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Article Date: 1/1/2014

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International Prescribing
INTERNATIONAL PRESCRIBING

International Contact Lens Prescribing in 2013

Our survey for 2013 includes information on more than 21,000 fits in 31 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); Ing. Mario Teufl, MSc; Christina N. Grupcheva, MD, PhD, FEBO, FICO (Hon); Deborah Jones, BSc, FCOptom, DipCLP, FAAO; Kah-Ooi Tan, BOptom (Hons), PhD, MBA; Alice Pesinova, BSc; Heiko Pult, MSc, PhD, FAAO, FBCLA, FEAO; Ole Ravn, MSc(Optom); Peter Gierow, PhD, FAAO; Jacinto Santodomingo, OD(EC), MSc, PhD, MCOptom, FBCLA, FAAO; Florence Malet, MD; Athina Plakitsi, PhD; Dr. Mihály Végh; Nir Erdinest, BOptom, MSc, PhD; Prema K. Chande, MOptom, DBM, FIACLE; Jona Birna Ragnarsdóttir, MSc; Motozumi Itoi, MD, PhD; Byoung Sun Chu, MOptom, PhD, FAAO, FIACLE; Jolanta Bendoriene, MD, PhD; Eef van der Worp, BSc, PhD, FAAO, FIACLE, FBCLA; Suresh Awasthi, BOptom, MPhil(Optom); Wanda Lam, OD, BSc; Weronika Leszczyńska, MSc; José Manuel González-Méijome, OD, PhD, FIACLE; Vadim Belousov; Mirna Stabuc Silih, MD, PhD; John Hsiao, BA, OD, FIACLE; & Jason J. Nichols, OD, MPH, PhD, FAAO

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

Dr. Woods is an associate professor, School of Medicine (Optometry), University of Deakin, Australia.

Dr. Tranoudis is director, Professional Affairs, Emerging Markets, Europe, Middle East and Africa, Johnson & Johnson Vision Care.

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

Dr. Efron is a research professor, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia.

Mario Teufl is an optometrist in Kärnten, Austria.

Dr. Grupcheva is a professor and head of the Department of Ophthalmology and Visual Science, Medical University-Varna, Bulgaria.

Dr. Jones is a clinical professor, School of Optometry and Vision Science, University of Waterloo, Canada.

Dr. Tan is the associate program director, Optometry Degree Programme at Singapore Polytechnic.

Alice Pesinova is associated with the Czech Association of Contactology, Prague, Czech Republic.

Dr. Pult is head of Dr. Heiko Pult Optometry and Vision Research in Weinheim, Germany.

Mr. Ravn is an optometrist at the Danish College of Optometry and Visual Science, Randers, Denmark

Dr. Gierow is head of the Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.

Dr. Santodomingo is Clinical Affairs Manager and Senior Research Scientist, Menicon Co., Ltd.

Dr. Malet works at Ophthalmology Center PointVision, Bordeaux, France.

Dr. Plakitsi is a lecturer in the Department of Optics and Optometry at the Technological Educational Institute of Athens, Greece.

Dr. Végh is head of the Hungarian Contactologic Society, Szeged, Hungary.

Dr. Erdinest works at Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Dr. Chande works at Lotus College of Optometry, Mumbai, India.

Jona Birna Ragnarsdóttir is an optometrist, Reykjavik, Iceland.

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

Dr. Chu works at the Department of Optometry & Vision Science, Catholic

University of Daegu, Korea.

Dr. Bendoriene works at Siauliai University, Siauliai, Lithuania.

Dr. van der Worp works at Eye Research Institute, Maastricht, the Netherlands.

Dr. Awasthi works at Geta Eye Hospital, Dhangadhi, Nepal.

Dr. Lam is the course controller for Contact Lenses, Department of Optometry, Auckland University, Auckland, New Zealand.

Weronika Leszczyńska is the professional relations manager for Bausch + Lomb, Warsaw, Poland.

Dr. González-Méijome works at the Clinical and Experimental Optometry Research Laboratory, University of Minho, Portugal.

Vadim Belousov is editor, Journal of Optometry, Moscow, Russia.

Dr. Silih is an assistant professor, Eye Hospital, University Medical Centre, Ljubljana, Slovenia.

Dr. Hsiao is an assistant professor, Department of Optometry, Chung Shan Medical University, Taichung, Taiwan.

Dr. Nichols is the Kevin McDaid Vision Source Professor at the University of Houston College of Optometry as well as the editor-in-chief of Contact Lens Spectrum.

