An international survey of daily disposable contact lens prescribing

Purpose The aim was to determine the extent of daily disposable contact lens prescribing worldwide and to characterise the associated demographics and fitting patterns. Methods Up to 1,000 survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected since 1996 were also analysed for seven nations to assess daily disposable lens fitting trends since that time. Results Data were collected in relation to 97,289 soft lens fits, of which 23,445 (24.1 per cent) were with daily disposable lenses and 73,170 (75.9 per cent) were with reusable lenses. Daily disposable lens prescribing ranged from 0.6 per cent of all soft lenses in Nepal to 66.2 per cent in Qatar. Compared with reusable lens fittings, daily disposable lens fittings can be characterised as follows: older age (30.0 ± 12.5 versus 29.3 ± 12.3 years for reusable lenses); males are over-represented; a greater proportion of new fits versus refits; 85.9 per cent hydrogel; lower proportion of toric and presbyopia designs and a higher proportion of part-time wear. There has been a continuous increase in daily disposable lens prescribing between 1996 and 2011. The proportion of daily disposable lens fits (as a function of all soft lens fits) is positively related to the gross domestic product at purchasing power parity per capita (r2 = 0.55, F = 46.8, p < 0.0001). Conclusions The greater convenience and other benefits of daily disposable lenses have resulted in this modality capturing significant market share. The contact lens field appears to be heading toward a true single-use-only, disposable lens market.

International survey of rigid contact lens fitting

Purpose To determine the extent of rigid contact lens fitting worldwide and to characterize the associated demographics and fitting patterns. Methods Survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected between 1996 and 2011 were also analyzed to assess rigid lens fitting trends in seven nations during this period. Results Data were obtained for 12,230 rigid and 100,670 soft lens fits between 2007 and 2011. Overall, rigid lenses represented 10.8% of all contact lens fits, ranging from 0.2% in Lithuania to 37% in Malaysia. Compared with soft lens fits, rigid lens fits can be characterized as follows: older age (rigid, 37.3 ± 15.0 years; soft, 29.8 ± 12.4 years); fewer spherical and toric fits; more bifocal/multifocal fits; less frequent replacement (rigid, 7%; soft, 85%); and less part-time wear (rigid, 4%; soft, 10%). High-Dk (contact lens oxygen permeability) (36%) and mid-Dk (42%) materials are predominantly used for rigid lens fitting. Orthokeratology represents 11.5% of rigid contact lens fits. There has been a steady decline in rigid lens fitting between 1996 and 2011. Conclusions Rigid contact lens prescribing is in decline but still represents approximately 10% of all contact lenses fitted worldwide. It is likely that rigid lenses will remain as a viable, albeit increasingly specialized, form of vision correction.

The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens interactions with the ocular surface and adnexa subcommittee

The report of this subcommittee concerns the impact of contact lenses (CLs) on the ocular surface, with a particular emphasis on CL discomfort (CLD). We define the ocular surface, its regional anatomy, and the physiological responses of each region to CL wear.

Influence of practice setting on contact lens prescribing in the United Kingdom

We sought to determine the impact of optometric practice setting on contact lens prescribing by analysing annual survey data of lens fits collected between 2009 and 2013 from independent and national group practices throughout the United Kingdom. Compared to national group practices, independent practices fit contact lenses to older patients and more females. Independent practices also undertake a lower proportion of soft lens fits overall (and thus a higher proportion of rigid lens fits), soft toric lens fits and daily disposable lens fits. There is a higher proportion of soft extended wear and multifocal lens fits in independent practices. We conclude that contact lens fitting behaviour is influenced by optometric practice setting.

Trends in US contact lens prescribing 2002-2014

Purpose To document contact lens prescribing patterns in the United States between 2002 and 2014. Methods A survey of contact lens prescribing trends was conducted each year between 2002 and 2014, inclusive. Randomly selected contact lens practitioners were asked to provide information relating to 10 consecutive contact lens fits between January and March each year. Results Over the 13-year survey period, 1650 survey forms were received from US practitioners representing details of 7702 contact lens fits. The mean (±SD) age of lens wearers was 33.6 (±15.2) years, of whom 65.2% were female. Rigid lens new fits decreased from 13.0% in 2002 to 9.4% in 2014. Across this period, silicone hydrogels have replaced mid water contact lens hydrogels as the soft lens material of choice. Toric lenses represented about 25 to 30% of all soft lens fits. Multifocal soft lenses are generally preferred to monovision. Daily disposable lens fits have recently increased, and in 2014, they represented 27.1% of all soft lens fits. Most lenses are prescribed on 1 to 2 weekly or monthly lens replacement regimen. Extended wear remains a minority lens wearing modality. The vast majority of those wearing reusable lenses use multipurpose lens care solutions. Lenses are mostly worn 7 d/wk. Conclusions This survey has revealed prescribing trends and preferences in the United States over the past 13 years.

