This article is our 20th consecutive annual report of international contact lens prescribing for Contact Lens Spectrum. The premise of the work is simple. As an alternative to asking a cross section of contact lens wearers about the lenses that they use and the basis on which the lenses are worn, we move upstream in the process and directly survey those who are fitting contact lenses in numerous markets around the world. This presents a more “leading edge” indicator of contact lens fitting habits; the lenses fitted today are those sold tomorrow. The aim here is to provide summary information for colleagues in clinical practice, industry, and academia about contact lens prescribing behaviors to inform their patient management, research and development, and educational curricula, respectively.
Since the start of this initiative, numerous colleagues have come forward to help coordinate work in their country or region pro bono. They each select a representative group of contact lens practitioners in their area (typically optometrists, opticians, and/or ophthalmologists) and supply a survey form either in hard copy or as an online questionnaire. The participating practitioners provide generic information about up to 10 contact lens fits including data on the age and sex of each patient and descriptors of the lens material, design, replacement frequency, wearing modality, anticipated weekly usage, and care system prescribed. Over time, we have collected information on about 414,000 contact lens fits in 71 markets. Here, we report our overview of the contact lens prescribing situation for 2020.
KEY WEARER INFORMATION
For 2020, data on about 100 or more fits were received from 24 markets, providing details of about 13,311 contact lens fits (Table 1). This is the lowest survey return in recent years and is explained by the difficulty in gathering this information during the global COVID-19 pandemic; this both limited the number of contact lens fits in many markets and also hindered the operation of survey-based work such as this. For example, New Zealand, which has contributed data to this initiative each year from 2004 to 2019, was not able to participate this year due the impact of national lockdowns on day-to-day optometric activity. Where data were made available, it was generally for contact lens fitting conducted during the middle or late northern hemisphere summer, with the exception of a small number of markets (e.g., Australia and the United Kingdom) where sufficient information could be collected before the slow-down or closure of contact lens practice from March 2020 onward.
| Country | Total fits | Mean ± SD age | % female | % new fits | % part time (≤ 3 days) |
|---|---|---|---|---|---|
| Australia (AU) | 192 | 37.5 ± 18.6 | 60% | 43% | 28% |
| Bulgaria (BG) | 440 | 28.5 ± 10.9 | 69% | 46% | 8% |
| Canada (CA) | 1,938 | 35.1 ± 17.2 | 67% | 34% | 15% |
| Switzerland (CH) | 143 | 37.0 ± 17.0 | 56% | 41% | 10% |
| China (CN) | 130 | 28.0 ± 12.9 | 67% | 46% | 6% |
| Colombia (CO) | 320 | 31.1 ± 12.1 | 67% | 46% | 2% |
| Denmark (DK) | 278 | 37.6 ± 17.2 | 59% | 44% | 0% |
| Spain (ES) | 510 | 32.0 ± 16.0 | 63% | 34% | 8% |
| France (FR) | 320 | 36.1 ± 17.6 | 62% | 43% | 6% |
| Greece (GR) | 771 | 30.2 ± 9.9 | 57% | 18% | 14% |
| Hungary (HU) | 100 | 29.0 ± 14.9 | 59% | 53% | 16% |
| Israel (IL) | 374 | 30.3 ± 10.8 | 63% | 15% | 9% |
| Italy (IT) | 465 | 33.3 ± 16.0 | 57% | 55% | 7% |
| Japan (JP) | 3,402 | 29.1 ± 15.2 | 65% | 45% | 11% |
| Lithuania (LT) | 450 | 31.3 ± 10.4 | 66% | 12% | 23% |
| Netherlands (NL) | 439 | 37.3 ± 18.8 | 59% | 46% | 6% |
| Norway (NO) | 190 | 34.2 ± 17.0 | 57% | 46% | 10% |
| Philippines (PH) | 192 | 29.7 ± 11.1 | 72% | 38% | 7% |
| Portugal (PT) | 119 | 31.3 ± 14.9 | 61% | 48% | 7% |
| Russia (RU) | 303 | 26.2 ± 10.2 | 71% | 47% | 3% |
| Sweden (SE) | 424 | 36.9 ± 15.8 | 60% | 25% | 10% |
| Taiwan (TW) | 423 | 28.1 ± 9.6 | 85% | 47% | 0% |
| United Kingdom (UK) | 761 | 38.7 ± 17.1 | 66% | 57% | 30% |
| United States (US) | 627 | 37.0 ± 16.8 | 63% | 29% | 6% |
| OVERALL | 13,311 | 32.4 ± 15.6 | 65% | 36% | 12% |
Our dataset reveals that the mean age at fitting is similar to previous years (32.4 ± 15.6 years), with 65% of lenses prescribed to females. Twelve percent of wearers fitted are anticipated to use their lenses on a part-time basis (i.e., three days per week or fewer). Overall, 36% of lenses are prescribed on a “new fit” basis. This can be interpreted as an indirect measure of the health of a contact lens market. A higher proportion of new fits signals a greater uptake of contact lenses by those who have no previous experience with lens wear and may indicate a growing market. On the other hand, when this metric is low, it means that many fits are to existing wearers who are prescribed a modification to their current lenses or an upgrade to their lens design or material—a sign that relatively few new wearers are being attracted to the market. In 2020, a small number of markets have more than a 50% newfit rate (United Kingdom, Italy, and Hungary), with this rate less than 20% for Greece, Israel, and Lithuania (Figure 1).
