Contact Lens & Anterior Eye 33 (2010) 27–29
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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) . 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]
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
Table 1 Number of lens wearers surveyed in each country 2000–2008. Country (abbreviation)
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
Table 2 Contact lens demographics 2000–2008. Country (abbreviation)
Age of new ﬁtsa
Age of reﬁtsa
Fits to females
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%
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  and the UK ). 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
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 ), 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 ). 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 ). 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  Morgan PB. Taking stock of the UK contact lens market. Optician 2009;238(6209):36–8.  Survey of living conditions 2007—sports and outdoor activities. http:// www.ssb.no/fritid_en/ [accessed on 7.08.09].  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.  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.