Demographics of international contact lens prescribing

Demographics of international contact lens prescribing

Contact Lens & Anterior Eye 33 (2010) 27–29 Contents lists available at ScienceDirect Contact Lens & Anterior Eye journal homepage: www.elsevier.com...

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Contact Lens & Anterior Eye 33 (2010) 27–29

Contents lists available at ScienceDirect

Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae

Short communication

Demographics of international contact lens prescribing Philip B. Morgan a, Nathan Efron b,*, Magne Helland c, Motozumi Itoi d, Deborah Jones e, Jason J. Nichols f, Eef van der Worp g, Craig A. Woods h a

Eurolens Research, The University of Manchester, Moffat Building, P.O. Box 88, Manchester M60 1QD, United Kingdom Institute of Health and Biomedical Innovation, and School of Optometry, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia Department of Optometry and Visual Science, Buskerud University College, P.O. Box 235, N-3603 Kongsberg, Norway d Department of Ophthalmology, Juntendo University School of Medicine, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan e School of Optometry, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada f College of Optometry, The Ohio State University, 320 W. 10th Ave., Columbus, OH 43210-1280, USA g University of Maastricht, P. Debijelaan 25, 6202 AZ, Maastricht, The Netherlands h Centre for Contact Lens Research, School of Optometry, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada b c

A R T I C L E I N F O

A B S T R A C T

Keywords: Contact lens International Demographics Fitting Survey

Knowledge of differences in the demographics of contact lens prescribing between nations, and changes over time, can assist (a) the contact lens industry in developing and promoting various product types in different world regions, and (b) practitioners in understanding their prescribing habits in an international context. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 reveal an ageing demographic, with Japan being the most youthful. The majority of fits are to females, with statistically significant differences between nations, ranging from 62 per cent of fits in Norway to 68 per cent in Japan. The small overall decline in the proportion of new fits, and commensurate increase in refits, over the survey period may indicate a growing rate of conversion of lens wearers to more advanced lens types, such as silicone hydrogels. ß 2009 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

1. Introduction An understanding of the world-wide demographics of a cohort of health care consumers in a defined health care market can guide modes of practice. This is certainly the case in respect of contact lenses, which are worn by a significant proportion of the population (e.g. 7.2, 12.0, 14.6 and 14.7 per cent of the adult population in the UK, Norway, Japan and the USA, respectively) [1]. Knowledge of factors such as the sex and age of lens wearers, and how these demographics change over time and vary between countries, are able to assist the contact lens industry in developing and promoting various product types in different world regions. Such information also helps explain different regional patterns of lens prescribing, and can be used by practitioners to position their own prescribing practices into an international context. Trade globalization has impacted the contact lens market, whereby the majority of contact lenses fitted around the world are manufactured and distributed internationally by four major companies—Bausch & Lomb, CIBA Vision, CooperVision and

* Corresponding author. Tel.: +61 7 3138 6401; fax: +61 7 3319 6974. E-mail address: [email protected] (N. Efron).

Johnson & Johnson Vision Care. As such, it is possible to draw comparisons of international prescribing trends based on the assumption that the same lens brands are being fitted in all markets, albeit in different proportions depending on regional variations in company marketing strategies. A number of factors impact upon the pattern of use of contact lenses in different countries, such as differences in population demographics, distribution of refractive errors, availability of lens brands and specific lens types, availability of brands and types of lens care systems, regulatory constraints, type of eye care provider (i.e. whether the primary contact lens providers are optometrist, opticians, ophthalmologists, or the market is unregulated) and the general affordability of lenses and lens care products. In this brief communication, we examine trends in the demographics of contact lens prescribing in seven nations over the past nine years.

