Article

INTERNATIONAL PERSPECTIVES

GERMANY, AUSTRIA, AND SWITZERLAND: GRÜNDLICH

This is the first of a new series of columns that will explore different contact lens markets around the world. Is contact lens fitting very different in various parts of the world, and can we learn from each other?

The simple answer to the first part of this question is yes, global contact lens markets differ considerably. Some regions focus primarily on daily disposable (DD) lenses, while in other markets corneal GP lenses can be a substantial portion of the lens fits. Some countries seem to embrace new developments such as orthokeratology or silicone hydrogel materials quickly, whereas others take a slower approach to such developments. We start with the German-speaking countries in Western Europe—notably Germany, Austria, and Switzerland. This region accounts for roughly 100 million people (more than 80 million in Germany, with Austria and Switzerland having about 8 to 9 million each). How are they different from—and where are they on par with—the rest of the world and the United States?

A “Rigid” Market

The best starting point would be to look at the Eurolens survey data as published in the January issue of Contact Lens Spectrum (Morgan et al, 2017), which focuses solely on lens fits rather than on numbers of lens wearers in a region or on sales data. One thing that becomes clear with regard to this region is that GP lenses are still relatively popular in Germany, Austria, and Switzerland, although the absolute numbers from the survey should be approached with care.

The 2015 survey data showed that GP lenses represented 50%, 40%, and 30%, respectively, of lens fits and refits in these countries. The 2016 data also show high numbers (with the data for Austria lacking). Generally speaking, these numbers seem exceptionally high even by the regional experts’ opinion; the number for Germany (50% of lens fits/refits with GPs) seems especially out of proportion.

One limitation of any survey is who sends it back. The 2016 German data, for instance, is based on 220 lens fits from 22 practices. If the more specialty lens-based practices are primarily returning the forms, this could obviously skew the data. Some practices in Germany do indeed fit more than 50% of their patients with GPs, in the regional experts’ opinion, but this certainly is not the standard in the general optical shops. The same seems to be true for Switzerland and Austria. One other thing to bear in mind is that the lens fits mentioned in the survey are “all lens fits”: this includes new fits and lens refits. With GPs, the number of refits outscores the number of new fits.

Nevertheless, in relative terms, GPs are still a significant option to eyecare practitioners in the German-speaking countries, even as a first-choice lens for some, which is also confirmed by the regional experts in the field. Corneal safety and vision quality are considered the main benefits of GPs and a reason to offer them to patients. In comparison, for all of the 34 countries represented in the survey, the average percentage of GP lens fits in 2016 was 7%; the United States is on par with this at 6%.

A Specialty?

You might assume that specialty lens fits are also likely very well represented in this region—given the GP lens popularity and the technical skills required to fit them. But interestingly, this does not seem to be the case.

For example, in Switzerland, Germany, and Austria, the percentage of orthokeratology lens fits has varied between 1% and 3% over the last few years—which seems to be roughly on par with the rest of the countries in the survey (2% orthokeratology lens fits overall).

The same pattern seems evident with scleral lens fits, although the numbers from the survey are too low to draw conclusions. General feedback from the regional representatives indicates that scleral lens fits are not very popular yet in general specialty lens practice in the region, which differs from the situation and the market in the United States, for example, where scleral lenses almost seem to have become “mainstream” in specialty lens practices around the country.

The Daily Disposable Market

In contrast to the high numbers of corneal GPs, DD contact lenses are not particularly popular among practitioners in the German-speaking countries. In the 2015 survey, DD lenses accounted for 2% in Germany for both hydrogel and silicone hydrogel materials, while this was 5% and 6%, respectively, in Austria. Worldwide, these numbers were considerably higher at 15% hydrogel and 9% silicone hydrogel. Switzerland is more in line with the benchmark, reporting 17% and 8% DD lenses, respectively. The 2016 data showed slightly higher numbers for Germany (4% and 9%) and Switzerland (10% and 12%); the Austrian data is unfortunately missing for 2016.

In sharp contrast to Germany, neighboring country Denmark fits 45% DD hydrogels and 7% silicone hydrogels; and, to use another European benchmark, the United Kingdom reported fitting 18% hydrogel and 32% silicone hydrogel DD lenses of all lens fits.

Traditionally, part-time wearers (defined as three days per week or less) impact the numbers of DD lenses in a country; however, the percentages of part-time wearers (10% in Germany and 13% in Switzerland for 2016) are pretty much in line with the world average (12%). In contrast, in the United Kingdom, which reported high numbers of DD lenses, 23% of contact lens wearers are part-time wearers.

Skills

You might assume that corneal astigmatism is one of the main reasons to fit a corneal GP lens, as vision with corneal GPs is exceptionally good in those cases. Following this line of thought, you might also guess that the number of toric soft lens fits would be lower in the German-speaking countries than in other countries that fit fewer GPs. But, the opposite is true. The average of soft lens fits in a toric design for all countries in the survey was 22%; this was 35% for Germany and 25% for Switzerland in 2016, while in Austria it was 36% in 2015.

As for material choice, the German-speaking countries are slightly ahead of the global average of 55% silicone hydrogel, with 72% (Germany), 73% (Switzerland), and 55% (Austria, 2015 data) of soft lenses fit being silicone hydrogel lenses.

Closing Remarks

Based on these findings, practitioners in the German-speaking countries generally seem to aim for a “full correction” and have the technical skills to achieve this, as illustrated by the higher numbers of GP and soft toric lens fits.

Generally speaking, this region has always reported higher levels of rigid lens fitting, probably related to their contact lens educational practices and high-quality local manufacturers. For these highly specialized contact lens labs and fitters, corneal GP quadrant-specific lenses are a relatively common commodity. And, if orthokeratology is performed, toric orthokeratology lenses may not be an exception to the rule.

In addition, a large proportion of contact lens practices in the German-speaking countries have access to a corneal topographer. This instrument seems to be more or less a standard right now, and it can help fit these lenses accurately. This may be a cause, or a result, of the relative popularity of GP lens fitting in these countries. In contrast, other specialty modalities such as orthokeratology and scleral lenses do not seem to be overly represented compared to the rest of the surveyed countries.

The German word Gr√ľndlich is best defined as “thorough,” “conscientious,” or “punctual” in English. These terms all seem quite applicable to the contact lens practice in the German-speaking countries. It seems to confirm the power of contact lens fitters in the consulting room, even in a world with consumers who are more aware and better informed than ever. CLS

Special thanks to Mario Teufl from Austria and Marion Beeler-Kaupke from Switzerland for their valuable input.

For references, please visit www.clspectrum.com/references and click on document #256.