Before the turn of the century, Nathan Efron and I were frustrated at the lack of information about contact lens prescribing that was available to researchers working in the field and contact lens practitioners in practice. We believed, I think correctly, manufacturers probably had a reasonable idea of the sorts of products that were being fitted but such information was expensive to collect and, understandably, not generally made public. We were keen to rectify this so in 1996, we initiated our first contact lens prescribing survey in the UK and reported our findings in this journal.1 The exercise generated a good level of interest so it was repeated in 1997 and indeed in every year since.2-25 In fact, this initiative has grown internationally with colleagues from around the world and we have now collected data on over 400,000 contact lens fits from over 70 countries, including 26,000 fits from the UK.

The survey work has adopted the same fundamental approach since its inception. At the start of 2021, 2,000 printed A4 forms were sent to 1,400 optometrists and 600 contact lens opticians, to addresses selected at random from the General Optical Council register. Recipients were invited to record information about the first 10 contact lens patients fitted with lenses after receiving the form; an online version is also available. Information about the date of fitting, new or refit, age, sex, material, design, frequency of replacement, days per week of wear, daily or extended wear, and care system is noted and the form returned to the University of Manchester for processing. A weighting system is used so that fits from busier practitioners (fitting a greater volume of lenses) are afforded a greater weight than less contact lens active colleagues.

After a reduction in the number of reported fits in 2020 (which we attributed to reduced practice activity due to Covid-19), this year saw a higher number of fits added to our database (968). Information was received from 101 practitioners made up of 80 contact lens opticians and 21 optometrists. Sixty-five percent of fits were to females and, overall, the mean ± standard deviation for patient age was 36.0 ±16.7 years with a range from eight to 85 years. Fifty-seven percent of patients prescribed were ‘new fits’ (ie to people with no recent experience of contact lens wear). About three-quarters of lenses (77%) were prescribed on a ‘full time’ basis of four days per week or more.

Soft lens details

Ninety-one percent of new lens fits and 93% of refits were with soft lenses. Silicone hydrogel materials were the dominant material prescribed (86%) with mid water content hydrogel the next most widely fitted (9%) (figure 1). Toric lens prescribing (defined when one or both lenses prescribed is of toric design) has now overtaken spherical lenses as the most widely prescribed lens design. This continues the remarkable increase in toric lens prescribing – the value of 44% of lens fits in 2021 compares with 14% in 1996. Multifocal lenses are also now widely prescribed, accounting for 17% of fits overall.


Figure 1: Main soft lens findings from the 2021 survey


The nature of the data collected allows for age-related prescribing to be assessed. Figure 2 shows the soft lens designs prescribed to children aged zero to 14 years between 1996 and 2021. The reduction in spherical lens fitting and increase in toric lenses over time reflects the market generally, as mentioned above, but of particular interest is the number of lenses prescribed to this group described as for ‘myopia

control’ (also known as ‘myopia management’). Although the overall number of fits to this age group is modest (about 7% of all fits) so care needs to be taken when considering apparent changes, there does appear to be an increase in recent years of myopia control prescribing, accounting for around 20% of fits in 2021.

Daily disposables continue to be the dominant prescribed UK soft lens replacement interval, and in 2021 accounted for 59% of soft lens fits. Our survey first noted a greater proportion of daily disposables compared with monthly-replaced lenses in 2013 and this trend shows no sign of reversing (figure 3).


Figure 3: Soft lens replacement intervals1996-2021

Fewer than 2% of soft lens fits were reported to be for extended wear. For reusable soft lenses, a multipurpose product was reported in over 99% of cases, with peroxide use now extremely marginal.


Rigid lens details

As in previous years, the number of rigid lens fits reported was low and as such, caution is required in interpreting the sub-categories of this lens type. This year, 6% of rigid lenses were reported to be a scleral design and most (65%) were manufactured from a high Dk (over 40 units) material. About three-quarters (77%) of rigid lenses were prescribed on a planned replacement basis, with most on a six monthly basis.

  • Philip Morgan is Professor of Optometry and director of Eurolens Research at the University of Manchester.


References

  1. Morgan PB, Ramsdale C and Efron N. Trends in UK contact lens prescribing 1996. Optician 1997; 213 (5583): 35-36.
  2. Morgan PB and Efron N. Trends in UK contact lens prescribing 1997. Optician 1997; 214 (5630): 32-33.
  3. Morgan PB and Efron N. Trends in UK contact lens prescribing 1998 Optician 1998; 216 (5679): 18-19.
  4. Morgan PB and Efron N. Trends in UK contact lens prescribing 1999. Optician 1999; 217 (5700): 43-44.
  5. Morgan PB and Efron N. Trends in UK contact lens prescribing 2000. Optician 2000; 219 (5749): 22-23.
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  24. Morgan PB. UK contact lens prescribing in 2019 Optician 2019; 4 October 2019 14-16.
  25. Morgan PB. Trends in UK contact lens prescribing 2020. Optician 2020; 4 September 2020 10-13.