1_06 International Pres_design
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.
Contact Lens Spectrum, Issue: January 2007