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Trend-Setting: Global Lens Distribution

The worldwide use of contact lenses as a form of vision correction gives us a glimpse into the prescribing trends of other countries.
Karen K. Yeung, O.D. and Carla S. Yee

6/15/2011

A global need for vision care persists and in response, the use of contact lenses has become prevalent throughout the world. The distribution of contact lenses varies per country, depending on patient demographics, contact lens availability, disposable income, practitioner perceptions and cultural factors. Studying the international trends of contact lens fittings—and formulating possible reasons for trends or exceptions—allows practitioners to compare their own contact lens prescribing practices with others around the world.

Unfortunately, the data regarding contact lens trends is proprietary, exclusive only to contact lens manufacturers. However, Philip B. Morgan, Ph.D, Nathan Efron, Ph.D., D.Sc., and colleagues have systematically surveyed and published contact lens trends internationally over the past 10 years. This article summarizes their latest publications, stemming from their international prescribing surveys.

What are the CL Demographics?
The global expansion of contact lenses shows many similarities between countries worldwide. Similar to previous years when the average age of contact lens wearers was in the early 30s, the 2010 survey reported that the average age of the contact lens wearer is 31.1-3  In general, countries with newer contact lens markets have higher rates of new contact lens fits (as opposed to refits) and younger patients. Nepal reported a rate of 92% new fits with an average age of 24.4 years old.3 China had the youngest average age of contact lens wearers at 23.7 years old.3  
Conversely, countries with more established contact lens markets reported older patients with a higher rate of refits into better contact lens materials and presbyopic correcting contact lenses. The United Kingdom reported a rate of 50% new fits with the highest average age of 34.9 years old.3 Taiwan had the lowest rate of new fits at 3%.3

Women comprise about two-thirds of all contact lens wearers worldwide.1,3 Whether this is due to cosmesis or other social issues, the data confirms that women are drawn to contact lens wear. The ratio of women to men contact lens wearers, however, varies by country. China had the highest percentage of female contact lens wearers at 79%.3 This statistic is likely influenced by the large percentage of young females within the population. Similarly, females comprise 76% and 75% of all contact lens fits in South Korea and Taiwan respectively. Conversely countries such as Iceland, Israel and Sweden had the lowest percentage of female contact lens wearers at 47%, 57% and 59% respectively.3

Gas-Permeable Lenses
In 2010, gas-permeable contact lenses accounted for 9% of all contact lens fits.3 Internationally, this reflects a continuing declining trend with an inverse relationship to the increased use of soft contact lenses, and more specifically, soft toric contact lenses.4,5 For example, Japan, with a strong rigid gas-permeable contact lens market, reported a huge decline in its gas-permeable contact lens use. Gas-permeable fittings comprised 35% of all contact lens fits in 2003, 24% in 2008 and an even lower, 20% in 2010.3,5

The 2010 survey reported countries such as Australia, Canada, Denmark, Iceland, Lithuania, Norway, Romania and Taiwan to have less than a 1% rigid gas-permeable contact lens use.3 Based off Dr. Morgan’s 2000 to 2008 survey, the majority of the rigid gas-permeable contact lens fittings (71%) were refits as opposed to new fits.5 This represents a higher rate than for soft contact lenses, where refits comprise 60% of all soft contact lens fittings.5

Silicone Contact Lenses
The silicone contact lens market has been growing rapidly. Between 2000 and 2008, silicone lenses constituted 4% to 36% of all soft contact lens fits.6 In 2010, the number of silicone contact lenses prescribed jumped even higher—comprising 51% of all soft contact lens fits.3 The disparity between countries is wide.

This trend seems to be universal; most countries saw an increase in their silicone contact lens fitting numbers from 2009 to 2010.3 High users of silicone contact lenses, such as Bulgaria, increased their use from 65% to 82% between 2009 and 2010.2,3 Canada similarly increased its use from 66% to 82% from 2009 to 2010.2,3 China was the anomaly, decreasing its use of silicone contact lenses from 6% in 2009 to 1% in 2010. This trend was offset with its increased use of daily disposable contact lenses—which rose from 11% in 2009 to 31% in 2010.2,3

When refitting patients, more practitioners tended to switch from non-silicone to silicone use when such contact lenses were available. With the recent availability of silicone daily disposable contact lenses, and the continually increasing parameters of these lenses, the market share of silicone contact lenses is predicted to have further growth.