An international survey of contact lens prescribing for presbyopia

Purpose:  The aim was to determine world-wide patterns of fitting contact lenses for the correction of presbyopia.

Methods:  Up to 1,000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year over five consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fittings or refittings performed after receiving the survey form.

Results:  Data were received relating to 16,680 presbyopic (age 45 years or older) and 84,202 pre-presbyopic (15 to 44 years) contact lens wearers. Females are over-represented in presbyopic versus pre-presbyopic groups, possibly reflecting a stronger desire for the cosmetic benefits of contact lenses among older women. The extent to which multifocal and monovision lenses are prescribed for presbyopes varies considerably among nations, ranging from 79 per cent of all soft lenses in Portugal to zero in Singapore. There appears to be significant under-prescribing of contact lenses for the correction of presbyopia, although for those who do receive such corrections, three times more multifocal lenses are fitted compared with monovision fittings. Presbyopic corrections are most frequently prescribed for full-time wear and monthly replacement.

Conclusions:  Despite apparent improvements in multifocal design and an increase in available multifocal options in recent years, practitioners are still under-prescribing with respect to the provision of appropriate contact lenses for the correction of presbyopia. Training of contact lens practitioners in presbyopic contact lens fitting should be accelerated and clinical and laboratory research in this field should be intensified to enhance the prospects of meeting the needs of presbyopic contact lens wearers more fully.

Trends in Australian contact lens prescribing during the first decade of the 21st century (2000–2009)

Purpose:  The aim was to document contact lens prescribing trends in Australia between 2000 and 2009.

Methods:  A survey of contact lens prescribing trends was conducted each year between 2000 and 2009. Australian optometrists were asked to provide information relating to 10 consecutive contact lens fittings between January and March each year.

Results:  Over the 10-year survey period, 1,462 practitioners returned survey forms representing a total of 13,721 contact lens fittings. The mean age (± SD) of lens wearers was 33.2 ± 13.6 years and 65 per cent were female. Between 2006 and 2009, rigid lens new fittings decreased from 18 to one per cent. Low water content lenses reduced from 11.5 to 3.2 per cent of soft lens fittings between 2000 and 2008. Between 2005 and 2009, toric lenses and multifocal lenses represented 26 and eight per cent, respectively, of all soft lenses fitted. Daily disposable, one- to two-week replacement and monthly replacement lenses accounted for 11.6, 30.0 and 46.5 per cent of all soft lens fittings over the survey period, respectively. The proportion of new soft fittings and refittings prescribed as extended wear has generally declined throughout the past decade. Multi-purpose lens care solutions dominate the market. Rigid lenses and monthly replacement soft lenses are predominantly worn on a full-time basis, whereas daily disposable soft lenses are mainly worn part-time.

Conclusions:  This survey indicates that technological advances, such as the development of new lens materials, manufacturing methods and lens designs, and the availability of various lens replacement options, have had a significant impact on the contact lens market during the first decade of the 21st Century.

Contact lens prescribing in the Australian states and territories 2001

Background: This study was conducted to ascertain current preferences for contact lens prescribing in the Australian states and territories.

Methods: One thousand questionnaires were randomly distributed to proportionate samples of optometrists in each state of Australia. We requested details of the first 10 patients fitted with contact lenses after receipt of the questionnaire.

