Professor Nathan Efron PhD DSc AC
Research Professor, Institute of Health and Biomedical Innovation, and School of Optometry, QUT
Professor Philip Morgan PhD
Professor and Director, Eurolens Research, The University of Manchester, Manchester UK
Dr Craig Woods PhD
Associate Professor, School of Medicine (Optometry), Deakin University, Geelong
The 16th annual survey of Australian contact lens prescribing was conducted from January to April 2015. The same format as in previous years was employed. An e-mail was sent to all 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 their 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 e-mail.
Completed questionnaires relating to 353 contact lens fittings were returned, 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 have a higher frequency of fitting contact lenses were afforded a higher weighting than those taking longer to fit the 10 patients with lenses.
This discussion concentrates 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.
In keeping with other markets around the world,1 the majority of lenses (62 per cent) were fitted to females. The average age of contact lens wearers at the time of fitting was 32.2 ± 16.5 years. The age at fitting ranged from eight to 75 years.
Figure 1. Detailed results for soft contact lens prescribing in the 2015 Australian survey. Si-H = silicone hydrogel, WC = water content
Soft lens materials and designs
Soft lenses are still the main type of contact lens fitted, accounting for 95 per cent of new fittings. Figure 1 is a composite of pie charts detailing the key findings of the 2015 survey in relation to soft lenses. Silicone hydrogels are still the dominant material, representing 75 and 76 per cent of materials prescribed as new fittings and refittings, respectively, which is broadly consistent with 2014 data2 (79 and 76 per cent). The balance is more or less evenly split between low-water, mid-water and high-water content hydrogel materials.
A surprise in this year’s survey is the apparent increase in the use of low-water content hydrogels (nine per cent of new fittings and refittings), which were prescribed for zero per cent of new fittings and only two per cent of refittings in 2014.2 The reason for this is unclear.
The major categories of lens designs are spherical, toric, multifocal, monovision, coloured (tinted) and anti-myopia. Spherical designs represent a small majority of new fittings (53 per cent). About one quarter of soft lenses prescribed are in toric form (23 per cent of new fittings and 21 per cent of refittings).
Continuing improvements in soft multifocal lens designs over the past decade have resulted in strong prescribing figures for these lenses. This year, multifocal lenses represent 18 per cent and 15 per cent of new fittings and refittings, compared with 11 per cent and eight per cent, respectively, in 2014.2
It is evident that multifocals are preferred over monovision lens wear for correcting presbyopia. This year, there have been six times more presbyopic new fittings with multifocal lenses (18 per cent) compared with monovision lenses (three per cent).
Coloured (tinted) lenses represented three per cent of new fittings and one per cent of refittings, which is up on last year’s result2 where there were no recorded fittings with these lenses. This may be attributed to the recent emergence of coloured soft lenses made from silicone hydrogel materials in the market.
Anti-myopia lenses incorporate special designs for arresting the rate of progression of myopia.3 No anti-myopia lens fittings were recorded, which perhaps is not surprising because these lenses are still in the experimental/development phase, and the single product now on the market (MiSight, CooperVision) is not yet commercially available in Australia.
Figure 2. Percentage of soft lens new fittings prescribed according to replacement frequency in Australia between 2000 and 2015
Soft lens replacement and wearing modality
The proportion of soft lenses prescribed for daily replacement continues to rise relentlessly in the Australian market (Figure 2). This lens category is now the overwhelming majority of fittings by replacement frequency, accounting for 62 per cent of new fittings. The balance of new fittings comprises largely monthly replacement lenses (35 per cent), with the fitting with one to two weeks replacement lenses having declined in recent years, from 21 per cent in 20124 to only two per cent this year. Only one per cent of lenses were being replaced less frequently than monthly.
Multi-purpose solutions remain the lens care option of choice for those wearing reusable lenses, representing 91 per cent of prescribed care regimens. The balance is made up almost exclusively of peroxide systems.
