Abstract
Purpose :
To identify published literature on epidemiology, patient and economic burden of astigmatism through a systematic literature review. The unmet needs of astigmatic patients with co-existing ocular conditions (such as cataract, glaucoma, dry eye, presbyopia, or macular degeneration) and the risks associated with untreated astigmatism were also reviewed.
Methods :
Using Cochrane methodology, a systematic literature review was conducted in MEDLINE, EMBASE, and Cochrane library (January 1996-May 2021). Studies published in the English language reporting on epidemiology and burden of astigmatism were included. Proceedings (2018-2021) from eye congresses were searched for evidence. A grey literature search was conducted using Google Scholar to identify relevant studies that were not captured by the database searches.
Results :
The literature search yielded 6,804 citations, of which 125 met the inclusion criteria (epidemiology: 68; patient burden: 60; economic burden: 6) and were summarized in this SLR. The prevalence of astigmatism in the general population varied from 7.6% to 61.7%, with higher rates in older individuals (≥70 years). The prevalence of with-the-rule astigmatism was higher in the younger population (≤40 years), while rates of against-the-rule and oblique astigmatism increased with age. The prevalence of astigmatism was higher for low levels (<1.5 D: 32.7%-100%) than higher levels (≥1.5 D: 0%-39.1%). Astigmatic patients experienced decreased quality of vision, increased rates of glare (52.9%-77.0%), halos (28.1%-80.0%), night-time driving difficulties (66.0%), risk of falls (particularly with oblique astigmatism), and spectacle dependence (44.8%-85.0%) leading to decreased vision-related quality of life. Astigmatic patients performed vision-related tasks slower (-1 D: 8.9% slower, -2 D: 28.7% slower) and made more errors (-1 D: 38.1% more errors, -2 D: 370% more errors) compared to fully corrected astigmatic patients. In astigmatic patients undergoing cataract surgery, post-operative spectacle cost (mean: $51-$916), outpatient visit cost (mean: $35-$348), travel cost (mean: $14-$21), and informal care cost (mean: $39-$71) contributed to the overall economic burden.
Conclusions :
Uncorrected astigmatism decreases patients' vision-related quality of life; increases productivity losses among working-age adults; and poses an economic burden on patients and their families.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.