Article

INTERNATIONAL CONTACT LENS PRESCRIBING IN 2016

Our 16th report in Contact Lens Spectrum outlines the latest trends in contact lens prescribing around the world.

Every year since 2001, we have reported on the nature of contact lens markets around the world by collecting fitting information from optometrists, ophthalmologists, and opticians at the time of contact lens prescribing. The database of prospectively collected details of 335,000 lens fits is a powerful bank of clinical information, reflecting changes in both available lens types, as well as practitioner attitudes, since the turn of the century. In this article, we present our report for 2016, which covers 20,000 contact lens fits in 33 markets.

A strength of our work is its consistent methodology, which allows for meaningful year-on-year comparisons. In 2016, as previously, the study authors each organized survey form distribution to qualified practitioners in their country or region. Each form was then completed to provide generic information about the first 10 patients fit with lenses after receipt. Generic patient details were captured as well as lens material, design, replacement, and wearing modality information; weekly wearing frequency; and care system type. Each fit was weighted to reflect activity of each practitioner. All study data were processed at the University of Manchester in the United Kingdom and the University of Waterloo in Canada.

CONTACT LENS WEARER DEMOGRAPHICS

Table 1 provides the main demographic information collected in the survey. The average age of the patients at fitting was 31.5 years, although there is great variation in this measurement. Some markets in northern Europe, in addition to Australia and New Zealand, report a mean age at fitting of close to 40 years. This signifies the maturity of the contact lens market in these countries. On the other hand, some emerging markets in eastern Europe, as well as Iran and Korea, report average fitting ages between 25 and 27 years.

TABLE 1 DEMOGRAPHIC INFORMATION FOR THE 33 COUNTRIES SURVEYED
Country Total fits Mean (±SD) age % female % new fits % part time (≤3 days)
Australia (AU) 353 36.3 ± 16.5 61% 42% 28%
Belgium (BE) 214 34.2 ± 13.6 60% 41% 12%
Bulgaria (BG) 560 26.9 ± 8.7 71% 59% 10%
Canada (CA) 783 36.4 ± 15.9 67% 27% 24%
Switzerland (CH) 167 37.3 ± 16.8 65% 41% 13%
China (CN) 248 25.5 ± 8.5 68% 31% 19%
Czech Republic (CZ) 247 31.4 ± 13.7 68% 38% 25%
Germany (DE) 220 37.5 ± 14.7 58% 37% 10%
Denmark (DK) 407 38.4 ± 15.9 63% 39% 0%
Spain (ES) 770 34.0 ± 15.1 65% 38% 10%
Greece (GR) 452 29.6 ± 9.8 49% 23% 10%
Hong Kong (HK) 266 29.1 ± 14.7 70% 14% 9%
Hungary (HU) 275 30.8 ± 12.7 65% 55% 12%
Indonesia (ID) 520 28.0 ± 9.0 77% 37% 19%
Israel (IL) 649 30.2 ± 11.6 66% 23% 9%
Iran (IR) 765 26.3 ± 4.6 70% 49% 34%
Italy (IT) 550 31.8 ± 14.2 59% 54% 7%
Japan (JP) 4115 30.0 ± 15.1 67% 44% 18%
Korea (KR) 320 27.1 ± 8.1 90% 6% 36%
Lithuania (LT) 691 29.0 ± 10.5 65% 22% 20%
Moldova (MD) 150 25.5 ± 10.0 68% 78% 4%
Netherlands (NL) 922 37.6 ± 17.1 62% 26% 5%
Norway (NO) 654 36.2 ± 16.7 59% 33% 12%
New Zealand (NZ) 446 39.5 ± 17.5 63% 28% 18%
Philippines (PH) 2259 28.4 ± 8.8 70% 22% 3%
Portugal (PT) 172 31.1 ± 13.1 65% 64% 18%
Russia (RU) 671 27.2 ± 9.9 63% 30% 6%
Sweden (SE) 351 38.3 ± 15.0 63% 23% 9%
Slovenia (SI) 137 38.0 ± 15.4 57% 34% 5%
Thailand (TH) 330 29.6 ± 8.6 58% 36% 1%
Taiwan (TW) 647 30.1 ± 10.9 75% 6% 0%
United Kingdom (UK) 603 37.9 ± 16.7 61% 45% 23%
United States (US) 138 35.3 ± 16.9 61% 32% 3%
Overall 20052 31.5 ± 13.9 65% 30% 12%

