Epidemiology and Burden of Astigmatism: A Systematic Literature Review

ABSTRACT Significance This is the first literature review to report the epidemiology, patient burden, and economic burden of astigmatism in the general adult population. The unmet needs of astigmatism patients with co-existing ocular conditions (cataract, glaucoma, dry eye, presbyopia, or macular degeneration) and risks associated with untreated astigmatism are also reviewed and reported. Purpose To identify, report and summarize the published literature on epidemiology, patient burden, and economic burden of astigmatism using a systematic literature review. Methods MEDLINE, EMBASE, and Cochrane Library databases were searched (January 1996-May 2021). Search results were limited to the English language. Proceedings (2018-2021) from ophthalmology congresses were searched along with gray literature using the Google Scholar platform. Results The literature search yielded 6,804 citations, of which 125 met the inclusion criteria (epidemiology: 68; patient burden: 60; economic burden: 6). Astigmatism prevalence in the general population varied from 8% to 62%, with higher rates in individuals ≥70 years. The prevalence of with-the-rule astigmatism was higher in individuals ≤40 years, while rates of against-the-rule and oblique astigmatism increased with age. Astigmatic patients experienced decreased vision quality, increased glare (53 to 77%), haloes (28 to 80%), night-time driving difficulties (66%), falls, and spectacle dependence (45 to 85%). Astigmatic patients performed vision-related tasks slower (1 D: 9% slower, 2 D: 29% slower) and made more errors (1 D: 38% more errors, 2 D: 370% more errors) compared to fully corrected individuals. In cataract patients with astigmatism, the annual mean per patient productivity loss costs ranged from €55 ($71) to 84 ($108) and mean informal care costs ranged from €30 ($39) to 55 ($71) with a mean of 2.3 to 4.1 hours spent on informal care. Conclusions Uncorrected astigmatism decreases patients' vision-related quality of life; decreases productivity among working-age adults and poses an economic burden on patients and their families.