Article Date: 1/1/2012

International Contact Lens Prescribing in 2011
INTERNATIONAL PRESCRIBING

International Contact Lens Prescribing in 2011

This year, we analyzed data from more than 22,000 prospective contact lens fits in 29 countries.

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); Christina N. Grupcheva, MD, PhD, FEBO, FICO (Hon); Deborah Jones, BSc, FCOptom, DipCLP, FAAO; Kah-Ooi Tan, BOptom (Hons), PhD, MBA; Alice Pesinova, BSc; Ole Ravn; Jacinto Santodomingo, OD(EC), MSc, PhD, MCOptom, FBCLA, FAAO; Florence Malet, MD; Mihály Végh, MD; Nir Erdinest, BOptom, MSc; Hreinn Ingi Hreinsson; Prema Chande, MOptom, DBM, FIACLE; Giancarlo Montani, FIACLE, FBCLA; Motozumi Itoi, MD, PhD; Byoung Sun Chu, MOptom, PhD, FIACLE, FAAO; Jolanta Bendoriene, MD, PhD; Eef van der Worp, BOptom, PhD, FAAO, FIACLE, FBCLA; Suresh Awasthi, MPhil; Wanda Lam, OD, BSc; José Manuel González-Méijome, OD, PhD, FIACLE; Edgar Davila-Garcia, OD, NCLEAC; Simona Radu, MD, FIACLE; Vadim Belousov; Oskar Johansson, BSc; Mirna Stabuc Silih, MD, PhD; John Hsiao, BA, OD, FIACLE; & Jason J. Nichols, OD, MPH, PhD, FAAO

This is the 11th annual report of contact lens prescribing trends that we have prepared for Contact Lens Spectrum. Each year, we capture current modes of contact lens practice by asking practitioners in each market (optometrists, opticians or ophthalmologists, as appropriate) to provide information about the first 10 lens fits undertaken after receiving our paper or electronic survey form. In 2011, we captured information about 22,362 fits in 29 countries.

Lens Wearer Demographics

Women continue to represent the majority of patients attending for contact lens fitting (Table 1). Sixty-seven percent of fits were to women, with minimal variations in this measure between countries, ranging from 56 percent in Slovenia to 77 percent in Taiwan (Figure 1). For both sexes across all nations, the average age at fitting was 31.2 years, ranging from 23 years in Nepal to 37 years in Sweden. In a number of mature contact lens markets, the mean fitting age is edging toward 40 years. For example, in the United Kingdom, New Zealand, Sweden, Australia and Denmark, the average age is greater than 35 years. The oldest patient reported this year was a 100-year-old man, who was fitted with extended-wear soft lenses.

To download a PDF of the Tables as it appears in print, please click here

Table 1. Demographic information for the 29 countries surveyed
Country Total fitsMean (±SD) age% female % new fits % part time (≤3days)
Australia (AU) 574 35.2 ± 14.7 70% 34% 21%
Bulgaria (BG) 674 28.0 ± 9.2 70% 49% 8%
Canada (CA) 1,185 34.9 ± 15.2 71% 31% 13%
China (CN) 243 25.6 ± 6.1 76% 21% 14%
Czech Republic (CZ) 442 30.2 ± 12.3 64% 59% 19%
Denmark (DK) 413 36.0 ± 14.5 59% 44% 0%
Spain (ES) 833 30.4 ± 13.9 59% 46% 9%
France (FR) 1,867 34.3 ± 15.7 66% 42% 5%
Hungary (HU) 142 29.0 ± 11.9 58% 42% 5%
Israel (IL) 376 27.6 ± 9.2 70% 37% 0%
India (IN) 80 30.2 ± 11.5 70% 36% 7%
Iceland (IS) 50 26.2 ± 13.0 57% 69% 16%
Italy (IT) 721 30.1 ± 12.2 60% 59% 1%
Japan (JP) 4,803 29.0 ± 13.5 67% 41% 11%
South Korea (KR) 417 26.1 ± 7.6 74% 21% 9%
Lithuania (LT) 728 26.3 ± 9.1 68% 29% 11%
Netherlands (NL) 1,182 34.9 ± 16.4 65% 38% 3%
Norway (NO) 715 34.2 ± 15.1 61% 38% 8%
Nepal (NP) 44 23.3 ± 4.9 64% 61% 0%
New Zealand (NZ) 1,140 36.5 ± 15.7 61% 55% 18%
Puerto Rico (PR) 489 34.0 ± 13.9 67% 39% 3%
Portugal (PT) 276 31.5 ± 12.5 73% 47% 9%
Romania (RO) 220 26.4 ± 8.9 76% 58% 19%
Russia (RU) 737 27.5 ± 9.7 66% 32% 7%
Sweden (SE) 775 36.5 ± 14.9 63% 31% 10%
Slovenia (SI) 189 29.8 ± 13.2 56% 57% 10%
Taiwan (TW) 1,934 26.7 ± 9.8 77% 20%
United Kingdom (UK) 690 36.2 ± 15.6 64% 50% 18%
United States (US) 423 32.4 ± 15.5 66% 22% 5%
Overall 22,362 31.2 ± 13.9 67% 36% 7%