Table 2 shows the main classifications of lenses prescribed. The rate of GP lens prescribing has remained stable at 13%, comprising 10% standard GP fits and 3% orthokeratology lenses. For daily wear soft lens fits, reusable lenses are prescribed slightly more commonly (44% of all fits, made up of 9% hydrogels and 35% silicone hydrogels) compared to daily disposable lenses (38% of all fits, broken down into 14% hydrogels and 24% silicone hydrogels). Five percent of all fits are reported to be soft extended wear contact lenses.
| Country | Rigid (non-OK) | OK | DD hydrogel | DD SiHy | Reusable DW hydrogel | Reusable DW SiHy | Soft EW |
|---|---|---|---|---|---|---|---|
| AU | 9% | 2% | 5% | 52% | 7% | 21% | 4% |
| BG | 14% | 0% | 4% | 6% | 10% | 58% | 8% |
| CA | 8% | 3% | 12% | 33% | 6% | 32% | 5% |
| CH | 34% | 7% | 2% | 30% | 3% | 21% | 4% |
| CN | 0% | 4% | 14% | 27% | 24% | 21% | 9% |
| CO | 21% | 0% | 1% | 2% | 10% | 65% | 1% |
| DK | 11% | 0% | 34% | 20% | 6% | 20% | 9% |
| ES | 16% | 14% | 7% | 9% | 12% | 41% | 2% |
| FR | 36% | 10% | 4% | 21% | 3% | 27% | 0% |
| GR | 2% | 0% | 8% | 5% | 26% | 59% | 0% |
| HU | 11% | 20% | 4% | 40% | 0% | 17% | 8% |
| IL | 4% | 0% | 22% | 24% | 17% | 31% | 1% |
| IT | 15% | 8% | 10% | 28% | 7% | 31% | 1% |
| JP | 12% | 0% | 28% | 23% | 12% | 25% | 0% |
| LT | 0% | 0% | 3% | 27% | 1% | 39% | 30% |
| NL | 35% | 6% | 15% | 13% | 4% | 24% | 3% |
| NO | 5% | 2% | 15% | 36% | 9% | 26% | 6% |
| PH | 7% | 1% | 2% | 6% | 24% | 50% | 12% |
| PT | 8% | 0% | 10% | 25% | 15% | 41% | 0% |
| RU | 0% | 0% | 0% | 7% | 7% | 79% | 7% |
| SE | 17% | 2% | 11% | 23% | 2% | 41% | 4% |
| TW | 5% | 0% | 46% | 12% | 29% | 8% | 0% |
| UK | 3% | 0% | 17% | 44% | 3% | 31% | 2% |
| US | 5% | 0% | 6% | 28% | 8% | 49% | 3% |
| OVERALL | 10% | 3% | 14% | 24% | 9% | 35% | 5% |
| SEE TABLE 1 for country abbreviations. OK = orthokeratology DD = daily disposable DW = daily wear EW = extended wear | |||||||
GP LENSES
It seems that the rate of GP lens prescribing has remained relatively constant in recent years due to an increasing diversity of utilization for this family of lens types (Table 3). One example here is scleral lens fitting, which was negligible 15 to 20 years ago but now accounts for around 3% of all patients fitted. Orthokeratology lens fits account for a similar fraction of overall activity, and Figure 2 shows a summary of differences between markets. This form of correction is relatively common in some European markets including France, Netherlands, Spain, and Italy. High-oxygen-permeable corneal GP lenses (Dk greater than 90 units) account for about half of all GP lens fits.