Less variation is seen in terms of gender distribution in lens fits. Overall, 65% of fits were to females, ranging from 49% in Greece to 90% in Korea. Thirty percent of lenses were prescribed as “new” fits, indicating that most patients presenting for contact lens fitting are existing wearers. Only 12% of lenses were prescribed for part-time use. These values are in line with recent years.

GP LENSES

Overall, standard GP lenses accounted for 7% of all lens fits, with a further 2% of fits for orthokeratology (Table 2), a slight decrease from 2015. Orthokeratology now represents 10% or more of all lens fits in Switzerland, Hong Kong, and the Netherlands and also accounts for high proportions of GP lens fits in Spain, Italy, and Taiwan (Table 3).

TABLE 2 BREAKDOWN OF ALL LENS FITS INTO SEVEN KEY CATEGORIES OF LENSES
Country Rigid (non OK) OK DD hydrogel DD SiHy Other DW hydrogel Other DW SiHy Soft EW
AU 4% 2% 19% 36% 5% 31% 4%
BE 7% 0% 9% 5% 12% 66% 1%
BG 11% 0% 2% 4% 7% 69% 7%
CA 5% 1% 18% 22% 3% 48% 3%
CH 22% 10% 10% 12% 8% 36% 2%
CN 1% 1% 26% 4% 39% 9% 20%
CZ 0% 0% 9% 23% 7% 49% 11%
DE 50% 3% 4% 9% 9% 24% 0%
DK 9% 1% 45% 7% 9% 23% 6%
ES 6% 7% 10% 5% 31% 39% 2%
GR 1% 0% 9% 8% 34% 47% 1%
HK 2% 15% 46% 13% 4% 19% 2%
HU 2% 0% 12% 17% 9% 60% 1%
ID 2% 0% 36% 11% 36% 13% 2%
IL 3% 0% 38% 11% 16% 32% 0%
IR 6% 0% 0% 1% 42% 33% 16%
IT 12% 6% 15% 32% 12% 23% 0%
JP 15% 0% 33% 13% 15% 24% 0%
KR 1% 0% 31% 16% 23% 28% 0%
LT 2% 0% 7% 22% 7% 36% 25%
MD 3% 8% 2% 3% 42% 32% 9%
NL 16% 10% 6% 5% 12% 44% 6%
NO 8% 2% 33% 17% 11% 20% 9%
NZ 3% 1% 17% 36% 6% 37% 2%
PH 2% 0% 0% 3% 10% 52% 32%
PT 2% 0% 17% 17% 10% 53% 0%
RU 0% 0% 8% 19% 9% 58% 6%
SE 7% 2% 26% 12% 12% 33% 7%
SI 64% 0% 3% 5% 1% 27% 0%
TH 0% 0% 2% 1% 97% 0% 0%
TW 4% 3% 51% 1% 36% 4% 0%
UK 12% 1% 18% 32% 6% 29% 2%
US 6% 0% 8% 7% 25% 46% 8%
Overall 7% 2% 19% 12% 18% 33% 9%
SEE TABLE 1 for country abbreviations. OK = ortho-k DD = daily disposable DW = daily wear EW = extended wear
TABLE 3 DETAILED INFORMATION FOR ALL PRESCRIBED GP LENSES ONLY FOR MARKETS REPORTING > 35 GP LENS FITS
BG CH DE DK ES HK IR IT JP NL NO NZ SI TW UK Overall
Rigid lenses for new fits 8% 28% 54% 16% 16% 17% 3% 16% 7% 32% 12% 5% 44% 30% 10% 9%
Rigid lenses for refits 21% 34% 53% 6% 14% 17% 9% 22% 22% 24% 10% 16% 76% 6% 15% 9%
MATERIALS
Low-Dk (<40) 0% 6% 24% 2% 2% 0% 0% 1% 11% 6% 17% 1% 0% 0% 21% 10%
Mid-Dk (40-90) 25% 27% 51% 42% 26% 12% 6% 27% 28% 39% 17% 13% 17% 62% 15% 32%
High-Dk (>90) 75% 68% 26% 57% 72% 88% 94% 72% 61% 55% 66% 87% 83% 38% 65% 58%
DESIGN
Sphere 52% 24% 40% 37% 27% 8% 27% 19% 81% 22% 51% 69% 50% 62% 47% 47%
Toric 41% 19% 18% 29% 9% 2% 0% 11% 2% 15% 10% 4% 45% 0% 7% 11%
Multifocal/monovision 7% 14% 7% 14% 5% 2% 7% 6% 11% 18% 8% 6% 1% 0% 9% 11%
Ortho-k 0% 30% 6% 11% 54% 86% 0% 32% 1% 38% 22% 22% 0% 38% 9% 19%
Anti-myopia 0% 13% 11% 5% 1% 0% 0% 6% 0% 3% 7% 0% 2% 0% 0% 3%
Other 0% 0% 17% 4% 5% 1% 66% 26% 6% 5% 2% 0% 2% 0% 28% 9%
Planned replacement 100% 68% 35% 84% 62% 99% 59% 54% 13% 55% 76% 11% 85% 62% 76% 50%
New fits into EW 20% 49% 19% 0% 23% 100% 0% 0% 0% 44% 27% 0% 26% 50% 0% 21%
Refits into EW 17% 18% 0% 3% 14% 22% 0% 0% 0% 28% 5% 4% 0% 34% 4% 9%
SEE TABLE 1 for country abbreviations. EW = extended wear

