Professor Emeritus Nathan Efron
AC DSc PhD BScOptom FAAO(Dip CCLRT) FCCLSA FACO
Professor Emeritus, Institute of Health and Biomedical Innovation, and School of Optometry, QUT, Brisbane, Australia
Professor Philip B Morgan PhD
Director, Eurolens Research, the University of Manchester, Manchester, UK
Professor Craig A Woods PhD
School of Medicine (Optometry), Deakin University, Geelong, Australia
The 18th annual survey of Australian contact lens prescribing was conducted between January and April 2017.
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 questionnaire, and a request that this be downloaded, 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 e-mail, fax or post.
Completed questionnaires relating to 362 contact lens fittings were returned, providing a sound basis for a meaningful analysis. Each fitting was given an annualised weighting based on the number of lenses fitted during the survey period and the time taken to complete the fittings. This means that data generated by practitioners with a higher frequency of fitting contact lenses were afforded a higher weighting than those with a lower frequency of fittings.
The discussion below 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 a majority of lenses (68 per cent) was fitted to females. The average age of contact lens wearers at the time of fitting was 37.3 ± 16.6 years. The age at fitting ranged from seven to 82 years.
Figure 1. Detailed results for soft contact lens prescribing, in the 2017 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 88 per cent of new fittings, representing a slight decrease from the past few years.2
Figure 1 is a composite of pie charts detailing the key findings of the 2017 survey in relation to soft lenses. Silicone hydrogels are still the dominant material, representing 79 and 82 per cent of materials prescribed as new fittings and refittings, respectively. The balance is a mixture of mid-water and high-water content hydrogel materials. No low-water content hydrogel lenses were recorded as being fitted in 2017. This represents a remarkable change in the market from 1977, at which time 87 per cent of lenses fitted were made from a low-water content material (38 per cent water content hydroxyethyl methacrylate, known as HEMA).3
The key categories of lens designs are spherical, toric, multifocal, monovision, coloured (tinted) and myopia control, with spherical and toric designs representing 78 per cent of new fittings. About one quarter of soft lenses prescribed are in toric form (37 per cent of new fittings and 28 per cent of refittings).
Figure 2 shows trends in the level of prescribing of contact lenses for presbyopia between 2003 and 2017. It can be seen that apart from one ‘reversal’ in 2011, multifocal lenses have been prescribed to a greater extent than monovision correction since 2007. This preference for multifocal lenses appears to have increased and consolidated over the past four years, perhaps reflecting significant advances in multifocal lens design and increasing availability in preferred materials and frequency of lens replacement. Coloured (tinted) lenses represented only one per cent of new fittings this year.
Figure 2. Percentage of all soft lenses prescribed for the correction of presbyopia
to thoseover 45 years of age, in Australia between 2003 and 2017
Myopia control lenses incorporate special designs for arresting the rate of progression of myopia.4 These lenses represented one per cent of new fittings and two per cent of refittings in 2017 (compared to no fittings being recorded previously),2 perhaps indicating that practitioners are now willing to try this new approach, after much discussion on practitioner forums and at clinical meetings over the past few years.
Soft lens replacement and wearing modality
Trends in the three key lens replacement modalities (daily, two-weekly and monthly) prescribed between 2000 and 2017 are illustrated in Figure 3. The relentless increase in the popularity of daily disposable lenses is clear; more than two-thirds of the new soft lens fittings this year were daily disposable lenses. If this rate of prescribing daily disposable lenses continues at the same rate as has been apparent over the past 17 years, virtually all soft lenses prescribed in Australia may be this lens type by the end of this decade.
Multipurpose solutions remain the lens care option of choice for those wearing reusable lenses, representing 95 per cent of prescribed care regimens. The balance comprises almost exclusively peroxide systems.
Figure 3. Percentage of all soft lenses prescribed for daily, 1-2 weekly
and monthly disposal, in Australia between 2000 and 2017
Conventional and orthokeratology rigid contact lenses represented 7.3 per cent and 2.7 per cent of all contact lens fittings, respectively. This increase in rigid lens prescribing compared with recent years2 perhaps reflects a renewed interest in large diameter rigid lenses, and orthokeratology for temporary myopia relief and/or myopia control.
Australia versus the World
We have conducted annual contact lens fitting surveys in about 40 countries over the past few years.1 This provides an opportunity to benchmark against international colleagues, and this year we compare contact lens prescribing in Australian against world trends (Figure 4). Seven key categories of lens type are represented. The outer and inner rings display the Australian and world-wide fitting data,1 respectively.
The most striking difference in contact lens prescribing between Australia and the rest of the world is the extent of fitting silicone hydrogel daily disposable lenses, which represent 38 and 12 per cent of all lenses fitted, respectively. Also, the use in Australia of ‘other’ daily wear hydrogel lenses, that is, excluding daily disposable lenses, is far less than the world average. There is also less prescribing of extended wear lenses in Australia compared with the rest of the world. Differences between Australia and the world average in respect of fitting other lens types are small.
Figure 4. Percentage of all contact lenses prescribed in Australia (outer ring) compared with the world average (inner ring).
DD: daily disposable, DW: daily wear, EW: extended wear, OK: orthokeratology, Si-H: silicone hydrogel
The results of our 2017 survey yet again confirm the high rate of prescribing daily disposable lenses in Australia. Silicone hydrogels are very firmly entrenched as the material of choice, representing about 80 per cent of all soft lens fittings. As was the case last year, we note continuing strong use of multifocals compared with monovision, and toric contact lens fitting continues at high levels.
1. Morgan PB, Woods CA, Tranoudis IG, et al. International contact lens prescribing in 2016. Contact Lens Spectrum 2017; 32: 1: 30–35.
2. Efron N, Morgan PB, Woods CA. Contact lens prescribing trends 2016. Optometry Australia Pharma 2016; 37: 12: 2–4.
3. Swarbrick H, Pye D, Holden BA. Current Australian contact lens practice. Aust J Optom 1985; 68: 2–7.
4. Sankaridurg P. Contact lenses to slow progression of myopia. Clin Exp Optom 2017; 100: 5: 432–437.