| AU | BG | CA | CH | CO | ES | FR | IT | JP | NL | SE | UK | US | OVERALL | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Rigid lenses for new fits | 9% | 17% | 13% | 42% | 17% | 21% | 60% | 16% | 4% | 36% | 20% | 2% | 8% | 13% | |
| Rigid lenses for refits | 13% | 12% | 11% | 40% | 25% | 34% | 35% | 32% | 19% | 45% | 21% | 4% | 4% | 15% | |
| MATERIALS | Scleral | 12% | 0% | 25% | 24% | 4% | 30% | 30% | 28% | 0% | 34% | 33% | 4% | 50% | 23% |
| PMMA | 0% | 0% | 0% | 0% | 16% | 1% | 0% | 2% | 1% | 1% | 0% | 0% | 0% | 1% | |
| Low Dk (< 40) | 0% | 0% | 3% | 3% | 5% | 2% | 4% | 1% | 10% | 3% | 35% | 5% | 0% | 4% | |
| Mid Dk (40-90) | 8% | 0% | 50% | 15% | 32% | 18% | 1% | 13% | 20% | 31% | 4% | 67% | 39% | 23% | |
| High Dk (> 90) | 80% | 100% | 22% | 58% | 43% | 48% | 64% | 56% | 69% | 31% | 28% | 23% | 12% | 49% | |
| DESIGN | Sphere | 49% | 99% | 19% | 3% | 51% | 42% | 53% | 24% | 78% | 13% | 56% | 32% | 16% | 38% |
| Toric | 5% | 0% | 11% | 35% | 27% | 4% | 11% | 23% | 2% | 49% | 15% | 12% | 20% | 19% | |
| Multifocal | 0% | 0% | 7% | 20% | 3% | 6% | 3% | 12% | 11% | 18% | 0% | 33% | 20% | 9% | |
| Monovision | 14% | 1% | 3% | 13% | 0% | 0% | 0% | 1% | 1% | 1% | 0% | 5% | 4% | 2% | |
| OK | 20% | 0% | 31% | 17% | 1% | 46% | 22% | 34% | 2% | 15% | 10% | 6% | 7% | 22% | |
| Myopia control | 11% | 0% | 29% | 12% | 0% | 2% | 0% | 2% | 0% | 3% | 19% | 13% | 7% | 6% | |
| Other | 1% | 0% | 1% | 0% | 18% | 1% | 11% | 4% | 6% | 1% | 0% | 1% | 25% | 4% | |
| Planned replacement | 48% | 100% | 47% | 84% | 78% | 92% | 92% | 62% | 23% | 57% | 99% | 55% | 77% | 66% | |
| Extended wear | 38% | 0% | 36% | 8% | 0% | 46% | 0% | 7% | 0% | 10% | 0% | 15% | 6% | 18% | |
| SEE TABLE 1 for country abbreviations. PMMA = polymethylmethacrylate OK = orthokeratology | |||||||||||||||
SOFT LENSES
Soft lenses account for 87% of lens fits, with this lens type now dominated by silicone hydrogel materials (72% of soft lenses prescribed) (Table 4). Figure 3 shows the increase in prescribing silicone hydrogel materials over the past 21 years for 17 markets for which we hold long-term data. The trend here is clear. Since the launch of silicone hydrogel lenses for daily wear use in 2004, there was a dramatic rise in the uptake of these lenses from 2004 to 2011, followed by a slower increase. In recent years, there is evidence of an emergence of a subset of markets (Spain, United Kingdom, Israel, Japan, and Denmark) that fit a somewhat lower proportion of silicone hydrogels compared to most countries including the United States, Lithuania, and Australia.