In addition to orthokeratology lenses, scleral lenses have seen an increase in use over recent years. Although the absolute numbers of such lenses are relatively small worldwide, there is a clear increase in the use of these lenses over the past decade or more (Figure 1).

Figure 1. Increase in the use of scleral and orthokeratology lenses.

Overall, high-Dk lenses (≥90 Dk) account for more than half of GPs prescribed. Spherical designs account for about 50% of fits, with only modest amounts of toric, multifocal, and monovision lenses prescribed. Half of GP lenses are prescribed on a planned replacement basis.

SOFT LENSES

Soft lenses account for 91% of new fits and refits, slightly up from last year (Table 4). Silicone hydrogel materials were prescribed to 55% of soft lens patients. It seems that the use of these materials is settling down at about this level after a significant increase during the first decade after those materials entered the market.

TABLE 4 DETAILED INFORMATION FOR ALL PRESCRIBED SOFT LENSES FOR MARKETS REPORTING >100 SOFT LENS FITS
AU BE BG CA CH CN CZ DE DK ES GR HK HU ID IL IR IT JP KR LT MD NL NO NZ PH PT RU SE TH TW UK US Overall
Soft lenses for new fits 95% 94% 92% 98% 72% 97% 100% 46% 84% 84% 100% 83% 99% 98% 95% 97% 84% 93% 100% 96% 89% 68% 88% 95% 98% 97% 100% 87% 100% 70% 90% 90% 91%
Soft lenses for refits 94% 92% 79% 93% 66% 99% 100% 47% 94% 86% 99% 83% 97% 97% 98% 91% 78% 78% 98% 99% 100% 76% 90% 84% 99% 96% 100% 91% 100% 94% 85% 95% 91%
MATERIALS
Low water content (<40%) 8% 7% 3% 1% 0% 16% 0% 0% 1% 15% 0% 32% 2% 2% 0% 13% 0% 8% 35% 0% 9% 2% 1% 0% 9% 1% 4% 8% 44% 58% 1% 3% 11%
Mid water content (40-60%) 8% 5% 2% 11% 11% 15% 9% 14% 23% 8% 4% 5% 10% 9% 3% 14% 19% 13% 7% 12% 5% 11% 24% 14% 3% 18% 4% 19% 0% 3% 10% 20% 10%
High water content (>60%) 10% 10% 6% 12% 16% 53% 9% 13% 41% 25% 40% 24% 9% 64% 52% 28% 14% 36% 13% 7% 42% 14% 29% 9% 5% 9% 11% 18% 55% 34% 18% 16% 24%
Silicone hydrogel 74% 77% 89% 76% 73% 16% 81% 72% 36% 51% 56% 39% 79% 25% 45% 45% 67% 43% 45% 81% 44% 73% 46% 77% 84% 72% 82% 55% 1% 6% 72% 62% 55%
DESIGN
Sphere 52% 50% 85% 38% 35% 72% 62% 31% 34% 46% 62% 37% 48% 74% 50% 56% 48% 79% 36% 71% 48% 42% 39% 52% 44% 29% 80% 40% 74% 36% 39% 54% 55%
Toric 22% 32% 12% 31% 25% 11% 23% 35% 36% 33% 29% 34% 35% 15% 41% 23% 28% 14% 19% 10% 4% 39% 35% 34% 20% 51% 12% 31% 26% 5% 32% 25% 22%
