Global prevalence and economic and humanistic burden of astigmatism in cataract patients: a systematic literature review

Abstract

Purpose: To systematically review the published evidence on the prevalence and economic and humanistic burden of astigmatism in cataract patients.

Materials and methods: For this systematic literature review, the Medline, PubMed, Embase, and Cochrane databases were searched from 1996 to September 2015 for available scientific literature that met the inclusion criteria. Studies published in the English language reporting prevalence and humanistic and economic burden in patients diagnosed with cataract and astigmatism were included.

Results: Of 3,649 papers reviewed, 31 studies from 32 publications met the inclusion criteria of this review. Preexisting astigmatism ≥1 D was present in up to 47% of cataract eyes. The cost burden of residual uncorrected astigmatism after cataract surgery was driven by the cost of spectacles, which was estimated to range from $2,151 to $3,440 in the US and $1,786 to $4,629 in Europe over a lifetime. In cataract patients, both preexisting and postoperative residual astigmatism were associated with poor vision-related patient satisfaction and quality of life, as well as higher spectacle burden. Astigmatism correction during cataract surgery appears to improve visual outcomes and results in overall lifetime cost savings compared to astigmatism correction with postoperative vision correction.

Conclusion: There is a high prevalence of preexisting astigmatism in cataract patients. Although published data are limited, both preoperative astigmatism and postoperative residual astigmatism affect visual function and vision-related quality of life, resulting in increased humanistic burden. Suboptimal correction of astigmatism during cataract surgery drives the continuous need for vision correction with spectacles in the postoperative period. Patients must bear the out-of-pocket expenses, since payers often do not reimburse the cost of spectacles. Greater access to astigmatism correction during cataract surgery could improve visual outcomes and quality of life in patients. More research is required to gain a better understanding of the disease burden of astigmatism in cataract patients.

Keywords: astigmatism; cataract; economic burden; humanistic burden; prevalence.

Figure 1

PRISMA (preferred reporting items for systematic reviews and meta-analyses) flow diagram.

Figure 2

Prevalence of cataract eyes with ≥1 D of preexisting astigmatism. Abbreviations: D, diopters; UK, United Kingdom.

Figure 3

Distribution of preexisting astigmatic cataract eyes with mild, moderate, or significant astigmatism. Note: Based on the categorization reported by Lyall et al. Abbreviations: D, diopters; UK, United Kingdom.

Figure 4

Distribution of preexisting astigmatic cataract eyes by type of orientation. Abbreviations: ATR, against the rule; OA, oblique astigmatism; WTR, with the rule.