Article

INTERNATIONAL CONTACT LENS PRESCRIBING IN 2019

We report on the prescribing trends highlighted by our 19th global survey including more than 20,000 fits.

Since the turn of the century, we have presented annual overviews of contact lens prescribing trends in Contact Lens Spectrum. The work was initiated to help eyecare practitioners who are active in contact lenses to benchmark their fitting habits against their peers as well as to provide context to researchers in the field working on next-generation products. The database of lens fits collected over this period now exceeds 400,000, and the information has been collected across 71 markets.

In each targeted market, we supply survey forms and request that practitioners complete generic information about the first 10 contact lens fits conducted after receipt. This fundamental approach has remained unchanged since the first survey was conducted in the United Kingdom in 1996, with only minor changes to the form to account for new products becoming available on the market. For example, an option for “anti-myopia” (now termed “myopia control”) lenses was introduced in the 2011 survey to allow us to track developments in that area.

The distribution of the survey form varies. Some markets continue to use paper forms with a reply-paid envelope; others distribute and collect the same form via e-mail or a web-based questionnaire. The work is coordinated in each market by national coordinators who are listed as co-authors of this paper.

The survey forms request information about the age and sex of each contact lens patient fitted in addition to data about the material, design, replacement frequency, and wearing modality of the fitted lenses; anticipated weekly usage; and care system type. Each fit is weighted based on the estimated annualized number of fits for each practitioner. The data are finally collated at both the University of Manchester in the United Kingdom and at the University of Waterloo in Canada.

KEY WEARER INFORMATION

In 2019, data for 100 or more fits were received from each of 25 markets (Table 1), with information captured for 20,746 lens fits in total. As in previous years, the mean age at fitting was in the early 30s (32.8 ± 14.9 years), and two-thirds of those fitted were female. Figure 1 shows the distribution of average age and the proportion of females fitted. At fitting, contact lens patients tend to be older in western Europe and in other developed markets (e.g., the average age at fitting was greater than 39 years in Denmark and Switzerland) and younger in developing and/or Asian markets (younger than 30 years on average in Japan, Mexico, Israel, and the Philippines).

TABLE 1 DEMOGRAPHIC INFORMATION FOR ALL SURVEYED MARKETS
Country Total fits Mean ± SD age % female % new fits % part time (≤ 3 days)
Australia (AU) 502 37.0 ± 17.4 65% 35% 23%
Bulgaria (BG) 430 30.5 ± 10.7 64% 37% 8%
Canada (CA) 2,745 36.6 ± 16.6 68% 39% 23%
Switzerland (CH) 146 39.6 ± 16.4 64% 35% 7%
Czech Republic (CZ) 300 30.1 ± 14.3 66% 55% 30%
Denmark (DK) 340 39.9 ± 16.9 62% 27% 3%
Spain (ES) 553 32.3 ± 15.6 60% 52% 18%
Finland (FI) 531 33.9 ± 13.8 74% 38% 29%
France (FR) 261 37.3 ± 17.6 70% 39% 6%
Greece (GR) 904 30.6 ± 10.9 64% 23% 11%
Hungary (HU) 136 31.2 ± 13.9 66% 64% 3%
Israel (IL) 388 29.9 ± 11.8 58% 34% 8%
Italy (IT) 520 35.3 ± 16.8 58% 50% 12%
Japan (JP) 3,711 29.8 ± 15.5 67% 45% 13%
Lithuania (LT) 551 30.5 ± 9.9 67% 23% 20%
Mexico (MX) 3,052 29.7 ± 11.3 62% 45% 1%
Netherlands (NL) 488 38.6 ± 18.1 59% 28% 3%
Norway (NO) 534 36.3 ± 17.0 63% 31% 8%
New Zealand (NZ) 465 37.6 ± 17.1 64% 39% 24%
Philippines (PH) 1,506 28.5 ± 9.1 72% 32% 5%
Portugal (PT) 114 34.8 ± 15.5 73% 52% 12%
Sweden (SE) 735 36.6 ± 14.9 65% 29% 10%
Taiwan (TW) 600 30.2 ± 10.8 85% 28% 0%
United Kingdom (UK) 1,036 37.7 ± 17.4 66% 54% 31%
United States (US) 198 35.5 ± 15.6 64% 30% 7%
OVERALL 20,746 32.8 ± 14.9 66% 39% 13%

Figure 1. The mean age and the proportion of females fitted in the 25 markets reported in the 2019 survey.

