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

Figures & data

Figure 1 PRISMA (preferred reporting items for systematic reviews and meta-analyses) flow diagram.

Table 1 Search strategy

	Search terms
1	exp cataract/or exp capsule opacification/
2	(cataract or (lens adj2 opac*)).ab,ti,kw.
3	exp refractive errors/or exp aniseikonia/or exp anisometropia/or exp astigmatism/or exp corneal wavefront aberration/or exp hyperopia/or exp myopia/or exp presbyopia/
4	(astig* or ametropia or myopi* or Hyperopi* or nearsightedness or farsightedness or (refractive adj2 (error or aberration))).ab,ti.
5	1 or 2
6	3 or 4
7	5 and 6
8	exp “Quality of Life”/
9	exp quality-adjusted life years/
10	(QoL or quality adjusted life year or QALY or hrqol or quality of life or DALY or disability adjusted life years or life year* or patient reported outcome or (years adj3 lost)).ab,ti.
11	(short-form 36 or SF-36 or SF-6D or euroqol or EQ-5D or HUI or health utility index).ab,ti.
12	(National Eye Institute Visual Function Questionnaire or NEI VFQ or cataract TyPE specification questionnaire or visual activities questionnaire or visual disability assessment or visual function or quality of life questionnaire or VF-14 or VF-8 or catquest 9SF questionnaire or cataract outcomes questionnaire).ab,ti.
13	“costs and cost analysis”/or exp “cost allocation”/or exp cost-benefit analysis/or exp “cost control”/or exp “cost of illness”/or exp “cost sharing”/or exp health care costs/or exp health expenditures/or exp economics, hospital/or exp hospital charges/or exp hospital costs/or exp economics, medical/or exp fees, medical/or exp economics, nursing/or exp economics, pharmaceutical/or exp fees, pharmaceutical/or exp prescription fees/
14	exp “costs and cost analysis”/or exp “cost allocation”/or exp cost-benefit analysis/or exp “cost control”/or exp “cost savings”/or exp “cost of illness”/or exp “cost sharing”/or exp health care costs/or exp direct service costs/or exp drug costs/or exp employer health costs/or exp hospital costs/or exp health expenditures/
15	exp Health Resources/
16	exp hospitalization/or exp “length of stay”/or exp patient admission/or exp patient discharge/or exp patient readmission/or exp institutionalization/
17	(cost* or economic* or price or hospitali* or length of stay or expenditure or fee* or pharmacoeconomic* or resource* or productivity* or loss of work or absenteeism or presenteeism or cost effectiveness or cost benefit or incremental cost or ICER).ab,ti.
18	exp epidemiology/or exp molecular epidemiology/or exp pharmacoepidemiology/
19	exp morbidity/or exp incidence/or exp prevalence/or exp mortality/or exp molecular epidemiology/or exp epidemiologic study characteristics as topic/or exp epidemiologic studies/or exp epidemiologic research design/
20	(epidemiolog* or incidence* or prevalen* or mortality or death or survival or risk factor or co-morbid* or morbid* or mortalit* or death or survival or die* or natural history or disease progress* or prognosis).ab,ti.
21	18 or 19 or 20
22	13 or 14 or 15 or 16 or 17
23	8 or 9 or 10 or 11 or 12
24	7 and 21
25	7 and 22
26	7 and 23
27	24 or 25 or 26
28	exp lenses, intraocular/or exp phakic intraocular lenses/
29	(intraocular lens or IOL).ab,ti.
30	28 or 29
31	toric*.mp.
32	30 and 31
33	7 and 32
34	27 or 33
35	Limit 34 to English language [limit not valid in CDSR, ACP Journal Club, DARE, CLCMR; records were retained]
36	Limit 35 to human [limit not valid in CDSR, ACP Journal Club, DARE, CCTR, CLCMR; records were retained]
37	Limit 36 to humans [limit not valid in CDSR, ACP Journal Club, DARE, CCTR, CLCMR; records were retained]
38	Remove duplicates from 37

Table 2 Characteristics of studies reporting prevalence of preexisting astigmatism