2. Methods An annual survey form was sent randomly to up to 1000 contact lens practitioners (ophthalmologists, optometrists and/or opticians depending on the market) in five countries since 2000 (Australia, Canada, the Netherlands, Norway and the UK), in The

1367-0484/$ – see front matter ß 2009 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.clae.2009.09.006

P.B. Morgan et al. / Contact Lens & Anterior Eye 33 (2010) 27–29

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Table 1 Number of lens wearers surveyed in each country 2000–2008. Country (abbreviation)

Year

Total

2000

2001

2002

Australia (AU) Canada (CA) Japan (JP) Netherlands (NL) Norway (NO) United Kingdom (UK) United States (US)

2124 1221 – 1607 922 1436 –

1612 1170 – 1478 1436 1399 –

1848 1575 – 1256 1470 693 879

1710 1352 4609 1145 1640 1057 534

1580 1434 4356 824 1784 1009 751

1245 1205 4786 1020 1647 964 963

1110 1509 4779 1000 1640 1210 660

885 1253 4552 160 1463 1131 374

887 1449 4719 1055 1352 978 93

13,001 12,168 27,801 9,545 13,354 9,877 4,254

Total

7310

7095

7721

12,047

11,738

11,830

11,908

9818

10,533

90,000

2003

2004

2005

2006

2007

2008

Table 2 Contact lens demographics 2000–2008. Country (abbreviation)

Age of new fitsa

Age of refitsa

New fits

Fits to females

Full-time wearers

Australia (AU) Canada (CA) Japan (JP) Netherlands (NL) Norway (NO) UK (UK) USA (US)

30.1  13.7 26.9  13.9 26.2  11.4 28.4  13.8 29.3  17.2 31.3  14.1 28.1  14.5

35.4  12.8 34.6  12.8 31.8  13.1 36.0  12.6 33.5  12.9 37.5  12.8 34.7  14.0

41% 37% 40% 36% 35% 49% 30%

64% 67% 68% 65% 62% 64% 65%

84% 88% 78% 98% 91% 80% 97%

a

Mean  standard deviation.

USA since 2002 and in Japan since 2003. Recipients anonymously recorded information about the first 10 patients prescribed contact lenses after receipt of paper or electronic survey forms. This information was entered onto a Microsoft Excel1 spreadsheet (Microsoft Corp., USA) and data were mined with the aid of the Excel1 Pivot Table function. Statistical analysis was conducted using stepwise logistic regression models and linear regression models (JMP, SAS Institute Inc., USA). 3. Results Over the survey period, responses were received for exactly 90,000 patients. The breakdown of this data by country and year are shown in Table 1. As can be seen from this table, with the exception of the Netherlands in 2007, and the USA in 2007 and 2008, there were in excess of 500 annual returns in any given nation/year combination. The return for the USA in 2008 (information relating to 93 lens fits) is especially low an caution needs to be exercised in interpreting that data from that cell. Key demographics averaged over the 9 survey years (2000– 2008) are shown in Table 2. Over the survey period, patient age was highest in the UK (31.3 and 37.5 years for new fits and refits, respectively) and lowest in Japan (26.2 and 31.8 years). The majority of fits were to females, with significant differences between nations (p < 0.0001), ranging from 62 per cent of fits in Norway to 68 per cent in Japan. Fig. 1 illustrates the changes in age for all lens fits over the survey period. A general trend of increasing age is evident (p < 0.0001). This figure also demonstrates consistently different age profiles between nations (p < 0.0001); for example, the age of lens wearers in Japan has remained lower than in other countries. The proportion of those in the presbyopic age range (>45 years) being fitted or refitted with contact lenses has increased dramatically over the survey period, especially in the European countries surveyed. Between 2000 and 2008, this proportion increased from 18 to 29 per cent of wearers in the Netherlands, 11 to 28 per cent in Norway and 20 to 27 per cent in the UK. The proportion of lenses fitted as new fits varied significantly between nations (p < 0.0001). The UK had the highest proportion

Fig. 1. Change in annual average age of lens wearers in the seven nations surveyed between 2000 and 2008.