Figure 1. Age and gender for patients receiving contact lenses.

GP Lenses

Overall, GP lenses have maintained their recent level at about 10 percent of fits (8 percent conventional and 2 percent orthokeratology) (Table 2). Table 3 shows a detailed analysis for the 10 countries providing information for 35 or more GP lens patients. GP lenses account for 18 percent or more of lens fits in France, Japan, the Netherlands, New Zealand and Slovenia. Most markets report little or no orthokeratology, but this lens type accounted for 5 percent or more of fits in Australia, Italy, the Netherlands and Taiwan. High-Dk materials were preferred (65 percent of fits in major GP lens markets).

Table 2. Breakdown on all lens fits into six key categories of lenses. See Table 1 for country abbreviations
Country Rigid OK Daily disposable Other soft DW SiHy DW (non-DD) Soft EW
AU 4% 5% 24% 9% 49% 10%
BG 3% 0% 2% 25% 56% 15%
CA 4% 2% 16% 17% 58% 3%
CN 3% 0% 14% 47% 12% 24%
CZ 0% 0% 20% 12% 51% 17%
DK 6% 0% 40% 15% 17% 22%
ES 4% 1% 18% 34% 38% 6%
FR 16% 1% 12% 11% 57% 2%
HU 10% 1% 20% 16% 47% 6%
IL 15% 1% 23% 27% 30% 4%
IN 8% 0% 5% 47% 23% 17%
IS 0% 0% 3% 40% 56% 1%
IT 6% 7% 44% 24% 20% 0%
JP 19% 0% 31% 25% 25% 0%
KR 9% 0% 21% 64% 4% 2%
LT 0% 0% 12% 15% 47% 25%
NL 20% 6% 6% 22% 44% 2%
NO 3% 0% 44% 9% 26% 19%
NP 14% 0% 10% 64% 12% 0%
NZ 17% 1% 21% 10% 45% 5%
PR 4% 1% 9% 31% 43% 13%
PT 7% 0% 17% 20% 55% 1%
RO 8% 1% 14% 11% 59% 6%
RU 2% 0% 11% 27% 59%
SE 2% 0% 23% 17% 39% 18%
SI 28% 0% 19% 4% 45% 4%
TW 0% 9% 34% 55% 1% 0%
UK 6% 0% 38% 10% 40% 6%
US 2% 0% 16% 17% 51% 14%
Overall 8% 2% 21% 26% 34% 9%