Extended Wear Lenses
Silicone contact lenses did not grow the extended wear market as initially predicted by contact lens manufacturers. In fact, extended wear represented less than 10% of all soft contact lens fits in 2010—similar to the 9% average rate from 2000 to 2009.2,3 Dr. Morgan and colleagues reported an increase (5%) in extended wear in 2000, a peak (9% to 12%) between 2002 and 2007, and a decline (7%) in 2009.7

In 2010, the rates varied greatly among countries.3 China had the highest rate of new fits (13%) and refits (17%) into extended wear lenses, although none were into silicone contact lenses.3 Bulgaria had the next highest rate of new fits (7%) and refits (21%) into extended wear. Conversely, countries such as Japan and Hong Kong reported 0% new fits and only 1% refit into extended wear in 2010.3

The rate differences between the countries may be related to the perceived health risks of extended wear. For example, Japan’s low rate of extended wear fits and high rate of daily disposable fits show a conservative trend for lower health risks. Additionally, high regulations in the country dissuaded immediate exposure of extended wear contact lens into the area. Conversely, the perception of extended wear lenses was particularly high in Australia, perhaps due to the country’s initial research done on extended wear silicone lenses, which generated the interest of local practitioners who began prescribing these lenses.

Surveys between 2000 and 2009 showed that men were more likely to be fit into extended wear as compared to daily wear contact lenses.7 This finding may be influenced by a gender-related difference in lifestyle preference. Patients that were fit into extended wear were also noted to be older (34.6 years old) compared to those fit with daily wear contact lenses (30.2 years old).7 This older demographic trend may be attributed to practitioners who are more willing to fit experienced contact lens patients who have a better understanding of the increased health risks involved with extended wear into this modality.

The Popular Daily Disposables
The rate of daily disposable contact lens fittings has been increasing, representing 30% of all soft contact lens fits in 2010.3 Daily disposables surpassed the fitting rate of one to two week disposable contact lenses (18%) and frequent replacement (8%) contact lenses, but remains less popular than one-month disposable contact lenses (44%).

The 2000 to 2008 surveys tell us that there are two distinct groups of daily disposable contact lens fitters: high prescribing rate and low prescribing rate countries.8 In 2010, the rates of daily disposable contact lens fits were markedly higher in Hong Kong (75%), Denmark (62%), and Taiwan (57%).3 Low prescribing countries include Croatia (6%) and Bulgaria (8%).3 Differences between the various countries may be attributed to cultural perception of hygiene and availability of disposable income. Given Dr. Efron’s definition of part-time wear as the use of contact lenses three or less days per week, 38% of daily wear contact lens wearers wore contact lenses on a part-time basis in 2000 through 2008.8 This is lower than the 6% part time wear with non-daily disposable contact lenses.8

Males are fit with more daily disposable contact lenses than other replacement schedule contact lenses. Additionally, daily disposable contact lenses are fit in younger patients (30.2 years old) as compared to other all modalities of contact lenses (30.5 years old).8

Correcting for Astigmatism
As toric lenses continue to improve and become widely available, the rate of fitting these lenses also increases. Dr. Efron and colleagues reported an increase of 22% to 28% of toric contact lens fittings from 2000 to 2009.4 The 2010 survey reported that the prescribing habits of toric contact lenses vary greatly between countries. Low prescribing countries include China (6%) and Bulgaria (7%).3 High prescribing countries include Hong Kong (42%) and Australia (37%).3

According to Brien Holden, Ph.D., 34.8% of the population has more than one diopter of astigmatism; toric contact lenses are, therefore, under-utilized worldwide.9 The different rates between countries may vary depending upon the prevalence of astigmatism in the region, affordability of astigmatism correcting contact lenses versus spherical contact lenses for lower astigmatic patients, success of gas-permeable contact lenses for astigmatic patients and limited parameter availabilities of daily disposable contact lenses with astigmatism correction.

The 2000 through 2008 surveys suggest that toric contact lenses are fit on older patients (30.8 years old) as opposed to spherical contact lenses (28.4 years old).4 More males are fit into toric contact lenses, and more toric contact lenses are prescribed in non-silicone as opposed to silicone contact lenses (26% vs 21%).6 This may be attributed to the limited yet growing parameters in the silicone material.