Women accounted for more than 55% of lens fits in every market and reached 70% or more of lens fits in France, Portugal, the Philippines, Finland, and Taiwan. Thirty-nine percent of all recorded fits were considered “new fits,” as distinct from “refits.” This value, which perhaps indicates the health of the contact lens market, has remained very similar throughout the lifetime of this survey work. Most patients (87%) were prescribed contact lenses for “full-time” wear, which is defined as four or more days per week.

Table 2 shows the major categories of lens types prescribed. GP lenses were supplied in 13% of fits (broken down into 10% of fits with conventional lenses and 3% with orthokeratology [OK]). OK fitting was significantly higher than average in the Netherlands, Hungary, and France. For soft lenses, nearly 50% more silicone hydrogel daily disposables are prescribed overall compared to their traditional hydrogel equivalent. This discrepancy is even greater for reusable lenses (a four-fold difference). Soft lenses for extended wear were prescribed in 7% of cases.

TABLE 2 BREAKDOWN OF ALL LENS FITS INTO SEVEN KEY CATEGORIES OF LENSES
Country Rigid (non-OK) OK DD hydrogel DD SiHy Reusable DW hydrogel Reusable DW SiHy Soft EW
AU 10% 3% 13% 35% 5% 30% 5%
BG 11% 0% 2% 9% 13% 61% 4%
CA 2% 2% 11% 33% 11% 37% 4%
CH 37% 5% 2% 27% 11% 17% 2%
CZ 5% 0% 5% 29% 7% 49% 4%
DK 10% 0% 47% 16% 3% 15% 10%
ES 11% 6% 8% 22% 12% 36% 4%
FI 3% 0% 3% 44% 1% 39% 10%
FR 27% 25% 1% 16% 3% 25% 1%
GR 1% 0% 16% 18% 21% 42% 2%
HU 9% 30% 1% 19% 14% 26% 2%
IL 4% 0% 31% 22% 13% 28% 2%
IT 15% 3% 18% 22% 11% 29% 1%
JP 12% 0% 29% 22% 12% 24% 0%
LT 3% 0% 4% 29% 0% 27% 37%
MX 12% 0% 5% 2% 8% 52% 22%
NL 27% 15% 7% 11% 6% 33% 0%
NO 11% 0% 25% 19% 4% 23% 18%
NZ 16% 4% 7% 36% 4% 32% 1%
PH 1% 0% 7% 6% 7% 63% 15%
PT 4% 0% 12% 19% 10% 55% 1%
SE 18% 1% 11% 24% 8% 33% 5%
TW 7% 5% 33% 6% 46% 4% 1%
UK 5% 0% 15% 43% 2% 33% 1%
US 17% 0% 8% 36% 4% 35% 1%
OVERALL 10% 3% 13% 22% 9% 35% 7%
SEE TABLE 1 for country abbreviations. OK = orthokeratology DD = daily disposable DW = daily wear EW = extended wear

Figure 2 shows the changes since 1997 for six major categories of contact lenses. Several clear trends are evident over this time period. Standard GP lenses have diminished from the high teens in percentage terms to about 10% of fits, although this is complemented by an increasing number of OK fits.

Figure 2. Summary of lens fits for all reporting markets from 1997 to 2019. EW = extended wear; DW = daily wear; Si-H = silicone hydrogel; DD = daily disposable; OK = orthokeratology.