Extended wear lenses represented four per cent of new soft lens fittings in 2015, so single use lenses (in other words, extended wear and daily disposable lenses combined) represented 66 per cent of new soft lens fittings this year. As we have noted previously, the increasing dominance of single-use lenses does not augur well for the soft contact lens solutions industry.
Conventional and orthokeratology rigid contact lenses represented four 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 the specialist nature and complexities of this fitting activity.
Figure 3. Percentage of all contact lenses prescribed in Australia (outer ring) compared with the rest of the world (inner ring). DD = daily disposable, DW = daily wear, EW = extended wear, OK = orthokeratology, Si-H = silicone hydrogel
Australia versus the world
We currently survey contact lens fitting in about 40 countries annually.1 This provides an opportunity to benchmark Australian trends against international colleagues. This year we compared contact lens prescribing with that of the world average.
The current pattern of contact lens fitting in Australia versus the rest of the world is shown in Figure 3. Six key categories of lens type are represented. The outer and inner rings display the Australian and world data,1 respectively.
Overall, Figure 3 reveals some differences in contact lens prescribing patterns between Australia and the rest of the world. Perhaps the starkest difference is seen in the prescribing of daily disposable lenses, which are represented by the combined grey (daily disposable hydrogel) and light blue (daily disposable silicone hydrogel) arcs. The extensive prescribing of daily disposable lenses in silicone hydrogel materials appears to be the main reason for this outstanding performance.
Rigid contact lenses have been losing ground in Australia for many years as a lens of first choice and are largely prescribed as a speciality lens for solving difficult cases. Although new information on orthokeratology continues to be published and discussed at conferences, this apparent interest has not translated into clinical practice, with this modality representing only one per cent of contact lens prescribing around the world1 and two per cent in Australia.
Extended wear lenses represent four per cent of contact lens fittings in Australia and seven per cent in the rest of the world.1 This indicates small but on-going interest in this modality, but perhaps not enough to warrant sufficient industry investment in research directed at further reducing the risk of microbial keratitis during overnight lens wear.
The highlight of our 2015 survey is the relentless rise in the prescribing of daily disposable lenses, at the expense of one to two weekly lens replacement. The market is now essentially polarised into a two-modality market: daily and monthly lens replacement. Silicone hydrogels remain the material of choice, representing three-quarters of all soft lens fittings. Taking these two factors together leads to the inescapable conclusion that daily disposable silicone hydrogel contact lenses are likely to continue to dominate the contact lens market in Australia and probably the world for the foreseeable future.
The emerging presbyopes of ‘Generation X’ (now aged early-30s to mid-40s) are hot on the heels of the already-presbyopic ‘Baby boomers’ (aged roughly 47 to 65), and it has been a struggle for the contact lens industry to properly cater for the vision needs of these growing demographic cohorts. The high rate of prescribing multifocal lenses recorded in the 2015 survey is perhaps an indication that as a profession and as an industry, we are rising to the challenge.
Other noteworthy market trends in summary are:
• On-going high rates of toric contact lens prescribing, indicating continuing practitioner confidence in this modality
• Hints of a possible re-emergence of interest in coloured lenses
• Apparent industry and practitioner caution in relation to purposeful prescribing for arresting the progression of myopia
• General lack of clinical interest in orthokeratology fitting.
- Morgan PB, Woods CA, Tranoudis IG, Helland M, Efron N et al. International contact lens prescribing in 2014. Contact Lens Spectrum 2015; 30: 1: 28-33.
- Efron N, Morgan PB, Woods CA. Contact lens prescribing trends 2014. Australian Optometry (Pharma Supplement) 2014; 35: 12: 2-5.
- Kollbaum PS, 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, Morgan PB, Woods CA. Trends in contact lens prescribing 2012. Australian Optometry (Contact Lenses Supplement) 2012; 33: 11: 3-5.