Research Professor, Institute of Health and Biomedical Innovation, and School of Optometry, QUT
Philip B Morgan
Professor and Director, Eurolens Research, The University of Manchester, Manchester UK
Craig A Woods
Associate Professor, School of Medicine (Optometry), Deakin University, Geelong
The 15th annual survey of Australian contact lens prescribing habits was conducted between January and April 2014. The same format as in previous years was employed. An email was sent to all 4,292 members of Optometry Australia with a link to a downloadable questionnaire, and a request that this be accessed, printed and completed to provide details of the first 10 patients fitted with contact lenses after receipt of the questionnaire.
The survey was specifically designed to be straightforward to complete while capturing key information about the patients. Practitioners were asked general questions about themselves. For each contact lens fitting, they were requested to complete the following details: date of fitting, new fitting or refitting, age and sex of patient, lens material, lens design, frequency of replacement, times per week of wear, modality (daily or extended wear) and care system. Practitioners were asked to return the questionnaire by fax, post or email.
Completed questionnaires were returned by only 54 practitioners, representing a disappointingly low response rate of 1.3 per cent; nevertheless, a total of 489 contact lens fittings were recorded, which provides a sound basis for a meaningful analysis. Each fitting was given a weighting based on the number of lenses fitted per year by the practitioner (based on the date information on the form). This means that data generated by practitioners who conducted many contact lens fittings were afforded a higher weighting than those performing fewer fittings.
The discussion below will concentrate primarily on data relating to new lens fittings, as opposed to refittings. We believe that new fittings are a more sensitive barometer of current patterns and future trends, whereas refittings are more indicative of previous fitting behaviours.
As has been a consistent trend over the past 15 years (Figure 1), and in keeping with other markets around the world, a majority of lenses (64 per cent in 2014) were fitted to females. The average age of contact lens wearers has gradually increased over the past 15 years (Figure 1), from 32 years in 2000 to 38 years in 2014. The age at fitting ranged from seven to 94 years.
Figure 1. Proportion of females fitted with contact lenses, and average age of lens wearers, in Australia between 2000 and 2014
The increasing age of lens wearers can be attributed to both positive and negative influences. On the positive side, this trend could be due to more fittings to presbyopes, as a result of ongoing improvements in methods of correcting presbyopia with contact lenses, especially multifocal lenses, as discussed below. On the negative side, an ageing contact lens demographic may be indicative of a stagnating contact lens market, in which the rate of new fittings to younger wearers is declining. This survey is unable to reveal which of these two influences predominates.
Soft lens designs
Soft lenses are still the main type of contact lens fitted, accounting for 97 per cent of new fittings. Figure 2 is a composite of pie charts detailing the key findings of the 2014 survey in relation to soft lenses. Silicone hydrogels represented 79 and 76 per cent of materials prescribed as new fittings and refittings, respectively—an increase over the 2013 data1 (77 and 67 per cent). The balance comprises mid and high water content hydrogel materials. Low water content hydrogel lenses were prescribed for zero per cent of new fittings and only two per cent of refittings in 2014.
Figure 2. Detailed results for soft contact lens prescribing in the 2014 Australian survey
(Si-H: silicone hydrogel; WC: water content)
Figure 3 shows trends of new fittings with lenses made from silicone hydrogel, hydrogel and rigid materials between 2000 and 2014. It is evident that the extent of silicone hydrogel lens fitting has expanded rapidly throughout this period and especially since 2005. This has clearly been at the expense of hydrogel lens prescribing, which has steadily declined from 80 per cent of new fittings in 2000 to 20 per cent in 2014.
Figure 3. Percentage of soft lens new fittings prescribed for rigid, silicone hydrogel (Si-H) and hydrogel lenses in Australia between 2000 and 2014
The major categories of lens designs are spherical, toric, multifocal, monovision, coloured (tinted) and anti-myopia. Spherical designs now represent a minority of new fittings (46 per cent).
There has been a significant increase in the prescribing of soft lenses for the correction of astigmatism in 2014, with 40 per cent of soft lens new fittings being with toric designs, versus 32 per cent in 2013.1 The current level of toric lens prescribing suggests that nearly all ‘clinically significant’ astigmatism (> 0.75 D) is being be corrected (the accepted target in this regard is about 35 per cent of lenses).2
Improvements in soft multifocal lens designs over the past decade have resulted in such lenses being preferred over monovision lens wear for correcting presbyopia in most countries.3 This trend is also evident in Australia, where there were significantly more presbyopic new fittings with multifocal lenses (11 per cent) compared with monovision lenses (three per cent).
There were no recorded fittings with coloured (tinted) soft lenses in the 2014 survey. This can be largely attributed to the fact that silicone hydrogel lenses, which as noted above, constitute the vast majority of soft lenses prescribed at present, have not been available in tinted/coloured form. This is about to change, with Alcon announcing earlier in 2014 the launch of its Air Optix Colors silicone hydrogel contact lenses in the USA.4
Anti-myopia lenses incorporate special designs for arresting the rate of progression of myopia.5 No anti-myopia lens fittings were recorded, which perhaps is not surprising because these lenses are still in the experimental and development phase, and the single product now on the market (MiSight, CooperVision)5 is not yet commercially available in Australia.
Soft lens replacement
Daily disposable lenses now represent the majority of fittings by replacement frequency, accounting for 56 per cent of new fittings. The balance of new fittings largely comprise monthly replacement lenses (37 per cent), with the fitting of 1-2 weeks replacement lenses having again declined significantly, from 15 per cent in 20131 to only seven per cent in 2014. As was the case last year,1 there was no record of lenses being replaced less frequently than monthly, indicating that we now have a soft lens market that is exclusively frequent lens replacement—that is, at least monthly.
