INTERNATIONAL PRESCRIBING

International Contact Lens Prescribing in 2010

We report on a prospective analysis of more than 24,000 contact lens fits from around the world during 2010.

By Philip B. Morgan, PhD, MCOptom, FAAO, FBCLA; Craig A. Woods, PhD, MCOptom, DipCLP, FAAO; Ioannis G. Tranoudis, DO, MSc, PhD, FIACLE, FBCLA; Magne Helland, BSc, MScOptom, FIACLE; Nathan Efron, PhD, DSc, MCOptom, FBCLA, FCCLSA, FIACLE, FAAO (DipCCLRT); Christina N. Grupcheva, MD, PhD, DSc, FEBO; Deborah Jones, BSc, FCOptom, DipCLP, FAAO; Kah-Ooi Tan, BOptom (Hons), PhD, MBA; Alice Pesinova, BSc; Ole Ravn; Jacinto Santodomingo, OD(EC), MSc, PhD, MCOptom, FBCLA, FAAO; Florence Malet, MD; Hrvoje Raguž, MD; Nir Erdinest, BOptom, MSc; Hreinn Ingi Hreinsson; Motozumi Itoi, MD, PhD; Byoung Sun Chu, MOptom, PhD, FIACLE; Jolanta Bendoriene, MD, PhD; Eef van der Worp, BOptom, PhD, FAAO, FIACLE, FBCLA; Suresh Awasthi, MPhil; Wanda Lam, OD, BSc; José Manuel González-Méijome, OD, PhD, FIACLE; Simona Radu, MD, FIACLE; Vadim Belousov; Jörgen Gustafsson, PhD; Mirna Stabuc Silih, MD, PhD; John Hsiao, BA, OD, FIACLE; & Jason J. Nichols, OD, MPH, PhD, FAAO

For the past nine years, we have described the current state of contact lens fitting worldwide in Contact Lens Spectrum. This year, we report on 24,642 lens fits in 27 markets. As in all previous years, coordinators in each market distributed up to 1,000 paper or electronic survey forms to contact lens practitioners who, in turn, collected information about their next 10 fits. Data were processed and checked in the survey administrative offices in Manchester, United Kingdom and in Waterloo, Canada.

Lens Wearer Demographics

Our surveys typically find that about two-thirds of contact lens fits are to females, with an average age at fitting in the early 30s. This year was no exception. Sixty-seven percent of fits were to women, with individual markets ranging from 57 percent in Israel (excluding Iceland with its low return) to 79 percent in China (Table 1). The oldest patient receiving lenses for the first time was a 95-year-old female in Japan. She was prescribed high-water-content hydrogels for extended wear.

The mean age for patients was 31.0 years; the lowest average age was 24.4 years in Nepal, and the highest was 34.9 years in three northern European markets—Norway, Sweden, and the United Kingdom. In general, more mature markets report older patients, principally driven by a larger, more experienced pool of existing wearers returning for refitting. About one-third (35 percent) of fits were to new patients, confirming that most lenses are prescribed to existing wearers.

Rigid Lenses

Overall, rigid lenses accounted for 9 percent of fits (Table 2 and Figure 1). Table 3 shows a detailed analysis for the 11 countries that provided information for 35 or more rigid lens patients. Rigid lens fitting remains strong in Japan, the Netherlands, New Zealand, and Portugal with a high proportion of orthokeratology fits in the latter three markets. On the other hand, some major markets have seen a significant reduction in rigid lens fitting in recent years including Australia (14 percent of fits in 2005 compared with 0 percent in 2010), Canada (8 percent versus 1 percent), and the United Kingdom (7 percent versus 4 percent).

Figure 1. The proportion of rigid lenses prescribed, shown as standard lenses and orthokeratology lenses.

Table 1. Demographic information for the 27 countries surveyed in 2010.

Table 2. Breakdown of lens fits into six key categories of lenses. See Table 1 for country abbreviations.

Table 3. Detailed information for prescribed rigid lenses only. See Table 1 for country abbreviations. Data presented for countries reporting >35 rigid lens fits. EW = extended wear.

Figure 2. Silicone hydrogel materials prescribed to daily wear soft lens patients across all replacement intervals.