The proportion of traditional hydrogel daily disposable lens fits has remained approximately the same for the past 20 years; this has, of course, been supplemented by additional silicone hydrogel daily disposables over the past decade. Lenses manufactured in these newer silicone hydrogel materials have been the more widely fitted form of daily disposable lenses for three consecutive years.

There has been a more dramatic change in reusable lenses; traditional hydrogel materials accounted for more than 50% of all lens fits 20 years ago compared to fewer than 10% in 2019.

GP LENSES

Altogether, GP lenses (including standard, scleral, and OK lenses) accounted for 14% of new fits (Table 3). Japan has continued to see a decline in its use of GP lenses, reaching only 4% of new fits in 2019 compared to more than 20% in 2003.

TABLE 3 DETAILED INFORMATION FOR ALL PRESCRIBED GP LENSES ONLY FOR MARKETS REPORTING > 35 GP LENS FITS
AU CA CH DK ES FR IT JP MX NL NO NZ SE TW UK OVERALL
Rigid lenses for new fits 10% 6% 54% 13% 19% 66% 14% 4% 17% 48% 10% 26% 11% 18% 1% 14%
Rigid lenses for refits 13% 4% 34% 9% 13% 39% 21% 19% 8% 39% 13% 21% 25% 4% 10% 13%
MATERIALS Scleral 11% 0% 24% 26% 18% 3% 13% 0% 3% 19% 55% 0% 45% 0% 10% 14%
PMMA 0% 0% 0% 20% 9% 0% 0% 1% 7% 1% 0% 0% 1% 0% 0% 2%
Low Dk (< 40) 0% 0% 13% 0% 10% 0% 11% 10% 20% 1% 7% 0% 8% 0% 7% 6%
Mid Dk (40-90) 9% 25% 26% 9% 23% 2% 40% 24% 10% 20% 10% 5% 6% 26% 43% 15%
High Dk (> 90) 80% 74% 37% 45% 39% 96% 37% 64% 60% 59% 29% 95% 41% 74% 40% 63%
DESIGN Sphere 38% 10% 27% 44% 23% 35% 29% 78% 71% 13% 57% 18% 38% 28% 57% 41%
Toric 4% 3% 37% 23% 11% 3% 22% 2% 9% 16% 29% 7% 37% 30% 5% 12%
Multifocal 0% 3% 11% 3% 1% 6% 10% 11% 1% 15% 4% 1% 3% 2% 15% 8%
Monovision 8% 2% 11% 1% 0% 0% 0% 2% 1% 9% 0% 5% 6% 0% 3% 3%
Ortho-k 21% 50% 11% 2% 38% 48% 17% 0% 0% 36% 2% 21% 3% 40% 5% 24%
Myopia control 25% 15% 3% 5% 16% 0% 0% 0% 2% 12% 6% 48% 2% 0% 7% 5%
Other 4% 17% 0% 21% 12% 8% 22% 7% 17% 0% 3% 0% 11% 0% 9% 8%
Planned replacement 22% 16% 32% 88% 76% 99% 80% 21% 94% 59% 33% 33% 99% 100% 43% 72%
Extended wear 9% 55% 7% 3% 56% 0% 7% 0% 61% 28% 2% 40% 0% 3% 5% 17%
SEE TABLE 1 for country abbreviations. PMMA = polymethylmethacrylate

Scleral lenses account for 14% of all GP lenses fitted. Among corneal GP lenses, high-Dk (greater than 90) was the most commonly prescribed material. Spherical designs were the most widely prescribed, with OK lenses the next most popular, accounting for 24% of GP lens fits. Approximately three-quarters of GP lenses are prescribed on a planned replacement basis.

SOFT LENSES

Soft lenses made up 87% of contact lens fits (Table 4). Taking a closer look at nine markets for which we have 15 years of consecutive data, silicone hydrogels represent 72% of all soft lenses prescribed over this time period; this material type dominates the reusable lens category in particular (Figure 3), reaching a plateau of around 80% of fits in 2013. The proportion of silicone hydrogels used for daily disposable lenses continues to rise and is currently at 62% (Figure 3).

