Ing. (FH); Svend-Erik Runberg, MSc; Ioannis G. Tranoudis, DO, MSc, PhD; Aris Chandrinos, DO, MSc; Philip Fine, BOptom; Giancarlo Montani; Edoardo Marani; Motozumi Itoi, MD, PhD; Jolanta Bendoriene, MD, PhD; Eef van der Worp, BSc, FAAO, FIACLE; Magne Helland, BSc, MScOptom, FIACLE; Geraint Phillips, BSc, OD, MCOptom, DipCLP; Vadim Belousov; & Joseph T. Barr, OD, MS, FAAO

For more than 10 years we've attempted to understand contact lens markets around the world in terms of the types of lenses that practitioners prescribe in each country. In 2006, we mailed a survey questionnaire (translated into local languages) to 1,000 practitioners in each of the 19 countries listed in Table 1. A smaller number of questionnaires was sent in markets where the total number of contact lens practitioners was fewer than 1,000. The precise composition of the practitioner cohort (the proportion of ophthalmologists, optometrists and opticians) necessarily varied by country, but a randomized selection of practitioners who are licensed to fit contact lenses was selected and contacted via mail or e-mail.

The questionnaire was a one-sided document designed to gather prospective information about the type of contact lenses and care products that practitioners prescribed to a maximum of 10 patients each whom they fit after the commencement of the study. We employed a system of weighting to better reflect the fitting practices of busier practitioners. We divided the wearers into 'new fits' (people with no previous contact lens experience or who had not worn lenses for a considerable time) and 'refits' (those attending for fitting as an existing wearer).

Demographics and Background Information

In 2006, we received prospective information on 22,394 fits across 19 countries. In all countries, the majority of patients were female (ranging from 56 percent in Italy to 75 percent in Lithuania as shown in Figure 1). In five countries, the average age of the fit wearers was relatively low at around 26 years (Lithuania, China, Russia, Israel and Italy) whereas most countries fell between 30 and 35 years for the average age of new fits and refits. The average age was highest in the United Kingdom at 37 years.

Soft vs. GP Lenses

The proportion of all GP lens fits remained similar to recent years at 11 percent, including 1 percent of orthokeratology fits (Table 2). This proportion was highest in Germany (42 percent of fits) with high levels also reported for Japan and Israel.

A notable shift in the fitting practices of Dutch practitioners has occurred in this regard over the past eight years. Between 1998 and 2001, more than 30 percent of fits in the Netherlands were with GP lenses; this has declined progressively over the past five years, reaching 13 percent this year.

GP Lenses

It's evident that a number of markets tend to use GP lenses only for more complex fittings (Table 3). For example, high levels of GP lens extended wear were reported in other countries where the proportion of GP lens fitting overall was very low (China, Denmark, Malaysia/Singapore and Norway, see Table 3).

The two countries in which practitioners fit the most GP lenses — Japan and Germany — did show some interesting differences. For example, most GP contact lenses (55 percent) prescribed in Japan are manufactured from high-Dk materials compared with only 1 percent of high-Dk GP lenses in Germany. On the other hand, close to 90 percent of GP contact lenses prescribed in Japan are spherical compared to less than 60 percent in Germany, where there is significant use of toric and orthokeratology contact lens designs.

Orthokeratology accounts for about 0.6 percent of reported fits in this survey; this figure is rather higher in some countries. In Canada, for example, the proportion of ortho-k lenses prescribed (2.5 percent of all fits) was only slightly less than other forms of GP lens fitting (4.4 percent of all fits). Australia also reported relatively high levels of orthokeratology prescribing (2.9 percent of all fits).

Planned replacement for GP lenses represents 30 percent of all new fits, a value that's often higher in markets that have low numbers of overall GP lens fitting.

Soft Lens Fitting

Soft lenses continue to dominate most markets, accounting for about 90 percent of all fits worldwide. Silicone hydrogel lenses continue to increase in use for daily wear lens fits, reaching 22 percent of fits in 2006 (Table 4) from a baseline of close to zero in 2004. In six countries, including the United States, more than one in three soft daily wear fits were with silicone hydrogel materials.

For lens design, spherical lenses now account for less than half of new daily wear soft fits in four countries — Germany, Norway, New Zealand and the United States — mainly because of high levels of soft toric lens fitting in these nations. In fact, the difference between the proportion of spherical lens fits and toric lens fits is only about 10 percent in these markets. This suggests that many practitioners are very satisfied with the performance of currently available soft toric lenses.

Practitioners in general rarely prescribe cosmetically tinted lenses, although 7 percent or more of new soft daily wear fits were with tinted lenses in the 'developing' markets of China, Colombia, Lithuania and Russia.

Monovision/multifocal fitting accounted for 9 percent of fits worldwide, with a maximum of 18 percent of new soft daily wear fits in the United States.

Daily disposables continue to vary greatly in their usage around the world. This is best illustrated by how practitioners prescribe them in the world's two biggest markets: Daily disposables account for 1 percent of new soft daily wear fits in the United States and for 41 percent of fits in Japan. Close to half of all soft daily wear fits are with daily disposable lenses in the Scandinavian markets of Denmark and Norway.