Results: One hundred and seventy-eight completed questionnaires were returned, detailing contact lens fits to 1,611 patients. The mean age of the patient group was 32.1 $pL 13.0 yrs (65 per cent female). For Australia as a whole: 53 per cent of patients were existing wearers, the remainder were new fits; 93 per cent of new fits were with soft lenses, of which seven per cent were for extended wear. Of the refits, 89 per cent were soft lenses and 18 per cent for extended wear. The lens material of first choice was mid-water-content (62 per cent of all soft lens fits). Only eight per cent of all soft fits were for lenses that were not replaced on a planned basis, with two weeks being the replacement interval of choice in all states and territories. The majority of rigid lenses were prescribed using mid-Dk materials (50 per cent). Analysis of solution prescribing indicates that multi-purpose products were the most common regimens for planned replacement soft lenses. The percentage of hydrogen peroxide prescribed increased as lens replacement became less frequent. By state or territory: practitioners in Tasmania prescribed more extended wear than those in any other state (p = 0.007) and practitioners in Queensland prescribed more daily disposable contact lenses than those in any other state (p = 0.009).

Conclusions: Non-planned replacement lenses are now rarely prescribed to patients. Extended-wear lenses and rigid lenses continue to be prescribed more to existing contact lens wearers than to new patients. The impact of soft multifocal lens designs on contact lens prescribing is very small, ranging from 2.6 per cent in Queensland to 4.7 per cent in Victoria, despite 20 per cent of patients being more than 45 years of age.

Clinical evaluation of long-term users of two contact lens care preservative systems

Purpose: To clinically evaluate long-term users of two different contact lens care preservative systems and to investigate whether prolonged use is associated with an increase in the prevalence of dry eye.

Methods: Eighty-nine wearers of group IV hydrogel or silicone hydrogel lenses participated in this one-visit, investigator-masked study. Subjects were required to have consistently used a polyhexamethylene biguanide (PHMB) or polyquaternium-1 (PQT) based solution for 2 years. Consistent use was defined as 80% for the past 2 years and 100% for the past year. Clinical assessments included: average and comfortable wear time; overall and end-of-day comfort; signs of dryness, discomfort, burning or stinging, grittiness or scratchiness and visual changes; non-invasive and fluorescein break-up-time; pre-ocular tear film lipids, tear meniscus height, Schirmer and fluorescein clearance tests; limbal and bulbar hyperemia; palpebral roughness; corneal and conjunctival staining; lens front surface wetting; and lens film deposits.

Results: Significantly more grittiness or scratchiness was reported by subjects using a PHMB-containing system (67% vs. 44%; P = 0.02). Palpebral roughness and hyperemia were significantly greater in the PHMB group wearing group IV lenses (P = 0.01 and P = 0.05, respectively). Corneal staining was significantly higher in the PHMB users in all four peripheral sectors (P < 0.01). Nasal and temporal conjunctival staining was also significantly higher for users of PHMB-containing systems (P < 0.05). Front surface lens wettability was significantly better for group IV PQT users compared to PHMB users (P = 0.008), with 84% vs. 72%, respectively, with lenses graded by the investigator as having good or excellent wettability. Significantly higher levels of lens front surface film deposits were noted with PHMB users (P = 0.007), with 58% of group IV lenses treated with PHMB compared with 38% of group IV lenses treated with PQT showing some lens front surface film deposition. No significant differences between the two preservative system groups were noted for the range of dry eye evaluations nor the remaining clinical assessments.

Conclusions: Differences in both ocular and lens characteristic were observed between long-term users of two preservative systems used in many contact lens multi-purpose solutions. The findings from this study did not support the hypothesis that prolonged use of PHMB-containing solutions leads to dry eye. Additional studies including a larger sample size and perhaps longer use of the systems could help to further elucidate differences in clinical performance between systems.

A disposable contact lens in independent practice : three years on

First introduced late in 1987 the Acuvue lens was originally launched as an extended-wear lens, though it soon became adapted to daily wear. It received an FDA licence for daily wear in the USA in 1990.

Survey of contact lens prescribing to infants, children, and teenagers

Purpose. To determine the types of contact lenses prescribed for infants (aged 0 to 5 years), children (6 to 12 years), and teenagers (13 to 17 years) around the world.

Methods. Up to 1000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year for 5 consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form.

Results. Data were received relating to 105,734 fits [137 infants, 1,672 children, 12,117 teenagers, and 91,808 adults (age ≥18 years)]. The proportion of minors (<18 year old) fitted varied considerably between nations, ranging from 25% in Iceland to 1% in China. Compared with other age groups, infants tend to be prescribed a higher proportion of rigid, soft toric, and extended wear lenses, predominantly as refits for full-time wear, and fewer daily disposable lenses. Children are fitted with the highest proportion of daily disposable lenses and have the highest rate of fits for part-time wear. Teenagers have a similar lens fitting profile to adults, with the main distinguishing characteristic being a higher proportion of new fits. Orthokeratology fits represented 28% of all contact lenses prescribed to minors.