TABLE 4 DETAILED INFORMATION FOR ALL PRESCRIBED SOFT LENSES FOR MARKETS REPORTING > 100 SOFT LENS FITS
AU BG CA CZ DK ES FI FR GR HU IL IT JP LT MX NL NO NZ PH PT SE TW UK US OVERALL
Soft lenses for new fits 90% 86% 94% 95% 87% 81% 97% 34% 98% 37% 99% 86% 96% 100% 83% 52% 90% 74% 98% 100% 89% 82% 99% 66% 87%
Soft lenses for refits 87% 91% 96% 95% 91% 87% 97% 61% 98% 68% 94% 79% 81% 96% 92% 61% 87% 79% 99% 93% 75% 96% 90% 89% 87%
MATERIALS Low water content (< 40%) 1% 0% 2% 1% 10% 1% 1% 1% 3% 1% 2% 1% 8% 0% 1% 4% 8% 2% 2% 0% 2% 60% 2% 0% 4%
Mid water content (40-60%) 15% 17% 10% 3% 28% 8% 2% 8% 7% 1% 14% 18% 8% 6% 2% 15% 11% 8% 11% 18% 8% 1% 5% 8% 9%
High water content (> 60%) 5% 1% 13% 9% 24% 18% 2% 1% 28% 23% 30% 16% 31% 1% 17% 4% 22% 5% 4% 4% 15% 27% 11% 6% 16%
Silicone hydrogel 78% 82% 76% 86% 38% 73% 95% 89% 62% 75% 53% 64% 53% 93% 81% 77% 59% 86% 83% 78% 76% 11% 81% 85% 72%
DESIGN Sphere 36% 68% 41% 48% 32% 41% 44% 27% 67% 31% 52% 35% 76% 85% 47% 36% 40% 46% 72% 35% 35% 33% 39% 52% 51%
Toric 22% 15% 32% 39% 23% 31% 32% 29% 20% 27% 33% 43% 17% 7% 42% 23% 37% 27% 22% 35% 47% 25% 30% 27% 28%
Cosmetic tint 0% 0% 1% 1% 3% 0% 0% 0% 2% 12% 2% 0% 2% 4% 7% 0% 0% 0% 1% 0% 0% 37% 1% 1% 2%
Multifocal 21% 17% 16% 13% 19% 20% 18% 40% 11% 30% 8% 18% 4% 5% 2% 26% 18% 12% 5% 29% 13% 5% 22% 15% 13%
Monovision 12% 0% 8% 0% 21% 1% 7% 3% 0% 0% 4% 0% 1% 0% 1% 13% 2% 12% 0% 1% 4% 0% 8% 4% 4%
Myopia control 8% 0% 2% 0% 1% 6% 0% 1% 0% 0% 0% 5% 0% 0% 0% 1% 3% 2% 1% 0% 0% 0% 1% 0% 1%
Other 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 1% 0%
REPLACEMENT Daily 58% 12% 48% 38% 78% 38% 54% 38% 35% 33% 56% 50% 59% 55% 10% 31% 62% 54% 16% 32% 46% 44% 62% 53% 45%
1-2 weekly 11% 7% 8% 14% 6% 5% 1% 17% 10% 2% 19% 7% 39% 6% 19% 2% 3% 9% 1% 2% 7% 7% 4% 17% 13%
Monthly 29% 76% 39% 46% 13% 52% 45% 42% 55% 65% 23% 39% 1% 40% 63% 48% 34% 34% 73% 66% 47% 45% 33% 30% 39%
3-6 monthly 1% 3% 4% 1% 3% 5% 0% 0% 0% 0% 1% 4% 0% 0% 6% 17% 0% 1% 6% 0% 0% 4% 0% 0% 3%
Annually 0% 3% 2% 1% 0% 0% 0% 2% 0% 0% 1% 0% 0% 0% 1% 1% 0% 0% 3% 0% 0% 0% 0% 0% 1%
Unplanned 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 2% 0% 0% 0% 0% 0% 0% 0%
Extended wear 6% 5% 4% 5% 11% 5% 10% 2% 2% 3% 2% 1% 0% 38% 25% 1% 21% 1% 16% 1% 7% 1% 1% 1% 9%
EW with silicone hydrogels 100% 83% 80% 100% 99% 71% 100% 100% 77% 100% 100% 100% 100% 97% 75% 100% 89% 80% 53% 100% 100% 40% 95% 100% 82%
MPS 98% 92% 85% 92% 67% 93% 95% 81% 96% 95% 87% 73% 80% 74% 99% 78% 78% 91% 94% 96% 94% 98% 96% 94% 89%
Presbyopes multi/mono 41%/24% 55%/0% 42%/20% 59%/0% 26%/32% 70%/4% 71%/14% 82%/9% 59%/1% 58%/3% 41%/13% 47%/0% 24%/2% 28%/0% 17%/3% 51%/21% 47%/6% 27%/26% 38%/8% 59%/3% 36%/16% 10%/0% 48%/18% 31%/13% 44%/14%
SEE Table 1 for country abbreviations. EW = extended wear MPS = multipurpose solution
The final row indicates the proportion of multifocal and monovision lenses prescribed when patients were over 45 years of age.

