International Prescribing

International Contact Lens Prescribing in 2012

Our 2012 survey of more than 20,000 contact lens fits was undertaken in 36 markets.

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, FAAO (DipCCLRT); Guillermo Carrillo Orihuela, BOptom, FIACLE; Christina N. Grupcheva, MD, PhD, FEBO, FICO (Hon); 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; Leon Sze and Patrick Cheng; Mihály Végh, MD; Nir Erdinest, BOptom, MSc; Jona Birna Ragnarsdóttir, MSc; Giancarlo Montani, FIACLE, FBCLA; Edgar Davila-Garcia, OD, FIACLE, NCLE-AC; Motozumi Itoi, MD, PhD; Byoung Sun Chu, MOptom, PhD, FAAO, FIACLE; Jolanta Bendoriene, MD, PhD; Eef van der Worp, BOptom, PhD, FAAO, FIACLE, FBCLA; Suresh Awasthi, BOptom MPhil(Optom); Wanda Lam, OD, BSc; Janet Casablanca, OD; José Manuel González-Méijome, OD, PhD, FIACLE; Oskar Johansson, BSc; Mirna Stabuc Silih, MD, PhD; John Hsiao, BA, OD, FIACLE; & Jason J. Nichols, OD, MPH, PhD, FAAO

Each year we survey contact lens prescribing colleagues around the world (optometrists, opticians, or ophthalmologists depending on the country) and request prospective information about the first 10 patients that they fit with contact lenses after receipt of our survey. In this, our 12th consecutive annual report for Contact Lens Spectrum, we present information relating to 20,566 contact lens fits across 36 countries.

Contact Lens Wearer Demographics

The most stable data point of the many that are captured in this work is the proportion of contact lenses that are prescribed to women versus men. As in 2011, and in line with all previous years of this survey, 67 percent of lenses were prescribed to females in 2012 (Table 1).

The average age remains in the low 30s: 31.7 ± 13.9 (mean ± standard deviation) for the various markets. The relatively large standard deviation for this value reveals large differences among the countries, with the average age at fitting younger than 24 years in Nepal and older than 36 years in the United Kingdom. Typically, older ages at lens fitting are found in the longer-established markets, with the mean age at fitting greater than 35 years for Australia, the Netherlands, New Zealand, and the Scandinavian countries in addition to the United Kingdom. About one-third of contact lenses prescribed are to new patients, with the remaining contact lenses fitted to existing lens wearers.

GP Lenses

The prescribing of GP lenses worldwide remains steady, with 11 percent of all lens fits in standard GP lenses and an additional 1 percent as orthokeratology fits (Table 2); this latter form of lens fit remains relatively popular (4 percent of all fits or greater) in Australia, Hong Kong, and the Netherlands.

GP lenses are commonly prescribed across a number of Latin and Central American markets as well as in the Caribbean; we surveyed many of these countries for the first time in 2012. For example, whereas GP lenses are prescribed to 7 percent or fewer patients in the United Kingdom, the United States, Australia, and Scandinavia, greater than one-in-five fits are with rigid materials in Argentina/Venezuela, Costa Rica, Mexico, and Peru. In addition, high rates of GP prescribing are seen in France, Japan, and the Netherlands as in previous years. A resurgence of scleral lens fitting has recently been discussed, and we tracked a record number of such fits in 2012—122 in total. High-Dk products remain the lens material of choice, reported in 60 percent of GP lenses prescribed (Table 3). About two-fifths of GP lenses are prescribed on a planned replacement basis.

Table 1. Demographic information for the 36 countries surveyed.

Soft Lenses

Soft lenses continue to account for about 90 percent of all contact lenses fitted (Table 4). Silicone hydrogel lens materials now represent more than half of all soft contact lenses prescribed, and they represent 70 percent or more of daily wear soft lens fits in Canada, Colombia, France, the Netherlands, and Slovenia (Figure 1).