Conclusions. Patterns of contact lens prescribing to infants and children are distinctly different to those of teenagers and adults in a number of respects. Clinicians can use the data presented here to compare their own patterns of contact lens prescribing to minors.

A seven year survey of the contact lens prescribing habits of Canadian optometrists

Purpose. Little is known about the contact lens prescribing habits of optometrists in North America. The purpose of this survey was to obtain data on the types of lenses and solutions prescribed by Canadian optometrists.

Methods. One thousand Canadian optometrists were surveyed annually over seven consecutive years (2000 to 2006; n = 7000) on their contact lens prescribing preferences. Each survey requested a range of information about the contact lenses prescribed to the first 10 patients after its receipt.

Results. Over this time period, 1008 (14.4%) of the surveys were returned, providing data on 9383 fits. During the seven-year period, the ratio of male:female fits was 1:2 (3123:6217, 43 not reported), with a mean age of 31.3 ± 13.6 years (range 2 to 82 years). The ratio of new fits to refits was 2:3 (3780:5518, 85 not reported), with 91.3% of all fits being soft contact lenses (SCL). Of the SCL fits, 59.5% were spherical, 28.5% toric, 9.7% multifocal, and 2.3% cosmetic tints. Gas permeable (GP) fits were 46.6% spherical, 18.6% toric, 19.5% multifocal, and 6.6% were for orthokeratology (OK). Over the seven-year period, SCL prescribed for continuous wear (CW) increased from 3.2% to 14.3% between 2000 and 2004 and reduced to 8.1% in 2006, for all fits. The use of mid-water content (MWC) materials decreased from 34.6% to 2.7% and the use of silicone hydrogel (SH) lenses increased from 61.4% to 96.2%, for all CW fits. GP lens continuous wear increased from 0.7% to 30.6% of all GP lens fits by 2006. Daily wear (DW) of SH lenses decreased from 49.6% (2000) to 33.7% (2004) and then increased to 86.1% in 2006, for SH fits. MWC SCL fit on a monthly planned replacement (PR) basis reduced in popularity over the seven-year period (75.0% to 39.9%) and in 2006 more patients were fit overall with SH lenses (42.9%). The use of non-PR SCL declined from 20.5% to 4.5% of all fits. Fitting of low-water content lenses also declined (15.1% to 7.0%). High-water content (5.4% to10.2%) and SH lenses (5.4% to 42.9%) both increased. By 2006, the majority of GP lenses fit were with high Dk (HDK) materials (50.3%).

Conclusions. The preferred contact lens modality for Canadian optometrists appears to be DW SCL, which are replaced monthly. The proportion of lenses used for CW peaked in 2004, with SH SCL being the preferred material. The market share for GP lenses remains relatively unchanged, with an increasing proportion used for OK and CW. The launch of DW SH lenses in 2004 resulted in a marked increase in their reported fits, with a similar effect following the launch of a HDK GP lens material for CW.

Managing the emerging presbyopic contact lens wearer

The article deals with a study that examined the performance of a new silicone hydrogel multifocal contact lens for emerging presbyopes compared to other forms of correction. Study participants were asked to wear a different lens design for a week at a time. They were divided into the asymptomatic group and the symptomatic group. Results of the study showed that 24 participants had no difficulties with near vision tasks. It also found similar ghosting between the multifocal and habitual corrections for the near tasks under low illumination.

Contact lens prescribing in Canada 2011

The annual survey to collect data on the contact lens prescribing preferences of practitioners has continued for 12 years in Canada. Practitioners were surveyed for information on the first 10 patients they fitted with contact lenses immediately after receipt of said survey. A total of 121 completed surveys were returned, detailing contact lens fittings for 1,184 patients.

Of the patients fitted with contact lenses, the results indicated that the majority were prescribed soft lenses. The preferred modality was monthly planned replacement and over 67 per cent of the soft lens fits were made of silicone hydrogel materials. Of the rigid lens fits, the majority were prescribed for daily wear, as the overnight use of rigid lenses appears to be mainly for orthokeratology. Practitioners are recommending multipurpose solutions for the majority of their soft lens patients (85.6%).