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
 CA ES FR IL IT JP KR NL NZ SI UK Overall
Rigid lenses for new fits 4% 2% 23% 9% 11% 8% 18% 21% 11% 19% 2% 13%
Rigid lenses for refits 7% 7% 12% 17% 15% 27% 7% 29% 27% 39% 11% 11%
Materials
Low Dk (<40) 6% 25% 0% 7% 8% 13% 0% 9% 7% 1% 5% 6%
Mid Dk (40-90) 50% 35% 15% 12% 13% 27% 71% 40% 19% 44% 36% 29%
High Dk (>90) 44% 40% 85% 81% 79% 60% 28% 51% 74% 55% 59% 65%
Design
Sphere 37% 37% 49% 55% 26% 84% 80% 21% 19% 59% 32% 51%
Toric 5% 3% 16% 30% 14% 2% 6% 19% 8% 37% 18% 15%
Multifocal/monovision 17% 10% 21% 4% 0% 7% 0% 28% 4% 0% 47% 13%
Ortho-K 29% 25% 4% 6% 54% 0% 0% 25% 7% 0% 1% 9%
Anti-myopia 5% 1% 11% 0% 4% 0% 14% 3% 4% 0% 0% 5%
Other 7% 23% 0% 6% 2% 7% 0% 4% 57% 4% 2% 8%
Planned replacement 32% 36% 73% 39% 12% 99% 49% 35% 100% 56% 51%
New fits into EW 25% 13% 15% 14% 0% 0% 1% 14% 39% 0% 0% 13%
Refits into EW 0% 0% 9% 5% 5% 0% 1% 18% 11% 11% 24% 24%

Soft Lenses

Soft lenses accounted for 90 percent of lens fits (Table 4). Silicone hydrogel materials continue to increase in popularity and now represent 70 percent or more of daily wear fits in Australia, Canada, Czech Republic, France, Hungary, Romania and Slovenia. Worldwide, 47 percent of fits were with this material.

Table 4. Detailed information for all prescribed soft lenses for markets reporting >100 soft lens fits. Daily wear lenses except where indicated. 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
 AU BG CA CN CZ DK ES FR HU IL IT JPKR LT NL NO NZ PR PT RO RU SE SI TW UK US Overall
Soft lenses for new fits 89% 97% 96% 90% 100% 96% 98% 77% 85% 91% 89% 92%82% 100% 79% 95% 89% 90% 96% 89% 99% 96% 81% 79% 98% 96% 90%
Soft lenses for refits 92% 97% 93% 99% 100% 91% 92% 88% 91% 83% 85% 73%93% 100% 71% 99% 73% 98% 91% 92% 97% 99% 61% 93% 89% 98% 91%
Materials
Low water content (<40%) 1% 10% 3% 26% 0% 3% 9% 1% 0% 1% 1% 12%24% 4% 5% 1% 2% 12% 7% 3% 7% 0% 3% 19% 1% 8% 9%
Mid water content (40-60%) 17% 22% 15% 47% 11% 41% 36% 10% 21% 32% 35% 43%51% 16% 18% 37% 19% 27% 17% 15% 25% 26% 4% 69% 23% 15% 32%
High water content (>60%) 10% 0% 11% 10% 19% 29% 9% 11% 3% 26%4%10%15%13% 16% 28% 12% 6% 15% 5% 3% 21% 1% 11% 23% 9% 12%
Silicone hydrogel 73% 68% 70% 17% 70% 26% 46% 78% 75% 41% 61% 35%10% 67% 61% 35% 67% 55% 62% 77% 64% 52% 92% 1% 53% 68% 47%
Design
Sphere 51% 82% 54% 75% 65% 47% 51% 40% 59% 74% 55% 82%60% 70% 48% 49% 46% 49% 45% 54% 74% 37% 66% 33% 45% 57% 53%
Toric 27% 8% 29% 3% 27% 34% 31% 33% 31% 23% 29% 13%18% 11% 35% 31% 26% 25% 40% 32% 4% 39% 27% 6% 37% 23% 23%
Cosmetic tint 1% 7% 1% 20% 1% 1% 7% 0% 1% 0% 1% 2%20% 15% 0% 1% 2% 7% 1% 13% 8% 0% 0% 60% 0% 1% 12%
Multifocal/monovision 22% 2% 16% 1% 7% 17% 10% 26% 8% 2% 15% 2%2% 4% 17% 17% 21% 19% 13% 0% 4% 23% 3% 1% 17% 18% 11%
Anti-myopia 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0%0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 3% 0% 0% 0% 0%
Other 0% 0% 0% 0% 1% 1% 0% 0% 0% 0% 0% 0%0% 0% 0% 2% 5% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0%
Replacement
Daily 29% 2% 17% 19% 26% 55% 21% 15% 25% 27% 50% 39%24% 17% 8% 56% 28% 11% 19% 17% 12% 29% 28% 38% 43% 19% 26%
1-2 weekly 39% 1% 14% 4% 19% 2% 6% 21% 18% 16% 8% 57%4% 3% 10% 6% 18% 28% 9% 45% 32% 14% 53% 23% 7% 27% 19%
Monthly 30% 61% 67% 37% 48% 38% 69% 60% 57% 55% 39% 2%9% 63% 75% 38% 50% 60% 69% 35% 46% 55% 19% 29% 49% 53% 45%
3-6 monthly 0% 35% 1% 27% 0% 3% 3% 3% 0% 1% 2% 0%50% 16% 5% 0% 1% 0% 1% 2% 11% 1% 0% 0% 0% 1% 6%
Annually 1% 0% 1% 11% 4% 0% 2% 0% 0% 1% 1% 0%10% 0% 1% 0% 1% 0% 3% 2% 0% 0% 0% 10% 0% 0% 3%
Unplanned 1% 1% 0% 1% 3% 1% 1% 0% 0% 1% 0% 2%3% 0% 2% 0% 2% 1% 0% 0% 0% 0% 0% 0% 0% 0% 1%
New fits into EW 11% 14% 2% 11% 15% 16% 4% 3% 0% 11% 0% 0%3% 18% 1% 25% 5% 9% 0% 0% 24% 6% 1% 3% 14% 9%
Refits into EW 11% 16% 4% 29% 23% 27% 6% 2% 10% 1% 0% 0%2% 29% 5% 16% 7% 16% 1% 15% 13% 6% 1% 10% 14% 11%
EW with silicone hydrogels 99% 90% 94% 13% 99% 91% 68% 100% 69% 100% 100% 44%7% 91% 95% 99% 78% 85% 100% 100% 100% 100% 10% 98% 98% 74%
MPS solutions 87% 100% 84% 75% 92% 68% 92% 83% 96% 92% 91% 87%100% 83% 82% 97% 83% 96% 91% 98% 97% 95% 90% 97% 92% 87% 90%
Presbyopes multi/mono 13%/48% 40%/0% 40%/12% 0%/0% 31%/2% 32%/20% 40%/2% 66%/4% 41%/0% 13%/14% 82%/6% 16%/1%3%/3% 27%/0% 42%/5% 58%/10% 30%/34% 38%/16% 64%/0% 11%/5% 18%/1% 41%/15% 29%/0% 4%/4% 33%/20% 45%/25% 41%/12%