Cosmetic tint 2% 0% 1% 1% 0% 16% 1% 0% 1% 1% 2% 2% 0% 12% 4% 20% 0% 2% 41% 10% 2% 0% 0% 1% 19% 0% 3% 0% 0% 58% 0% 4% 11%
Multifocal/monovision 23% 18% 2% 30% 40% 1% 14% 34% 28% 19% 8% 17% 17% 0% 5% 0% 24% 5% 4% 5% 11% 18% 26% 14% 17% 21% 3% 29% 0% 1% 27% 16% 11%
Anti-myopia 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 10% 0% 0% 0% 0% 0% 0% 0% 0% 36% 0% 0% 0% 0% 0% 2% 0% 0% 0% 0% 0% 0%
Other 1% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 2% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0%
REPLACEMENT
Daily 60% 15% 8% 44% 34% 39% 37% 27% 61% 18% 17% 72% 29% 49% 51% 2% 57% 54% 48% 41% 6% 16% 62% 55% 6% 35% 29% 45% 3% 57% 59% 17% 38%
1-2 weekly 6% 4% 3% 12% 16% 12% 20% 10% 7% 2% 25% 3% 8% 9% 19% 3% 4% 43% 13% 3% 1% 11% 5% 5% 0% 1% 23% 4% 0% 8% 5% 22% 14%
Monthly 31% 79% 80% 44% 43% 32% 42% 48% 29% 71% 57% 24% 62% 26% 29% 35% 35% 2% 29% 55% 84% 64% 29% 37% 87% 63% 44% 50% 96% 34% 35% 60% 42%
3-6 monthly 2% 1% 9% 0% 3% 5% 0% 3% 2% 5% 0% 1% 0% 15% 0% 56% 3% 0% 9% 1% 8% 9% 3% 1% 5% 0% 4% 0% 0% 0% 1% 0% 4%
Annually 1% 0% 0% 0% 4% 11% 1% 9% 1% 4% 0% 0% 0% 0% 1% 4% 0% 0% 0% 0% 1% 0% 1% 0% 2% 0% 0% 1% 0% 2% 0% 0% 1%
Unplanned 0% 0% 0% 0% 0% 0% 0% 3% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 1% 0% 0% 0% 0%
New fits into EW 3% 2% 7% 1% 0% 16% 7% 0% 14% 1% 0% 2% 0% 4% 0% 13% 0% 0% 0% 25% 11% 5% 9% 1% 40% 0% 2% 5% 0% 0% 3% 0% 9%
Refits into EW 6% 0% 9% 5% 5% 23% 13% 1% 3% 3% 1% 2% 1% 0% 0% 21% 1% 0% 0% 26% 6% 10% 10% 2% 31% 0% 7% 9% 0% 0% 3% 13% 11%
EW with silicone hydrogels 100% 100% 100% 88% 100% 24% 100% 100% 90% 30% 80% 70% 68% 39% 40% 99% 50% 50% 93% 100% 86% 96% 100% 21% 100% 100% 97% 100% 100% 49%
MPS 91% 82% 100% 81% 51% 98% 87% 43% 91% 88% 99% 72% 97% 100% 92% 98% 86% 81% 100% 84% 100% 88% 93% 86% 98% 92% 99% 89% 100% 92% 87% 90% 92%
Presbyopes multi/mono 44%/19% 59%/0% 42%/4% 60%/12% 79%/8% 0%/0% 61%/0% 65%/10% 43%/20% 61%/8% 55%/0% 39%/9% 57%/5% 0%/0% 37%/3% 79%/6% 31%/1% 31%/0% 42%/0% 0%/8% 37%/10% 51%/9% 36%/3% 40%/2% 87%/0% 27%/0% 52%/21% 1%/0% 7%/0% 42%/20% 20%/13% 42%/8%
See Table 1 for country abbreviations. MPS = multipurpose solution
The final row indicates the proportion of multifocal and monovision lenses prescribed when patients were over 45 years of age.