Spherical lenses remain the most popular design, followed by torics, which account for 25 percent of soft contact lens fits. If considering only spherical and toric lens fits, the percentage of toric lenses rises to 32 percent—and it is this value that needs to be judged when determining whether the “correct” level of toric contact lenses are being prescribed. Previous reports suggest that about 45 percent of a population has refractive astigmatism of 0.75DC or greater; with this cylindrical power being the typical entry point for marketed toric contact lenses, the actual rate of prescribing appears to be rather lower than that required by the population.

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

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

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

Figure 1. Soft lens prescribing. Distribution of silicone hydrogel (SH) and hydrogel (H) lenses prescribed on a daily wear (DW) or extended wear (EW) basis. See Table 1 for country abbreviations.

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

Figure 2. Toric lens prescribing. See Table 1 for country abbreviations.

However, some markets appear to meet or exceed this proportion of toric lens fitting (Figure 2). In fact, 13 markets have a prescribing rate for toric contact lenses of 40 percent or greater. These levels are much higher than those in our earlier Contact Lens Spectrum reports, confirming the improvements in soft toric lenses delivered by the various manufacturers as well as the confidence that practitioners have in these lenses.

Ninety-five percent of soft contact lenses are replaced monthly or more frequently, with 33 percent of lens fits now daily disposables.

The level of extended wear prescribing remains modest at 5 percent of new fits and 9 percent of refits. When extended wear is the prescribed contact lens modality, the great majority of lenses are in silicone hydrogel materials. A few markets prescribe a much higher proportion of extended wear contact lenses; more than 20 percent of soft contact lens refits are into this modality in Colombia, Norway, and Puerto Rico.

In 13 markets there was a prescribing rate for toric soft contact lenses of 40 percent or greater.

Latin America, Mexico, and the Caribbean

We have reported on some markets in the Latin American and Caribbean region previously, but this year we report on 1,379 fits in eight countries around the region. There is a good level of similarity in the contact lens prescribing patterns of these markets, so presenting average findings for the region is appropriate. Figure 3 shows the overall patterns of prescribing in this region compared to the rest of the world. Rigid lenses and extended wear soft lenses are more commonly prescribed in this region, whereas daily disposables are rarely prescribed. Figure 3. Lens prescribing in Latin America, Mexico and the Caribbean.

The prescribing of contact lenses to correct presbyopia (multifocals or monovision) in patients who are over 45 years of age varies considerably among the markets surveyed. More than 60 percent of this age category are prescribed multifocal contact lenses in Bulgaria, France, Lithuania, and Singapore. On the other hand, this value is less than 20 percent in Indonesia, Japan, Korea, Peru, and Taiwan. In general, most markets have continued to move away from prescribing monovision in favor of prescribing more multifocal soft contact lens designs (Table 4). CLS

This survey was funded by the sponsors of Eurolens Research at the University of Manchester: Bausch + Lomb Incorporated, Alcon Vision Care, CooperVision Limited, Johnson & Johnson Vision Care, Menicon Co. Ltd., and Sauflon Pharmaceuticals Limited.

Additional funding and/or assistance was provided for the following: Bulgaria, Czech Republic, Israel, Hungary, Slovenia—Johnson & Johnson Vision Care; Australia—Optometrists Association Australia; Korea—CooperVision; Norway—the Norwegian Association of Optometry; Netherlands—Bausch & Lomb Benelux; Puerto Rico—The Puerto Rico College of Optometrists; Spain—Spanish General Council of the Colleges of Opticians-Optometrists; Sweden—the Swedish Optometry Association and the Swedish Contact Lens Association.

The authors acknowledge the administrative support of Eurolens Research and the Centre for Contact Lens Research at the University of Waterloo, Canada. Data collection was facilitated by Chua Siqi, Winnie Chua, Abigail Lee, Tan Ya Lun (Singapore), and Optik Melawai and Optik Seis (Indonesia).