Toric lenses accounted for 23 percent of lens fits. This figure rises to 29 percent if monovision, multifocal and cosmetically tinted lenses are excluded.

More than half of patients with presbyopia are prescribed multifocal lenses (41 percent) or monovision (12 percent). In Italy and France, patients who are 45 years old or older receive the highest proportion of presbyopia-correcting lenses (Figure 2).

Figure 2: Soft lenses prescribed for presbyopia.

We continue to see a great difference in lens replacement frequencies around the world. Daily disposables are prescribed for 56 percent of soft lens fits in Norway, but only 2 percent in Bulgaria (Figure 3). In general, however, about 90 percent of lenses are replaced monthly or more frequently. Only in South Korea are more than half of soft lens fits prescribed on a less frequent replacement schedule.

Figure 3: Worldwide prescribing of daily disposable lenses.

Overall, 90 percent of lenses are prescribed with multipurpose solutions.

Extended wear lenses have maintained their recent level at about 10 percent of soft lens fits; 74 percent of fits for extended wear are with silicone hydrogel lenses.

Puerto Rico
This year, for the first time, we analyzed data from Puerto Rico. We received data for 489 contact lens fits. Age and sex distributions were in line with other markets; 5 percent of lenses were GP, which is lower than the global average but not dissimilar to many other markets. Fewer daily disposables were prescribed than in most countries, and most soft lenses were replaced on a monthly basis. The proportions of toric, multifocal and extended-wear lenses were similar to world averages.
Lens types fitted in Puerto Rico (outside) compared to the global average (inside).