Figure 3. Prescribing of silicone hydrogel lenses for nine markets reporting at least 15 years of consecutive data (AU, CA, CZ, JP, NL, NO, NZ, UK, US).

Spherical, toric, and multifocal lenses accounted for 51%, 28%, and 13% of soft lenses prescribed, respectively. Multifocal lens prescribing has increased from approximately 25% of lenses fitted to presbyopes in 2005 to around 40% in 2019 (Figure 4). In addition, 10% to 15% of this group are prescribed monovision lenses; this would suggest that close to half of presbyopes, when fitted with soft contact lenses, receive a distance-only correction. In general, the fraction of presbyopes within the pool of fitted contact lens patients has increased from 20% to 35% of all fits over the past 15 years.

Figure 4. Prescribing of multifocal lenses (blue line) and combined multifocal/monovision lenses (red line) when presbyopes are fitted. Also shown is the proportion of contact lens fits to people aged 45 years and over (green line). Data for the nine markets for which at least 15 years of consecutive prescribing data was reported (AU, CA, CZ, JP, NL, NO, NZ, UK, US).

Myopia control lenses account for 1% of soft lens fits, although this percentage is substantially higher in Australia (8%) and Spain (6%). These values increase significantly when we evaluate contact lens fits only to people aged 17 years and younger. For example, the overall proportion of myopia control lenses rises to 6% for this age group.

Significantly, for the first time in this work (and a quarter of a century after their launch), daily disposables now represent the most widely prescribed soft lens replacement interval at 45% of fits, followed by monthly lenses at 39%. Denmark is once again the market in which daily disposables are most commonly prescribed (78% of all soft lens fits), with Norway and the United Kingdom also registering fitting rates greater than 60%. The extended wear modality was prescribed in 9% of soft lens fits, with silicone hydrogels being used in 82% of these fits. Multipurpose solutions were prescribed for use alongside 89% of reusable soft lenses. CLS

Funding and/or assistance was provided for the following markets: Australia—Optometry Australia; Bulgaria—Vision Protect Ltd; Argentina, Chile, France, Greece, and Israel—Johnson & Johnson Vision; Mexico—Johnson & Johnson Vision, CooperVision, and Alcon; Finland—Finnish Association of Vision and Eye-care; Norway—the Norwegian Association of Optometry; Netherlands—Bausch + Lomb; Spain—Spanish General Council of the Colleges of Opticians-Optometrists; Switzerland—Swiss Society of Optometry and Optics SBAO/SSOO.

The authors acknowledge the administrative support of Eurolens Research at The University of Manchester and the Centre for Ocular Research and Education at the University of Waterloo.