December 2017 ADVANCING OPTOMETRY Corneal diseases CFEH’s Chairside reference Contact lens trends Efron, Morgan and Woods 18th annual survey results CPD POINTS WITH PHARMA ONLINE ® December 2017 Editor JEFF MEGAHAN 02 13 National Communications Contact lens prescribing Early keratoconus and Manager SANDRA shaw trends 2017 potential progression Dr Nathan Efron, Dr Philip B Lindsay Moore Clinical Editor Associate Professor MARK ROTH Morgan and Dr Craig A Woods BSc(Pharm) BAppSc(Optom) PGCertOcTher NEWENCO FAAO 14 OAM 05 CHAIR-SIDE REFERENCE Vision and life-threatening Corneal ectatic diseases Cover complications of Sjögren’s Corneal topography map. Image and thinning disorders syndrome courtesy of Medmont Centre for Eye Health Vanessa Tang and Dr Adrian Optometry Australia Bruce 20 ABN 17 004 622 431 Relief for blepharitis and Suite 101, 70 York Street 08 dry eye South Melbourne VIC 3205 Dr Allan Ared Ph 03 9668 8500 Ultra-widefield imaging in Fax 03 9663 7478 clinical practice [email protected] Michael Wicks 22 www.optometry.org.au Therapeutic News of note Mark Roth Copyright © 2017 10 All lenses great and small Comments made in Pharma are of a general nature and intended for Damon J Ezekiel 24 guidance only. Optometry Australia and the individual contributors expressly Assessing artificial tears disclaim all liability and responsibility Dr Nicholas Young to any person in respect of, and for the 12 17 consequences of, anything done or Axial versus tangential Melbourne Rapid Fields omitted to be done in reliance wholly or partly on anything in this publication. maps Selwyn M Prea, Dr Algis J 26 Vingrys and Dr George YX Pharma is distributed in Australia Richard Lindsay, Andrew PBS list of medicines and New Zealand. All references to Huhtanen and Jillian Kong prescribed by optometrists, pharmaceutical preparations in Pharma Campbell November 2017 are applicable within Australia. 2 DECEMBER 2017 Contact lens prescribing trends 2017 Materials Designs Replacements Professor Emeritus Monovision Tint 7% 1% Myopia 3-6 Monthly Annually Nathan Efron Mid WC control 1% 1% 1% 16% Multifocal Monthly 14% 21% AC DSc PhD BScOptom High WC Sphere 1-2 weekly Daily FAAO(Dip CCLRT) FCCLSA FACO 6% 41% 10% Si-H 67% Toric New fittings 79% Professor Emeritus, Institute of 37% Health and Biomedical Innovation, Myopia and School of Optometry, QUT, Mid WC Monovision Unplanned 4% control 2% Brisbane, Australia 10% 2% Multifocal High WC 16% 8% Monthly 38% Sphere Professor Philip B Morgan PhD 50% Daily Refittings Si-H 52% Toric 82% 1-2 weekly Director, Eurolens Research, 28% 9% the University of Manchester, Manchester, UK Figure 1. Detailed results for soft contact lens prescribing, in the 2017 Australian survey (Si-H: silicone hydrogel; WC: water content) Professor Craig A Woods PhD School of Medicine (Optometry), Deakin University, Geelong, meaningful analysis. Each fitting was are more indicative of previous fitting Australia given an annualised weighting based behaviours. on the number of lenses fitted during the survey period and the time taken In keeping with other markets around to complete the fittings. This means the world,1 a majority of lenses (68 that data generated by practitioners per cent) were fitted to females. The THE 18TH ANNUAL survey of with a higher frequency of fitting average age of contact lens wearers Australian contact lens prescribing contact lenses were afforded a higher at the time of fitting was 37.3 ± 16.6 was conducted between January and weighting than those with a lower years. The age at fitting ranged from April 2017. The same format as in frequency of fittings. seven to 82 years. previous years was employed. An e-mail was sent to all members of The discussion below concentrates Soft lens materials and designs Optometry Australia with a link to primarily on data relating to new lens a questionnaire, and a request that fittings, as opposed to refittings. We Soft lenses are still the main type of this be downloaded, printed and believe that new fittings are a more contact lens fitted, accounting for 88 completed to provide details of the first sensitive barometer of current patterns per cent of new fittings, representing a 10 patients fitted with contact lenses and future trends, whereas refittings slight decrease from the past few years.2 after receipt of the questionnaire. The survey was specifically designed to be straightforward to complete while 100% capturing key information about their 90% Monovision Multifocal patients. 80% Practitioners were asked general 70% questions about themselves. For each 60% contact lens fitting, they were requested 50% to complete the following details: date of fitting, new fitting or refitting, age 40% and sex of patient, lens material, lens 30% design, frequency of replacement, times per week of wear, modality (daily Proportion of fittings 20% or extended wear) and care system. 