Anti-myopia Lenses

For the first time, we included “anti-myopia” as a lens design category to capture lens fits specifically designed to arrest the progression of myopia. Five percent of GP lens fits and 0.1 percent of soft lens fits were given this designation. This data set serves as a useful baseline for the possible growth in this area of contact lens practice in the coming years. CLS

This survey was funded by the sponsors of Eurolens Research at the University of Manchester: Bausch + Lomb Inc.; Ciba Vision (UK) Ltd.; CooperVision Ltd.; Johnson & Johnson Vision Care; Menicon Co. Ltd.; and Sauflon Pharmaceuticals Ltd.

Additional funding and/or assistance was provided for the following: Bulgaria, Israel, Romania, Slovenia, Hungary, Czech Republic—Johnson & Johnson Vision Care; ustralia—Optometrists Association Australia; China—Ciba Vision Shanghai; Korea—Korean Optometric Association; Norway—Norwegian Association of Optometry; the Netherlands—Bausch + Lomb Benelux; Puerto Rico—Johnson & Johnson Vision Care and The Puerto Rico College of Optometrists; Spain—Spanish General Council of the Colleges of Opticians-Optometrists; Sweden—Swedish Optometry Association and the Swedish Contact Lens Association.

The authors acknowledge the kind administrative support of the Centre for Contact Lens Research at the University of Waterloo, Canada.

Dr. Morgan is director, Eurolens Research, University of Manchester, UK.
Dr. Woods is an associate professor, School of Medicine (Optometry), Deakin University, Geelong, Australia.
Dr. Tranoudis is director, Professional Affairs, Central Eastern Europe, Middle East, and Africa, Johnson & Johnson Vision Care.
Dr. Helland is a docent/associate professor at the Department of Optometry and Visual Science at Buskerud University College, Kongsberg, Norway.
Dr. Efron is a research professor, School of Optometry, Queensland University of Technology, Brisbane, Australia.
Dr. Grupcheva is a professor and head of the Department of Ophthalmology and Visual Science, Medical University-Varna, Bulgaria.
Dr. Jones is a lecturer at the School of Optometry and a clinical scientist at the Centre for Contact Lens Research at the University of Waterloo, Canada.
Dr. Tan is associate program director for optometry at Singapore Polytechnic.
Alice Pesinova represents the Czech Association of Contactology, Prague, Czech Republic.
Ole Ravn works at the Danish College of Optometry and Visual Science, Randers, Denmark.
Dr. Santodomingo is global professional relations manager, Menicon Co. Ltd.
Dr. Malet works at Hôpital Pellegrin in Bordeaux, France.
Dr. Végh is head of the Hungarian Contactologic Society.
Nir Erdinest works for Hadassah Hebrew University Medical Center, Israel.
Hreinn Ingi Hreinsson is a contact lens practitioner in Reykjavik, Iceland.
Prema Chande works at Lotus College of Optometry, Mumbai, India.
Giancarlo Montani works at Formazione Continua in Medicina, Centro di Recerche in Contattologia, University of Salento, Lecce, Italy.
Dr. Itoi is an associate professor, Department of Ophthalmology, Juntendo University, Tokyo, Japan.
Dr. Chu works at the School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia.
Dr. Bendoriene works at Siauliai University, Siauliai, Lithuania.
Dr. van der Worp is affiliated with the Eye Research Institute, Maastricht, the Netherlands.
Suresh Awasthi works at Tribhuvan University, Kathmandu, Nepal.
Dr. Lam is the course controller for contact lenses, Department of Optometry, Auckland University, Auckland, New Zealand.
Dr. González-Méijome works at the Clinical and Experimental Optometry Research Laboratory, University of Minho, Portugal.
Dr. Dávila-Garcia is in private practice in San Juan, Puerto Rico.
Dr. Radu is in private practice in Bucharest, Romania.
Vadim Belousov is editor of Journal of Optometry, Moscow, Russia.
Oskar Johansson is a lecturer at Section of Optometry and Vision Science, Linnaeus University, Kalmar, Sweden.
Dr. Silih, is assistant professor, Eye Hospital, University Medical Centre, Ljubljana, Slovenia.
Dr. Hsiao is assistant professor, Department of Optometry, Chung Shan Medical University, Taichung, Taiwan.
Dr. Nichols is editor of Contact Lens Spectrum.


Contact Lens Spectrum, Volume: 27 , Issue: January 2012, page(s): 26 - 32