| AU | BG | CA | CN | CO | CZ | DK | ES | FR | GR | IL | IT | JP | LT | NL | NO | PH | PT | RU | SE | TW | UK | US | OVERALL | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Soft lenses for new fits | 91% | 83% | 87% | 93% | 83% | 100% | 86% | 79% | 40% | 98% | 99% | 84% | 96% | 100% | 64% | 88% | 90% | 92% | 100% | 80% | 96% | 98% | 88% | 87% | |
| Soft lenses for refits | 87% | 88% | 89% | 98% | 75% | 100% | 91% | 66% | 65% | 98% | 95% | 68% | 81% | 100% | 55% | 93% | 94% | 91% | 100% | 79% | 93% | 96% | 89% | 86% | |
| MATERIALS | Low water content (< 40%) | 12% | 0% | 3% | 12% | 0% | 10% | 1% | 2% | 4% | 1% | 1% | 2% | 7% | 0% | 4% | 0% | 18% | 0% | 4% | 1% | 51% | 4% | 2% | 5% |
| Mid water content (40-60%) | 0% | 11% | 8% | 5% | 4% | 2% | 22% | 5% | 5% | 4% | 3% | 8% | 9% | 6% | 8% | 13% | 6% | 2% | 0% | 8% | 1% | 4% | 7% | 6% | |
| High water content (> 60%) | 2% | 7% | 11% | 28% | 10% | 4% | 28% | 20% | 3% | 30% | 38% | 13% | 29% | 0% | 22% | 15% | 7% | 24% | 3% | 8% | 27% | 13% | 7% | 17% | |
| Silicone hydrogel | 86% | 83% | 78% | 56% | 86% | 85% | 49% | 73% | 87% | 66% | 59% | 78% | 55% | 94% | 66% | 72% | 69% | 73% | 93% | 83% | 21% | 79% | 84% | 72% | |
| DESIGN | Sphere | 37% | 63% | 38% | 71% | 44% | 38% | 33% | 48% | 39% | 59% | 52% | 25% | 74% | 74% | 30% | 34% | 54% | 28% | 84% | 34% | 83% | 34% | 42% | 51% |
| Toric | 37% | 15% | 32% | 6% | 32% | 57% | 26% | 25% | 28% | 26% | 40% | 34% | 17% | 11% | 29% | 43% | 22% | 39% | 10% | 36% | 16% | 38% | 33% | 27% | |
| Cosmetic tint | 0% | 0% | 1% | 15% | 2% | 0% | 3% | 0% | 0% | 4% | 0% | 0% | 2% | 6% | 0% | 0% | 12% | 0% | 1% | 0% | 1% | 1% | 2% | 2% | |
| Multifocal | 16% | 19% | 23% | 4% | 10% | 5% | 22% | 13% | 30% | 9% | 8% | 30% | 5% | 7% | 24% | 19% | 12% | 26% | 4% | 22% | 0% | 22% | 16% | 14% | |
| Monovision | 5% | 1% | 5% | 3% | 6% | 0% | 16% | 1% | 1% | 0% | 0% | 2% | 1% | 0% | 6% | 4% | 0% | 4% | 2% | 6% | 0% | 5% | 6% | 3% | |
| Myopia control | 5% | 0% | 1% | 0% | 3% | 0% | 1% | 13% | 1% | 1% | 0% | 8% | 0% | 0% | 10% | 1% | 0% | 3% | 0% | 2% | 0% | 1% | 1% | 2% | |
| Other | 0% | 2% | 0% | 0% | 3% | 0% | 0% | 0% | 0% | 0% | 0% | 1% | 0% | 1% | 1% | 1% | 0% | 0% | 0% | 0% | 0% | 0% | 1% | 0% | |
| REPLACEMENT | Daily | 67% | 13% | 54% | 48% | 4% | 46% | 68% | 22% | 45% | 13% | 49% | 50% | 58% | 43% | 50% | 59% | 10% | 38% | 8% | 43% | 62% | 64% | 38% | 46% |
| 1-2 weekly | 12% | 10% | 6% | 7% | 0% | 8% | 2% | 2% | 14% | 34% | 25% | 3% | 40% | 2% | 6% | 7% | 1% | 8% | 25% | 3% | 2% | 3% | 16% | 16% | |
| Monthly | 12% | 73% | 40% | 31% | 74% | 45% | 28% | 66% | 41% | 51% | 23% | 37% | 1% | 54% | 42% | 28% | 66% | 53% | 65% | 53% | 36% | 33% | 46% | 35% | |
| 3-6 monthly | 1% | 4% | 0% | 6% | 12% | 0% | 2% | 8% | 0% | 1% | 0% | 8% | 0% | 0% | 1% | 2% | 19% | 0% | 2% | 1% | 0% | 0% | 0% | 1% | |
| Annually | 7% | 0% | 0% | 4% | 3% | 1% | 0% | 1% | 0% | 0% | 3% | 1% | 0% | 0% | 0% | 4% | 4% | 0% | 0% | 0% | 0% | 0% | 0% | 1% | |
| Unplanned | 0% | 0% | 0% | 4% | 6% | 0% | 0% | 0% | 0% | 0% | 0% | 1% | 1% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | |
