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Epidemiology and Burden of Astigmatism: A Systematic Literature Review.

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.

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