It is interesting to consider the use of these higher-oxygen materials in daily disposable versus reusable lenses (Figure 2). Silicone hydrogels are prescribed much more widely for reusable lenses (in 28 of the 33 countries studied) than for daily disposable use. The reason for this is likely to be a combination of cost, the greater range of reusable silicone hydrogel brands compared with daily disposable silicone hydrogels, and a perception that the need for this material type is greater when lenses are reused rather than when they are discarded each day.

Figure 2. Soft lens materials for daily disposable and reusable lenses.

The use of daily disposables is extremely varied. In 10 countries, they account for more than half of all soft lenses prescribed; in some others, their use is in the single digits (Figure 3). Worldwide, the use of monthly replaced lenses (42%) was slightly greater compared to that of daily disposables (38%).

Figure 3. Daily disposable prescribing in 2016.

A key finding in 2016 was the continued increase in the prescribing of multifocal and monovision soft lenses in some markets. For example, these designs now account for more than 30% of soft lens fits in Canada, Switzerland, and Germany. Such popularity, in addition to toric lens prescribing, pushes spherical lenses down to less than 40% of fits in many markets. When considering presbyopes, multifocals are now the preferred option over monovision. There is still considerable room for growth in this sector, however, as only half of presbyopes overall receive a multifocal or monovision lens option. CLS

Funding and/or assistance was provided for the following markets: Australia–Optometry Australia; Bulgaria–Vision Protect Ltd.; China–China Optometric and Optical Association; Greece and Israel–Johnson & Johnson Vision Care; Hong Kong–Hong Kong Association of Private Practising Optometrists; Korea, Thailand, and Indonesia–CooperVision; Norway–the Norwegian Association of Optometry; Netherlands–Bausch + Lomb; Portugal–Professional Association of Graduates in Optometry; Spain–Spanish General Council of the Colleges of Opticians-Optometrists; Sweden–the Swedish Optometry Association and the Swedish Contact Lens Association; Switzerland–Swiss Society of Optometry and Optics SBAO/SSOO. The authors acknowledge the administrative support of Eurolens Research and the Centre for Contact Lens Research at the University of Waterloo, Canada.

EXTREME MARKETS

Patients around the world want the same performance characteristics from their contact lenses—safe, comfortable wear and clear vision. Differences between markets must be principally explained by the diverse range of contact lens education and training, local commercial supply logistics, and practitioner attitudes. It would be inappropriate to label a market as being “right” or “wrong,” but it is informative to consider the diversity of the global situation.

Germany

Germany has long been considered a center of GP fitting excellence, and our 2016 survey found that half of all lenses prescribed fell into this category. In fact, neighboring markets also demonstrate a similar trait, with both the Netherlands and Switzerland reporting more than 25% of lenses as standard GP or orthokeratology fits.

Hong Kong

Hong Kong is a unique contact lens market. In 2016, we found that the great majority of GP fits in this market were for orthokeratology rather than conventional fitting. This probably relates to the success of this modality for myopia control, which is widely prescribed there. Indeed, a majority of the orthokeratology fits were prescribed to patients under 18 years old, supporting this contention.