| Extended wear | 5% | 9% | 6% | 10% | 1% | 1% | 10% | 2% | 0% | 0% | 1% | 1% | 0% | 31% | 5% | 6% | 12% | 0% | 6% | 5% | 0% | 2% | 3% | 5% | |
| EW with silicone hydrogels | 100% | 81% | 99% | 19% | 93% | 100% | 94% | 92% | 100% | • | 67% | 100% | 71% | 100% | 99% | 96% | 62% | 100% | 93% | 96% | • | 100% | 51% | 93% | |
| MPS | 92% | 97% | 80% | 98% | 97% | 95% | 60% | 95% | 93% | 92% | 85% | 76% | 82% | 84% | 88% | 85% | 92% | 97% | 97% | 95% | 99% | 96% | 90% | 88% | |
| Presbyopes multi/mono | 49%/13% | 65%/2% | 54%/12% | 53%/33% | 43%/23% | 52%/0% | 36%/27% | 58%/4% | 74%/4% | 60%/2% | 83%/0% | 76%/4% | 28%/2% | 48%/2% | 58%/14% | 49%/11% | 51%/0% | 70%/17% | 39%/0% | 53%/14% | 6%/0% | 56%/10% | 52%/17% | 52%/10% | |
| See Table 1 for country abbreviations. EW = extended wear MPS = multipurpose solution The final row indicates the proportion of multifocal and monovision lenses prescribed when patients were over 45 years of age. |
|||||||||||||||||||||||||
About half of all soft lenses prescribed are spheres, one-quarter are torics (this would include patients fitted with one spherical lens and one toric lens), and 14% are multifocals. If only presbyopes are considered, 52% are prescribed multifocal lenses and 10% a monovision correction. Overall, 2% of soft lens fits were described as “myopia control” (a term that is now used synonymously with “myopia management”). This lens type, of course, is generally prescribed to children. Figure 4 shows an analysis of how commonly these lenses are prescribed to patients aged 6 to 17 years for markets for which we hold information about at least 1,000 lens fits from 2018 to 2020. This demonstrates a high proportion of myopia control lenses prescribed for this age group in Spain, Australia, Netherlands, and Italy. This finding is especially important in Spain, where a significant fraction of all contact lenses are prescribed to children (i.e., myopia control lenses represent a “high proportion of a high proportion”), and this signifies an important development in that market in recent years.
In 2020, daily disposable contact lenses were prescribed slightly less (46% of daily wear soft lens fits) compared to reusable lenses (the remaining 54%). Again, there is considerable variation in prescribing of this lens type (Figure 5), although many markets prescribe around 40% or more of soft contact lenses for daily replacement. Spain, Greece, Bulgaria, the Philippines, Russia, and Colombia are the only markets that do not reach this threshold. CLS
Funding and/or assistance was provided for the following markets: Australia—Optometry Australia; Bulgaria—Vision Protect Ltd; France, Greece, and Israel—Johnson & Johnson Vision; Norway—Norwegian Association of Optometry; Spain—Spanish General Council of the Colleges of Opticians-Optometrists; Switzerland—Swiss Society of Optometry and Optics SBAO/SSOO.
The authors acknowledge the administrative support of Eurolens Research, University of Manchester, and the Centre for Ocular Research and Education (CORE) at the University of Waterloo.
![]({"src":"/media/33ifzikc/cover_cls_0121.jpg","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})