High-Dk lenses (>90 units) are the rigid lens of choice overall, accounting for 62 percent of fits. Most rigid lenses (65 percent) are prescribed on a planned replacement modality (usually annually); a significant amount of extended wear prescribing was reported for New Zealand and Portugal, mainly due to the popularity of orthokeratology outlined above.

Soft Lenses

Soft contact lenses continue to dominate most markets and indeed account for close to 100 percent of fits in Australia, Canada, Denmark, Iceland, Lithuania, Norway, Romania, and Taiwan. Overall, 91 percent of reported fits were with soft lenses (Table 4). Daily disposables have now reached 30 percent of fits, with this value significantly higher in Hong Kong (75 percent), Denmark (62 percent), and Taiwan (57 percent). Silicone hydrogel materials account for more than half of all soft lenses prescribed (51 percent) and now represent 73 percent of lens fits in the United States (Figure 2). Low-water lenses are fitted in only 7 percent of soft lens patients.

Presbyopic corrections (multifocal and monovision lenses) represent 12 percent of soft lens fits globally; this value varies markedly, from 0 percent in Korea to 36 percent in Sweden. Closer analysis of the Swedish data demonstrates that for new fits to patients older than age 45, 62 percent are prescribed a multifocal lens (with a further 12 percent provided with a monovision correction). A similar analysis for France and Portugal demonstrates that 79 percent and 100 percent, respectively, of new patients in the presbyopic age range are prescribed a multifocal contact lens.

There is considerable disparity among markets for toric lenses, with 6 percent of soft fits as torics in China compared to 42 percent in Hong Kong. High rates of toric lens prescribing (more than 30 percent of soft lens fits) are reported for Australia, Spain, France, Israel, the Netherlands, Portugal, and the United Kingdom. This metric has fallen this year for the United States (21 percent of soft lens fits).

In addition to the popularity of daily disposables described above, the other two main categories for soft lens replacement are one- to two-weekly and monthly lenses (18 percent and 44 percent of soft lens fits, respectively). Overall, fewer than 10 percent of soft lens fits worldwide are prescribed with a replacement frequency that is less than monthly. This varies, however, with more than 20 percent of soft lenses prescribed on a three- to six-monthly replacement basis in both China and Korea.

Extended wear soft lenses account for less than 10 percent of soft lens fits, although some markets (Norway and Lithuania) prescribe more than a quarter of soft lenses for this modality of wear. Multipurpose solutions account for 88 percent of all care systems prescribed for use with soft lenses (Figure 3). CLS

Figure 3. Care systems prescribed for use with soft lenses.

This survey was funded by the sponsors of Eurolens Research at the University of Manchester: Bausch + Lomb Incorporated, Alcon Laboratories (UK) Limited, Abbott Medical Optics (UK) Limited, Ciba Vision (UK) Limited, CooperVision Limited, Johnson & Johnson Vision Care, Menicon Co. Ltd., and Sauflon Pharmaceuticals Limited. Additional funding and/or assistance was provided for the following: Bulgaria, Israel, Romania, Slovenia, Croatia—Johnson & Johnson Vision Care; Australia—Optometrists Association Australia; Norway—the Norwegian Association of Optometry; the Netherlands—Bausch & Lomb Benelux; Spain—Spanish General Council of the Colleges of Opticians-Optometrists; Sweden—the Swedish Optometry Association and the Swedish Contact Lens Association; South Korea—Korean Optometric Association.

Table 4. Detailed information for prescribed soft lenses for markets reporting >100 soft lens fits. See Table 1 for country abbreviations.

The French Market

A significant addition to our 2010 contact lens prescribing data is information about the French market, which is appearing this year for the first time in our survey. France is an unusual market for western Europe in that ophthalmologists have responsibility for contact lens prescribing; other contact lens markets in the region are typically serviced by optometrists and opticians. The French market has a number of distinguishing features. The proportion of rigid lenses is close to twice that of the global average whereas daily disposable soft lenses are less widely prescribed compared to other markets. Silicone hydrogels are widely used for daily wear use; extended wear is rarely prescribed. France has a reputation for high use of bifocal and multifocal contact lenses; products of this type are often launched early in France. This contention is supported by the 2010 survey, which demonstrates that more than 80 percent of presbyopes in France are prescribed a multifocal contact lens correction (rather than a distance-only correction). The contact lens market in France compared to worldwide.

The final row indicates the proportion of multifocal and monovision lenses prescribed when patients were older than 45 years of age.