Iran

The number of GP lenses prescribed in Iran is close to the global average, but the distribution of soft lens replacement intervals is significantly different. We found very little daily disposable lens prescribing here, and most soft lenses are replaced less frequently than monthly. Specifically, 56% of soft lenses are prescribed to be replaced on a three- to six-month basis, and 4% of fits are for annual replacement.

Lithuania

In common with previous years, the defining feature of the Lithuanian market is the high number of extended wear lenses prescribed. One-quarter of all lenses prescribed are for this modality, comfortably the highest proportion in this year’s survey. In contrast, GP fitting at 2% of fits is much lower compared to most other markets.

Figure 4. Some international markets report higher or lower than average statistics.


Professor Morgan is director of Eurolens Research at The University of Manchester, United Kingdom. Professor Woods is Head of Clinical Partnerships in the School of Medicine (Optometry) at the University of Deakin, Australia. Dr. Tranoudis is senior director, Professional Affairs Europe Middle East Africa & Latin America, Johnson & Johnson Vision Care. Magne Helland is an associate professor at the Department of Optometry and Visual Science, University College of Southeast Norway, Kongsberg, Norway. Professor Efron is emeritus professor from the School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia. Dr. Jones is director of the Centre for Contact Lens Research at the University of Waterloo, Canada. Marco van Beusekom is Professional Affairs Manager Benelux, Johnson & Johnson Vision Care. Dr. Grupcheva is a professor and head of Department of Ophthalmology and Visual Science and Vice Rector for Innovations and Translational Research at the Medical University-Varna, Bulgaria. Deborah Jones is a clinical professor at the School of Optometry and Vision Science, University of Waterloo, Canada. Marion Beeler-Kaupke, Schweizerischer Berufsverband für Augenoptik und Optometrie SBAO, Switzerland. Polo Qi is chairman of the Education Committee, China Optometric and Optical Association. Dr. Tan is CEO of Brien Holden Vision Institute, China. Dr. Krasnanska is with the Czech Association of Contactology, Prague, Czech Republic. Dr. Pult is the owner of Optometry and Vision Research in Weinheim, Germany. Ole Ravn is with the Danish College of Optometry and Visual Science, Randers, Denmark. Dr. Santodomingo-Rubido is Clinical Affairs Manager & Senior Research Scientist, Menicon Co., Ltd. Dr. Végh is an associate professor in the Department of Ophthalmology at the University of Szeged, Szeged, Hungary; professor in the School of Optometry at Semmelweis University, Budapest; and head of the Hungarian Contactologic Society. Dr. Fan is Professional Services Director for CooperVision Asia Pacific. Dr. Erdinest is with Hadassah Hebrew University Medical Center, Jerusalem. Ali Reza Jafari is a contact lens researcher at the Basir Eye Health Research Center in Tehran, Iran. Giancarlo Montani works at the University of Salento, Lecce, Italy. Dr. Itoi is an associate professor in the Department of Ophthalmology at the Juntendo University, Tokyo. Dr. Chu is in the Department of Optometry & Vision Science at the Catholic University of Daegu, Korea. Dr. Bendoriene works at the Siauliai University, Lithuania. Veronica Ziziuchin is a resident at Nicolae Testemiţanu State University of Medicine and Pharmacy, Chișinău, Moldova. Dr. van der Worp is with the Eye Research Institute, Maastricht, the Netherlands. Dr. Lam works in the School of Optometry and Vision Science at the University of Auckland, New Zealand. Dr. Romualdez-Oo is based in Manila, Philippines. Dr. Abesamis-Dichoso is based in Manila, Philippines. Dr. González-Méijome is with the Clinical and Experimental Optometry Research Laboratory at University of Minho, Portugal. Vadim Belousov is editor of the Journal of Optometry, Moscow. Dr. Gierow is a professor in the department of Medicine and Optometry at Linnaeus University, Kalmar, Sweden. Dr. Silih is assistant professor at the Eye Hospital, University Medical Centre, Ljubljana, Slovenia. Dr. Hsiao is an associate professor in the Department of Optometry at Chung Shan Medical University, Taichung, Taiwan. Dr. Nichols is an assistant vice president for industry research development and professor at UAB, editor-in-chief of Contact Lens Spectrum, and editor of Contact Lenses Today.