Fig. 2. Box-and-whiskers plot showing the age of lens wearers receiving new fits and refits for the seven nations surveyed between 2000 and 2008. The upper and lower extremities of the box represent the 75th and 25th percentiles, the bar within the box represents the median, and the whiskers represent the full extent of the data ranges. Country abbreviations are given in Table 1.

P.B. Morgan et al. / Contact Lens & Anterior Eye 33 (2010) 27–29

of new fits (49 per cent) and the USA had the lowest (30 per cent). As can be seen from Fig. 2, for all nations surveyed the median age of lens wearers was higher for refits versus new fits. In general, there has been a small decline in the proportion of new fits from 40% to 35% between 2000 and 2008 (p < 0.0001). We arbitrarily define ‘part-time’ and ‘full-time’ as wearing the lenses one to three times per week and four to seven times per week, respectively. There was considerable variance in the proportion of part-time wearers between nations (p < 0.0001), ranging from 21 per cent of all wearers in the UK to 3 per cent in the Netherlands and the USA; these values did not change significantly over the survey period. 4. Discussion Differences in the age of lens wearers in different nations may relate to variations in the balance between competing influences. For example, purposeful marketing to attract younger wearers would tend to lower the age of wearers and successful industry promotion and fitting of bifocal lenses to the presbyopic demographic would tend to increase the age of wearers. Variations between nations in the balance between males and females fitted with lenses may be attributed to a variety of complex and interrelated cultural factors. For example, in nations with higher rates of participation in sports, more males might wear contact lenses, as sporting participation is generally higher among males (e.g. see data for Norway [2] and the UK [3]). A culture nurturing an emphasis on beauty and appearance and/or a strong perception of contact lenses as a fashion item akin to facial cosmetics might tend to favour a higher proportion of females wearing contact lenses in some markets. The general decline in the proportion of new fits, and commensurate increase in the proportion of refits, across nations over the past few years probably reflects a growing rate of conversion of lens wearers into superior products, such as fitting better toric lens designs or changing from hydrogel to silicone hydrogel materials. The increase in age of lens wearers over the survey period may in part be attributed to an increased amount of

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fitting to presbyopes as improved multifocal/varifocal lenses are introduced into the market. The proportion of part-time wearers in a given region would be expected to be influenced primarily by the uptake of daily disposable lenses, as these lenses are especially suited to this modality of wear. Certainly, of the seven nations surveyed, the UK has the second highest proportion of part-time wearers (20 per cent) and the second highest uptake rate of daily disposable lenses (32 per cent in 2008 [4]), and the Netherlands has the lowest proportion of part-time wearers (2 per cent) and the lowest uptake rates of daily disposable lenses (7 per cent in 2008 [4]). However, other factors must be at play; Norway, for example, has a relatively low proportion of part-time wearers (9 per cent) but the highest uptake rate of daily disposable lenses (36 per cent in 2008 [4]). Future papers in this series of short communications will explore specific examples of international trends in the prescribing of contact lens materials, designs and modalities of wear. The data presented in this paper has ‘set the scene’ for this series by providing an overview of the demographics of contact lens wear across seven nations over nine years. Acknowledgements We wish to thank Lyndon Jones (Canada), and Gretchyn Bailey, Joe Barr and Carla Mack (USA), for assisting in the collection of some of the data reported here. References [1] Morgan PB. Taking stock of the UK contact lens market. Optician 2009;238(6209):36–8. [2] Survey of living conditions 2007—sports and outdoor activities. http:// www.ssb.no/fritid_en/ [accessed on 7.08.09]. [3] Rowe N, Beasley N, Adams R. Sport, physical activity and health: future prospects for improving the health of the nation. In: Driving up participation: the challenge for sport. London: Sport England; 2004. p. 14–26. [4] Morgan PB, Woods CA, Tranoudis IG, Efron N, Knajian R, Grupcheva CN, et al. International contact lens prescribing in 2008. Contact Lens Spectrum 2009;24(2):28–32.