Very few contact lens fits worldwide are for soft lenses on an unplanned replacement schedule.

Extended wear soft lens fits remain very similar to 2005, with 8 percent of new soft fits and 14 percent of refit soft fits in this modality. The consistent trend of more refits into extended wear than new fits is presumably related to the increased confidence of practitioners to fit existing patients into extended wear (when there's a history of successful daily wear and/or good evidence for compliant contact lens wear) rather than fitting someone who is new to contact lenses or who has not previously been examined by the practitioner with extended wear. CLS

This survey was funded by the sponsors of Eurolens Research: Bausch & Lomb Incorporated, Alcon Laboratories (UK) Limited, Advanced Medical Optics (UK) Limited, CIBA Vision (UK) Limited, Clearlab UK Limited, CooperVision Limited, Johnson & Johnson Vision Care, Menicon Co. Ltd., and Sauflon Pharmaceuticals Limited. Additional funding was provided by the Optometrists Association Australia for Australia; by Johnson & Johnson Vision Care for Greece and the Czech Republic; by the Norwegian Optometric Association for Norway; by Bausch & Lomb Benelux for the Netherlands; and by CooperVision, Inc. for China and Malaysia/Singapore.

For references, please visit www.clspectrum.com/references.asp and click on document #134.

Lens Fitting in China

For the first time in 2006, we've undertaken a survey of fitting trends in China (Figure 2), a growing market of significant importance to the contact lens industry because of its large population and high prevalence of myopia. Furthermore, the improving economic situation in many of its regions make contact lenses an affordable option for vision correction.

The fitting trends in China are somewhat different to most of the other countries investigated. Its practitioners reported almost no GP lens fitting, and the number of daily disposable lenses prescribed is also very small. Seventy-five percent of lenses prescribed are conventional daily wear hydrogels (often on an annual replacement basis), with a high level of soft lens extended wear as well; in this latter case, almost all the lenses prescribed are conventional hydrogels rather than silicone hydrogels.

The U.S. Market 2002-2006

We've conducted this survey in the United States for five consecutive years, and in general the fitting practices each year have been remarkably consistent. For example, over this period, the proportion of reported GP lens fits has varied only between 8.6 percent to 12.2 percent of all lens fits. Another consistent theme is the continued low level of daily disposable prescribing, which continues to surprise contact lens colleagues from other parts of the world.

In 2006, of new daily wear soft lens fits, 20 percent were with daily disposable lenses across the 19 countries of this survey. This value was only 1 percent in the United States, and the figure below suggests that this rate of fitting has declined in recent years.

A significant change to the U.S. market has been the use of silicone hydrogel lenses prescribed for daily wear (Figure 3). These materials now account for 37 percent of new daily wear soft lens fits in the United States, which represents a significant change in just the last two years alone

Dr. Morgan is the director of Eurolens Research at the University of Manchester, UK.

Dr. Woods is the research manager of the Centre for Contact Lens Research at the University of Waterloo,
Waterloo, Canada.

Dr. Jones is the clinic director and head of the Pediatric and Special Needs Clinic at the School of Optometry, University of Waterloo, Waterloo, Canada.

Dr. Efron is a research professor in the School of Optometry at the Queensland University of Technology, Brisbane, Australia.

Dr. Tan works for Marketing and Professional Services, Asia Pacific at CooperVision Inc., Singapore.

Dr. Gonzalez is an optometrist in Sunrise, FL.

Ms. Pesinova is an optometrist with the Czech Contactology Association in Prague, Czech Republic.

Dr. Grein is a professor of optometry at the University of Applied Sciences, Jena, Germany.

Dr. Runberg is a senior lecturer and head of the Danish College of Optometry, Randers, Denmark.

Dr. Tranoudis is the professional affairs manager, Central & Southeastern Europe, Johnson & Johnson Vision Care.

Dr. Chandrinos is an assistant professor in the Department of Optics at the TEI of Athens, Greece.

Dr. Fine works in the Department of Optometry , Hadassah College, Jerusalem, Israel.

Mr. Montani is coordinator of the contact lens course at the Department of Optics and Optometry at the University of Lecce, Italy.

Mr. Marani is a consultant at Formazione Continua in Medicina, Italy.

Dr. Itoi is an associate professor in the Department of Ophthalmology at Juntendo University, Tokyo, Japan.

Dr. Bendoriene works at Kaunas University of Medicine, Kaunas, Lithuania.

Dr. van der Worp works for the Eye Research Institute Maastricht and Hogeschool van Utrecht, the Netherlands.

Dr. Helland is an associate professor at the Department of Optometry and Visual Science at Buskerud University College, Kongsberg, Norway.

Dr. Phillips is the clinic director of the Department of Optometry at Auckland University, Auckland, New Zealand.

Mr. Belousov is the editor of the Journal of Optometry, Moscow, Russia.

Dr. Barr is editor of Contact Lens Spectrum. He's a professor and associate dean for clinical services and professional program at The Ohio State University College of Optometry.