Every year since 2001, we have reported data from an international survey of contact lens prescribing in Contact Lens Spectrum. This work, which first started in the United Kingdom, has now recorded information about more than 250,000 contact lens fits in 54 countries.

Our approach is simple. We ask contact lens prescribers (optometrists, opticians, or ophthalmologists, depending on the country) to record information about the first 10 contact lens fits that they perform after the start of the survey period each year. Each fit is then weighted to reflect the volume of fits performed by each practitioner. Information is collated at our two survey offices in Manchester, United Kingdom and Waterloo, Canada. For this report of contact lens prescribing in 2013, we report data for 21,673 lens fits in 31 markets around the world.

Lens Wearer Demographics

Contact lenses are predominantly prescribed to females (63% of all fits) (Table 1). There is some variation among markets, with this value less than 50% in Spain and Nepal compared to as high as 75% in Bulgaria.

Table 1. Demographic information for the 31 countries surveyed.

Country Total fits Mean (±SD) age % female % new fits % part time (≤3days)
Austria (AT) 310 35.4 ± 14.9 69% 20% 2%
Australia (AU) 458 38.2 ± 15.9 66% 36% 24%
Bulgaria (BG) 747 27.7 ± 9.3 75% 35% 1%
Canada (CA) 1080 34.7 ± 15.2 66% 29% 19%
China (CN) 160 28.4 ± 6.7 72% 31% 16%
Czech Republic (CZ) 370 30.0 ± 13.6 63% 58% 22%
Germany (DE) 708 35.0 ± 14.0 62% 33% 6%
Denmark (DK) 660 37.5 ± 15.2 62% 48% 2%
Spain (ES) 1026 31.9 ± 14.7 46% 55% 8%
France (FR) 1320 34.7 ± 15.4 69% 41% 5%
Greece (GR) 370 33.9 ± 13.1 56% 40% 8%
Hungary (HU) 470 27.9 ± 11.7 61% 53% 9%
Indonesia (ID) 231 26.3 ± 9.5 73% 53% 9%
Israel (IL) 1230 29.2 ± 11.5 62% 28% 11%
India (IN) 90 29.5 ± 11.1 70% 28% 4%
Iceland (IS) 62 27.1 ± 14.3 52% 35% 35%
Japan (JP) 4290 29.0 ± 13.9 68% 43% 13%
South Korea (KR) 370 24.8 ± 7.2 75% 20% 10%
Lithuania (LT) 760 27.2 ± 9.9 30% 24% 21%
Netherlands (NL) 1280 36.2 ± 15.8 66% 32% 3%
Norway (NO) 768 36.3 ± 15.3 58% 27% 6%
Nepal (NP) 221 24.3 ± 7.7 48% 32% 0%
New Zealand (NZ) 945 35.8 ± 15.8 63% 39% 20%
Poland (PL) 140 31.5 ± 11.5 78% 43% 3%
Portugal (PT) 220 31.0 ± 12.2 59% 43% 10%
Russia (RU) 660 27.3 ± 10.1 38% 46% 3%
Sweden (SE) 450 40.4 ± 16.0 64% 30% 16%
Slovenia (SI) 190 31.7 ± 14.4 59% 21% 8%
Taiwan (TW) 556 26.0 ± 9.0 76% 10% 0%
United Kingdom (UK) 781 36.8 ± 15.9 63% 53% 23%
United States (US) 750 34.7 ± 15.6 64% 25% 5%
Overall 21673 32.0 ± 14.3 63% 36% 10%

The average age of patients at lens fitting is higher than what’s often presumed, at 32.0 years worldwide. However, significant differences are apparent among countries. The more established contact lens markets in western Europe and North America have mean ages at fitting of about 35 years or older, while, in 2013, this parameter was 40.4 years for Sweden. On the other hand, markets in eastern Europe and Asia usually feature younger wearers, with the average age at fitting of 27.7 years, 26.3 years, and 24.8 years for Bulgaria, Indonesia, and South Korea, respectively.

Most fits around the world are to existing contact lens wearers, with only 36% reported as “new fits,” and most people are fitted on a full-time basis (four days per week or more of wear), with only 10% of patients fitted for part-time wear.