10% Practitioners were asked to return the 0% questionnaire by e-mail, fax or post. 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 Year Completed questionnaires relating to 362 contact lens fittings were Figure 2. Percentage of all soft lenses prescribed for the correction of presbyopia to returned, providing a sound basis for a those over 45 years of age, in Australia between 2003 and 2017 DECEMBER 2017 3 The 18th annual survey by Efron, Morgan and Woods 80% and two per cent of refittings in 2017 Daily 1-2 weekly Monthly (compared to no fittings being recorded 70% previously),2 perhaps indicating that 60% practitioners are now willing to try this new approach, after much discussion 50% on practitioner forums and at clinical meetings over the past few years. 40% 30% Soft lens replacement and wearing modality 20% Proportion of fittings Trends in the three key lens 10% replacement modalities (daily, two- 0% weekly and monthly) prescribed 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 between 2000 and 2017 are illustrated Year in Figure 3. The relentless increase in the popularity of daily disposable Figure 3. Percentage of all soft lenses prescribed for daily, 1-2 weekly and monthly lenses is clear; more than two-thirds disposal, in Australia between 2000 and 2017 of the new soft lens fittings this year were daily disposable lenses. If this rate of prescribing daily disposable lenses continues at the same rate as has Figure 1 is a composite of pie charts perhaps reflecting significant advances been apparent over the past 17 years, detailing the key findings of the 2017 in multifocal lens design and increasing virtually all soft lenses prescribed in survey in relation to soft lenses. Silicone availability in preferred materials Australia may be this lens type by the hydrogels are still the dominant and frequency of lens replacement. end of this decade. material, representing 79 and 82 per Coloured (tinted) lenses represented cent of materials prescribed as new only one per cent of new fittings this Multipurpose solutions remain the lens fittings and refittings, respectively. The year. care option of choice for those wearing balance is a mixture of mid-water and reusable lenses, representing 95 per high-water content hydrogel materials. Myopia control lenses incorporate cent of prescribed care regimens. The No low-water content hydrogel lenses special designs for arresting the rate of were recorded as being fitted in 2017. progression of myopia.4 These lenses This represents a remarkable change in represented one per cent of new fittings Continued page 4 the market from 1977, at which time 87 per cent of lenses fitted were made from a low-water content material (38 Rigid (non-OK) OK DD hydrogel per cent water content hydroxyethyl DD Si-H Other DW hydrogel Other DW Si-H methacrylate, known as HEMA).3 Soft EW The key categories of lens designs are 5% 7% 3% spherical, toric, multifocal, monovision, coloured (tinted) and myopia control, 9% 7% 2% with spherical and toric designs 15% representing 78 per cent of new fittings. 19% About one quarter of soft lenses Inner ring 30% World prescribed are in toric form (37 per 33% cent of new fittings and 28 per cent of Outer ring refittings). Australia 12% Figure 2 shows trends in the level of prescribing of contact lenses for 3% 18% presbyopia between 2003 and 2017. It can be seen that apart from one 38% ‘reversal’ in 2011, multifocal lenses have been prescribed to a greater extent than monovision correction since Figure 4. Percentage of all contact lenses prescribed in 2007. This preference for multifocal Australia (outer ring) compared with the world average (inner lenses appears to have increased and ring). DD: daily disposable, DW: daily wear, EW: extended wear, consolidated over the past four years, OK: orthokeratology, Si-H: silicone hydrogel 4 DECEMBER 2017 an opportunity to benchmark against Conclusions Trends 2017 international colleagues, and this year we compare contact lens prescribing in The results of our 2017 survey From page 3 Australian against world trends (Figure yet again confirm the high rate of 4). Seven key categories of lens type are prescribing daily disposable lenses in balance comprises almost exclusively represented. The outer and inner rings Australia. Silicone hydrogels are very peroxide systems. display the Australian and world-wide firmly entrenched as the material of fitting data,1 respectively. choice, representing about 80 per cent of all soft lens fittings. As was the case Rigid lenses The most striking difference in contact last year, we note continuing strong Conventional and orthokeratology rigid lens prescribing between Australia use of multifocals compared with contact lenses represented 7.3 per cent and the rest of the world is the extent monovision, and toric contact lens and 2.7 per cent of all contact lens of fitting silicone hydrogel daily fitting continues at high levels.