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

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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
b
Institute of Health and Biomedical Innovation, and School of Optometry, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia
c
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

A R T I C L E I N F O A B S T R A C T

Keywords: Knowledge of differences in the demographics of contact lens prescribing between nations, and changes
Contact lens over time, can assist (a) the contact lens industry in developing and promoting various product types in
International different world regions, and (b) practitioners in understanding their prescribing habits in an
Demographics international context. Data that we have gathered from annual contact lens fitting surveys conducted
Fitting
in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 reveal
Survey
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 Johnson & Johnson Vision Care. As such, it is possible to draw

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: n.efron@qut.edu.au (N. Efron).
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 opti-
cians 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
28 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) Year Total

2000 2001 2002 2003 2004 2005 2006 2007 2008

Australia (AU) 2124 1612 1848 1710 1580 1245 1110 885 887 13,001
Canada (CA) 1221 1170 1575 1352 1434 1205 1509 1253 1449 12,168
Japan (JP) – – – 4609 4356 4786 4779 4552 4719 27,801
Netherlands (NL) 1607 1478 1256 1145 824 1020 1000 160 1055 9,545
Norway (NO) 922 1436 1470 1640 1784 1647 1640 1463 1352 13,354
United Kingdom (UK) 1436 1399 693 1057 1009 964 1210 1131 978 9,877
United States (US) – – 879 534 751 963 660 374 93 4,254

Total 7310 7095 7721 12,047 11,738 11,830 11,908 9818 10,533 90,000

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) 30.1  13.7 35.4  12.8 41% 64% 84%

Canada (CA) 26.9  13.9 34.6  12.8 37% 67% 88%
Japan (JP) 26.2  11.4 31.8  13.1 40% 68% 78%
Netherlands (NL) 28.4  13.8 36.0  12.6 36% 65% 98%
Norway (NO) 29.3  17.2 33.5  12.9 35% 62% 91%
UK (UK) 31.3  14.1 37.5  12.8 49% 64% 80%
USA (US) 28.1  14.5 34.7  14.0 30% 65% 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
Fig. 1. Change in annual average age of lens wearers in the seven nations surveyed
nation/year combination. The return for the USA in 2008
between 2000 and 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
Fig. 2. Box-and-whiskers plot showing the age of lens wearers receiving new fits
increased from 18 to 29 per cent of wearers in the Netherlands, 11
and refits for the seven nations surveyed between 2000 and 2008. The upper and
to 28 per cent in Norway and 20 to 27 per cent in the UK. lower extremities of the box represent the 75th and 25th percentiles, the bar within
The proportion of lenses fitted as new fits varied significantly the box represents the median, and the whiskers represent the full extent of the
between nations (p < 0.0001). The UK had the highest proportion 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
29
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 pro-
spects 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.