GP Lenses

GP lens fitting in 2013 remained similar to recent years, with 12% of fits in “standard” GP lenses and a further 1% with orthokeratology lenses (Table 2). The presence in 2013 of data for the German, Austrian, and Polish markets confirms the relative popularity of GP lenses in these countries (see sidebar on p. 35). Significant levels of GP fitting also are apparent in France, Japan, the Netherlands, and Slovenia.

The number of scleral lens fits edged upward again, with 170 such fits recorded for 2013. High-Dk materials (40 to 90 units) were the most commonly prescribed (56% of fits) (Table 3). Spherical lenses were the most popular GP lens design, and 12% of GP lenses prescribed were multifocals.

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

Country Rigid (non OK) OK DD hydrogel DD Si-H Other DW hyrogel Other DW Si-H Soft EW
AT 23% 7% 7% 7% 17% 39% 0%
AU 5% 0% 17% 10% 10% 50% 7%
BG 7% 0% 2% 2% 12% 64% 14%
CA 4% 1% 16% 6% 14% 56% 4%
CN 2% 0% 30% 1% 38% 23% 6%
CZ 4% 0% 13% 10% 15% 55% 3%
DE 26% 1% 10% 7% 19% 37% 1%
DK 7% 1% 39% 8% 9% 27% 9%
ES 10% 3% 15% 7% 24% 40% 2%
FR 16% 2% 7% 10% 7% 57% 1%
GR 5% 0% 7% 3% 29% 50% 6%
HU 2% 1% 8% 11% 18% 54% 5%
ID 3% 0% 29% 3% 54% 12% 0%
IL 12% 0% 24% 7% 27% 26% 4%
IN 8% 0% 12% 0% 34% 45% 0%
IS 0% 0% 37% 0% 4% 59% 0%
JP 17% 0% 30% 9% 20% 23% 0%
KR 15% 0% 15% 5% 48% 14% 2%
LT 0% 0% 17% 6% 8% 50% 19%
NL 18% 5% 2% 4% 15% 54% 1%
NO 6% 0% 23% 12% 4% 29% 27%
NP 20% 0% 0% 0% 73% 7% 0%
NZ 16% 1% 21% 9% 5% 46% 2%
PL 19% 0% 2% 3% 0% 74% 2%
PT 5% 0% 9% 14% 17% 55% 0%
RU 1% 0% 5% 5% 18% 57% 13%
SE 1% 1% 31% 7% 11% 36% 14%
SI 50% 0% 0% 9% 2% 32% 7%
TW 3% 5% 51% 0% 42% 0% 0%
UK 7% 1% 30% 13% 8% 37% 4%
US 5% 1% 17% 8% 6% 54% 9%
Overall 12% 1% 18% 8% 16% 41% 5%

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.

AT DE ES FR IL JP NL NP NZ SI TW UK US Overall
Rigid lenses for new fits 23% 25% 11% 29% 10% 9% 20% 52% 11% 9% 21% 3% 4% 12%
Rigid lenses for refits 32% 28% 15% 12% 12% 24% 24% 4% 21% 60% 6% 14% 6% 15%
Materials Low Dk (<40) 8% 7% 12% 1% 20% 11% 4% 0% 0% 0% 5% 1% 35% 6%
Mid Dk (40-90) 60% 68% 15% 7% 57% 28% 52% 69% 23% 29% 25% 51% 40% 38%
High Dk (>90) 32% 25% 73% 92% 23% 61% 44% 31% 77% 71% 70% 48% 25% 56%
Design Sphere 25% 44% 45% 42% 76% 85% 39% 93% 37% 39% 30% 39% 50% 51%
Toric 23% 23% 8% 15% 14% 2% 11% 7% 9% 34% 8% 15% 10% 14%
Multifocal/monovision 11% 13% 10% 17% 3% 8% 26% 0% 12% 25% 0% 28% 13% 14%
Ortho-K 24% 4% 26% 13% 1% 1% 22% 0% 7% 0% 63% 9% 12% 11%
Anti-myopia 0% 1% 1% 14% 1% 0% 0% 0% 2% 0% 0% 0% 0% 2%
Other 18% 15% 10% 0% 4% 4% 2% 0% 32% 3% 0% 10% 16% 8%
Planned replacement 45% 24% 31% 90% 33% 10% 43% 31% 35% 43% 100% 39% 22% 46%
New fits into EW 35% 1% 1% 11% 0% 1% 13% 0% 2% 0% 0% 0% 0% 7%
Refits into EW 22% 0% 1% 6% 18% 0% 0% 5% 0% 0% 0% 12% 4% 5%

Soft Lenses

Soft lenses accounted for 88% of new contact lens fits in our 2013 survey (Table 4). Silicone hydrogel materials have continued to increase, now representing 59% of soft contact lenses prescribed. However, these lens materials have an even greater presence in some European markets, accounting for more than 80% of contact lens types prescribed in Bulgaria, France, Poland, and Slovenia.