Soft lens modalities of wear
Extended wear lenses represented two per cent of new soft lens fittings in 2014, so all single use lenses (extended wear and daily disposable lenses combined) represented 58 per cent of all new soft lens fittings this year. The dominance of single use lenses does not auger well for the soft contact lens solutions industry.
Soft lens solutions
Multi-purpose solutions accounted for 95 per cent of prescribed care regimens, with the balance made up almost exclusively of peroxide systems.
Non-orthokeratology and orthokeratology rigid contact lenses represented five per cent and two per cent of all contact lens fittings, respectively.
Because of the low level of rigid lens fitting in Australia at present, a valid statistical analysis of sub-categories of materials, designs and replacement frequencies cannot be undertaken. The limited extent of orthokeratology fitting in Australia is probably due to the specialist nature and complexities of this fitting activity.
Australia versus Hong Kong
We currently survey contact lens fitting in about 40 countries annually.3 This provides an opportunity to benchmark Australian trends against international colleagues, and this year we compare contact lens prescribing with that of a prominent Asian region, Hong Kong. The current pattern of contact lens fitting in these two countries in displayed in Figure 4. Six key categories of lens type are represented. The outer and inner rings display the Australian and Hong Kong data, respectively.
Figure 4. Percentage of all contact lenses prescribed in Australia (outer ring) compared with Hong Kong (inner ring)
DD: daily disposable; DW: daily wear; EW: extended wear; OK: orthokeratology; Si-H: silicone hydrogel
Overall, Figure 4 reveals some differences in contact lens prescribing patterns between Australia and Hong Kong. The majority of daily disposable lenses in Hong Kong are with hydrogel materials, whereas in Australia this category is dominated by silicone hydrogels. In the daily disposable domain, silicone hydrogel lenses are generally more expensive that hydrogel lenses6 and it is known that the cost of daily disposable lenses has a strong influence on the prescribing of this lens type in different nations.7 However, Hong Kong has a higher gross domestic product than Australia does, suggesting this discrepancy is unrelated to cost factors. Differences in the marketing and availability of hydrogel versus silicone hydrogel daily disposable lens products may account for the disparity in prescribing.
Hong Kong has twice the rate of orthokeratology fitting (four per cent) than does Australia (two per cent). This is unsurprising, in view of the incidence of myopia throughout Asia and the reported potential for orthokeratology lenses to arrest the rate of progression of myopia.5 Non-orthokeratology rigid lens fitting is lower in Hong Kong (three per cent) than in Australia (five per cent).
Whereas extended wear lenses represented five per cent of contact lens fittings in Australia, no extended wear fittings were recorded in Hong Kong. The reason for this stark difference is unclear but may be related to differences in lifestyles of contact lens wearers.
The highlight of our 2014 survey is the continuing increased use of daily disposable lenses, to the point where they now represent the majority of fittings according to lens replacement frequency. This lens type is becoming available in an expanding array of materials and designs, and the greater cost of using daily disposable lenses—at least on a full-time basis—appears to be less of a disincentive to adopt this form of lens wear than it was when daily disposable lenses were introduced into the market 20 years ago.
Equally dramatic is the ongoing rise in popularity of silicone hydrogel materials, which now represent 79 per cent of all new lens fittings. It is not rocket science to predict that the future contact lens market will be dominated by daily disposable silicone hydrogel contact lenses.
The shifting age profile of lens wearers to an older demographic is noteworthy, but it is unclear whether this represents good news (more fittings for presbyopia) or bad news (fewer fittings to younger wearers). The majority of lenses are still fitted to females.
The other significant change this year has been the ongoing decline in 1-2 weekly lens replacement to only seven per cent. Full correction of astigmatism remains the norm, with continuing high levels of practitioner confidence in toric lens fitting. Multifocal soft lenses remain the preferred form of correction for presbyopes over monovision. Rigid lens prescribing, including orthokeratology fitting, continues to be low.
- Efron N, Morgan PB, Woods CA. Contact lens prescribing trends. Australian Optometry (Pharma Supplement) 2013; 34: 12: 2-4.
- Holden BA. The principles and practice of correcting astigmatism with soft contact lenses. Aust J Optom 1975; 58: 279-299.
- Morgan PB, Woods CA, Tranoudis IG, Helland M, Efron N, Teufl IM, Grupcheva CN et al. International contact lens prescribing in 2013. Contact Lens Spectrum 2014; 29: 1: 30-35.
- McCarthy CE. Alcon introduced Air Optix Colors. Optometry Times 2014. Accessed on July 9, 2014 at: http://optometrytimes.modernmedicine.com/optometrytimes/news/alcon-introduces-air-optix-colors?page=full.
- Kollbaum PS1, Jansen ME, Tan J, Meyer DM, Rickert ME. Vision performance with a contact lens designed to slow myopia progression. Optom Vis Sci 2013; 90: 205-214.
- Efron N, Efron SE, Morgan PB, Morgan SL. A ‘cost-per-wear’ model based on contact lens replacement frequency. Clin Exp Optom 2010; 93: 253-260.
- Morgan PB, Efron N, Woods CA, The International Contact Lens Prescribing Survey Consortium. An international survey of toric contact lens prescribing. Eye Contact Lens 2013; 39: 132-137.