Addressing Presbyopia
The use of monovision and presbyopia-correcting soft contact lenses is increasing, accounting for 12% of all soft contact lens fits in 2010 as opposed to 8% in 2009.2,3 High utilizers of presbyopia-correcting contact lenses include France and Denmark, where monovision and multifocal contact lenses constitute 27% and 22% respectively of all of their soft contact lens fits. Low utilizers of presbyopia-correcting contact lenses include Israel and Japan, where monovision and multifocal contact lenses constitute 3% and 2% respectively of all of their soft contact lens fittings.3

If we consider only presbyopic patients over the age of 45, countries such as Slovenia and Taiwan do not fit any monovision or multifocal soft contact lenses.10 Other countries, such as Portugal, fit multifocal soft contact lenses exclusively for all presbyopic patients, as opposed to monovision.10 Translating and simultaneous design, gas-permeable contact lenses still have a role—constituting 17% of all fitted multifocal contact lenses.

Women dominate the majority of presbyopic contact lens fits, reflecting a social trend for cosmesis. When comparing the increasing population of presbyopic patients with the use of presbyopia correcting contact lenses, the use of monovision and multifocal contact lenses is under-utilized. Only 37% of presbyopic patients wearing contact lenses are wearing presbyopia-correcting contact lenses; the remaining patients wear distance contact lenses with reading glasses on top.10 The varying rate of presbyopia-correcting contact lens usage between countries may be due to limitations of current, though improving, multifocal contact lenses, limited fitting skills by practitioners and patient costs.

Dr. Morgan, Dr. Efron and their research team have provided invaluable insight to the international contact lens market through their annual surveys and publications. The overall increase of soft contact lens wearers—though leading to the unfortunate decline of gas permeable contact lens usage—reflects globalization and the availability of contact lenses to the majority of people worldwide. Although prescribing trends do vary between countries, the overall need for eye care is ubiquitous. By understanding these trends and predicting each country’s limitations, practitioners, especially those who serve a diverse patient population from different nationalities, can better understand their own patients as well as evaluate their own prescribing techniques by comparing them to other contact lens fitters worldwide. 

Dr. Yeung, O.D., is the director of the UCLA Arthur Ashe Student Health Optometry Clinic. She is a diplomate in Cornea, Contact Lenses and Refractive Technologies through the American Academy of Optometry.

Carla Yee is currently in her third undergraduate year at the University of California, Los Angeles. She is a pre-optometry student majoring in psychobiology.

1. Morgan PB, Efron N, Helland M, et al. Demographics of international contact lens prescribing. Cont Lens Anterior Eye. 2010 Feb;33(1):27-9.
2. Morgan PB, Efron N, Woods CA, et al. International contact lens prescribing in 2009. CL Spectrum. 2010 Feb.
3. Morgan PB, Efron N, Helland M, et al. International contact lens prescribing in 2010. CL Spectrum. 2011 Jan.
4. Efron N, Morgan PB, Helland M, et al. Soft toric contact lens prescribing in different countries. Cont Lens Anterior Eye. 2011 Feb;34(1):36-8.
5. Efron N, Morgan PB, Helland M, et al. International rigid contact lens prescribing. Cont Lens Anterior Eye. 2010 Jun;33(3):141-3.
6. Morgan PB, Efron N, Helland M, et al. Twenty first century trends in silicone
 hydrogel contact lens fitting: An international perspective. Cont Lens Anterior Eye. 2010 Aug;33(4):196-8.
7.Morgan PB, Efron N, Helland M, et al. Global trends in prescribing contact lenses for extended wear. Cont Lens Anterior Eye. 2011 Feb;34(1):32-5.
8. Efron N, Morgan PB, Helland M, et al. Daily disposable contact lens prescribing around the world. Cont Lens Anterior Eye. 2010 Oct;33(5):225-7.
9. Holden BA. The principles and practice or correcting astigmatism with soft contact lenses. Aust J Optom. 1975 Aug;58(8):279-99.
10. Morgan PB, Efron N, Woods CA, et al. An international survey of contact lens prescribing for presbyopia. Clin Exp Optom. 2011 Jan;94(1):87-92.



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