Toric lenses now account for 27% of lens fits; this value is 34% if only spherical and toric lenses are considered (i.e., if fits such as multifocal, monovision, and cosmetic tints are discounted), indicating that clinically significant astigmatism in the majority of lens wearers is being corrected with current generation toric lenses.

Table 4. Detailed information for all prescribed soft lenses for markets reporting >100 soft lens fits. (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.

AT AU BG CA CN CZ DE DK ES FR GR HU ID IL JP KR LT NL NO NP NZ PL PT RU SE SI TW UK US Overall
Soft lenses for new fits 77% 96% 94% 96% 97% 96% 75% 94% 89% 71% 98% 93% 97% 90% 91% 77% 100% 80% 96% 48% 89% 65% 98% 100% 99% 91% 79% 97% 96% 88%
Soft lenses for refits 68% 94% 95% 94% 98% 96% 72% 90% 85% 88% 92% 96% 98% 88% 76% 87% 100% 76% 93% 96% 79% 93% 93% 98% 98% 40% 94% 86% 94% 85%
Materials Low water content (<40%) 2% 6% 4% 5% 15% 2% 1% 2% 5% 2% 2% 1% 6% 4% 10% 34% 2% 1% 2% 18% 1% 0% 6% 6% 1% 0% 46% 1% 3% 5%
Mid water content (40-60%) 18% 17% 11% 18% 54% 17% 25% 39% 36% 7% 33% 17% 74% 29% 41% 29% 10% 10% 17% 50% 23% 3% 14% 17% 27% 4% 45% 14% 17% 23%
High water content (>60%) 15% 8% 3% 9% 6% 11% 14% 25% 4% 8% 2% 10% 6% 26% 10% 13% 19% 12% 20% 22% 8% 0% 7% 3% 21% 1% 9% 29% 8% 13%
Silicone hydrogel 66% 69% 82% 68% 25% 70% 60% 33% 55% 83% 63% 71% 15% 40% 39% 24% 69% 77% 61% 9% 68% 97% 72% 73% 51% 96% 0% 57% 73% 59%
Design Sphere 37% 47% 89% 46% 48% 56% 36% 41% 43% 42% 47% 57% 48% 68% 79% 37% 67% 45% 48% 93% 43% 36% 45% 78% 31% 73% 93% 45% 48% 53%
Toric 41% 32% 8% 32% 10% 32% 39% 37% 38% 29% 27% 30% 14% 26% 15% 22% 17% 36% 30% 7% 40% 38% 36% 15% 27% 26% 6% 34% 27% 27%
Cosmetic tint 1% 1% 1% 0% 16% 2% 1% 0% 1% 1% 4% 0% 31% 2% 4% 41% 9% 0% 0% 0% 1% 0% 0% 4% 0% 0% 0% 1% 1% 3%
Multifocal/monovision 21% 20% 3% 21% 2% 7% 24% 21% 19% 28% 21% 13% 7% 4% 3% 0% 6% 20% 21% 0% 14% 26% 18% 2% 41% 1% 1% 21% 23% 15%
Anti-myopia 0% 1% 0% 0% 9% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0%
Other 0% 0% 0% 0% 15% 3% 1% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 2% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Replacement Daily 19% 31% 5% 24% 33% 25% 23% 65% 25% 22% 11% 21% 33% 36% 48% 25% 27% 9% 51% 0% 37% 6% 24% 12% 45% 22% 55% 50% 30% 31%
1-2 weekly 8% 19% 4% 17% 5% 17% 26% 5% 2% 20% 14% 11% 12% 18% 48% 7% 4% 9% 6% 1% 7% 4% 6% 28% 4% 38% 25% 6% 32% 18%
Monthly 41% 45% 58% 57% 42% 55% 40% 26% 66% 54% 59% 66% 38% 43% 2% 11% 65% 77% 42% 7% 55% 90% 63% 54% 51% 40% 18% 43% 37% 44%
3-6 monthly 19% 2% 23% 1% 10% 0% 3% 3% 5% 2% 6% 0% 17% 1% 0% 56% 3% 4% 1% 0% 1% 0% 0% 5% 0% 0% 0% 1% 2% 4%
Annually 11% 2% 10% 0% 10% 4% 7% 0% 2% 2% 1% 2% 1% 2% 0% 1% 1% 0% 0% 93% 0% 0% 7% 0% 0% 0% 2% 0% 0% 2%
Unplanned 1% 1% 0% 0% 0% 0% 1% 0% 0% 0% 8% 0% 0% 0% 2% 1% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 1%
New fits into EW 0% 4% 7% 2% 3% 3% 0% 10% 2% 0% 1% 5% 0% 2% 0% 1% 9% 0% 21% 0% 1% 0% 1% 9% 12% 12% 0% 0% 4% 3%
Refits into EW 4% 3% 1% 9% 17% 5% 9% 4% 1% 12% 3% 1% 8% 6% 0% 0% 0% 3% 23% 2% 31% 0% 4% 3% 0% 16% 15% 16% 0% 7%
EW with silicone hydrogels 100% 99% 69% 100% 75% 100% 100% 96% 83% 85% 96% 91% 100% 20% 23% 24% 94% 99% 98% 100% 92% 100% 100% 98% 91% 97% 100% 97% 94% 91%
MPS solutions 52% 92% 99% 83% 93% 87% 56% 86% 83% 83% 82% 91% 100% 92% 83% 100% 76% 90% 98% 100% 96% 96% 79% 96% 98% 99% 70% 93% 86% 86%
Presbyopes multi/mono 51%/11% 25%/25% 2%/6% 42%/13% 0%/20% 19%/1% 60%/5% 56%/13% 65%/1% 72%/4% 58%/13% 61%/4% 0%/0% 15%/17% 20%/1% 0%/0% 54%/0% 54%/5% 46%/23% 0%/0% 28%/16% 90%/0% 70%/0% 19%/0% 61%/9% 5%/0% 18%/0% 35%/23% 53%/15% 50%/10%

Daily disposable lenses represent 31% of fits worldwide. Once again, there are clear differences among markets, with daily disposables accounting for 65%, 48%, 51%, and 55% of soft lens fits in Denmark, Japan, Norway, and Taiwan, respectively, compared to fewer than 10% of fits in the Netherlands, Nepal, and Poland. There has been a significant increase in daily disposable lens prescribing in the United States (Figure 1). Our data indicate that between 2002 and 2007, this lens type accounted for only 5% to 10% of fits in the United States, but this has risen since that time frame and stands at 30% of fits for 2013.

images

Figure 1. Daily disposable contact lens prescribing over time in seven major markets.

The breakdown of daily disposable contact lenses into traditional hydrogels and silicone hydrogels was recorded for the first time in 2013 (Table 2 and Figure 2). Overall, about one-third of daily disposable lenses prescribed are silicone hydrogels, although this figure is higher for Hungary, the Netherlands, and Portugal.

images

Figure 2. Daily disposable prescribing in 2013.

In general, extended wear is rarely prescribed (3% of new fits and 7% of refits), although, as in previous years, many more patients are prescribed this modality in Norway and Lithuania (Figure 3). Half of all patients in the presbyopic age range are prescribed multifocal contact lenses, while 10% receive a monovision correction. Multipurpose lens care solutions are prescribed to 85% of contact lens wearers, although notable variations exist worldwide (Figure 4). CLS

images

Figure 3. Extended wear prescribing in 2013.

images

Figure 4. Solution prescribing for soft lenses. MPS = multipurpose solution.

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, France, Greece, Israel, Hungary, Slovenia—Johnson & Johnson Vision Care; Australia—Optometrists Association Australia; Korea and China—CooperVision; Norway—the Norwegian Association of Optometry; the Netherlands and Poland—Bausch + Lomb; 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.

Germany, Austria, and Poland

Data were recorded for Germany in 2013 after a six-year gap, and the 2013 survey presents information for Poland and Austria for the first time. These markets feature more GP lens fits compared to most other countries (Figure 5), with fewer daily disposables and extended wear lenses. Germany and Austria are the markets in which peroxides are most widely prescribed, accounting for more than 40% of soft lenses dispensed (Figure 4).

images

Figure 5. Contact lens prescribing in Austria, Germany, and Poland. DW = daily wear EW = extended wear Si-H = silicone hydrogel OK = orthokeratology



Contact Lens Spectrum, Volume: 29 , Issue: January 2014, page(s): 30 - 35

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