Study	Design	Location	Sites/centers	Period	Sample size		Age (years), mean ± SD	Female (%)	Astigmatism (D), mean ± SD
					Eyes	Patients
Behndig et al^Citation13	Retrospective cohort	Sweden	Multicenter	2008–2010	17,056	NR	NR	NR	NR
Chen et al^Citation14	Cross-sectional	China	Single-center	July 2009–May 2011	4,831	2,849	70.6±9.6	61.7	1.01±0.69
Cui et al^Citation15,Citation20	Cross-sectional	China	Single-center	2007–2011	6,750	4,561	70.4±10.5	55.6	0.9*
De Bernardo et al^Citation16	Retrospective cohort	Italy	Single-center	January 2012–April 2013	757	380	71.9±10.2	53.7	1.02±0.69
Ercegović et al^Citation17	Retrospective cohort	Croatia	Single-center	April 2011–June 2011	392	202	77*	55	0.75*
Ferrer-Blasco et al^Citation18	Prospective	Spain	Single-center	NR	4,540	2,415	60.6±9.9	68.2	0.9±0.9
Guan et al^Citation19	Cross-sectional	China	Single-center	November 2009–November 2011	1,430	827	72.3±11.6	56.6	1.07±0.73
Hoffman and Hütz^Citation21	Retrospective cohort	Germany	Single-center	2000–2006	23,239	15,448	74*	NR	NR
Khan and Muhtaseb^Citation22	Cross-sectional	UK	Single-center	NR	1,230	746	75.5±10.7	54	1.03±0.73
Lekhanont et al^Citation23	Prospective	Thailand	Single-center	January 2008–September 2010	2,010	1,005	68.2±9.2	61.4	1.05±0.62
Lyall et al^Citation24	Prospective cohort	Scotland	Single-center	NR	3,498	1,814	74.5±10.2	60.1	1.04±0.78
Miyake et al^Citation25	Retrospective	Japan	Single-center	April 2002–September 2009	12,428	7,187	69.9±12.1	NR	1.02±0.81
Oh et al^Citation26	Retrospective cohort	South Korea	Single-center	May 2009–July 2013	2,847	2,847	66.6±12.1	64.2	0.79±0.64
Ostri et al^Citation27	Cross-sectional	Denmark	Single-center	January 2002–December 2013	21,524	14,071	72±12	61	1.06±0.9
Prakairungthong et al^Citation28	Retrospective cohort	Thailand	Single-center	October 2010–September 2011	2,688	2,671	66.2±10.8	57	1.09±0.87
Riley et al^Citation29	Prospective	New Zealand	Single-center	January 1997–March 2000	502	488	74.9±9.8	NR	NR
Westin et al^Citation30	Retrospective cohort	Sweden	Unclear	March 2013	6,712	NR	73.8±9.3	60.5	−0.71±0.78
Yuan et al^Citation31	Retrospective cohort	China	Multicenter	May 2012–April 2013	12,449	6,908	69.8±11.2	53.7	1.15±0.84

Note:

* Median.

Abbreviations: NR, not reported; D, diopters; SD, standard deviation; UK, United Kingdom.

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.²⁴
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.

Table 3 Characteristics of studies reporting economic burden

Study	Design	Location	Cost year	Sample size		Age (years), mean	Female, %	Astigmatism (D), mean
				Eyes	Patients
Laurendeau et al^Citation32	Cost–consequence analysis	Multinational	2006	NR	NR	70	NR	NR
Pineda et al^Citation33	Cost–utility analysis	USA	2008	NR	NR	≥65	NR	1.5–3
Ochoa et al^Citation34	Cost-effectiveness analysis	Colombia	2013	NR	NR	NR	NR	>0.75
Colin et al^Citation36	Retrospective cohort	France	NR	NR	580,253	73.6	66.7	NR
Kim et al^Citation35	Cross-sectional	South Korea	NR	NR	150	>45	NR	NR

Note: For all studies, costs have been inflated from base year to 2017 and converted to US$.

Abbreviations: D, diopters; USA, United States of America; NR, not reported.

Table 4 Characteristics of studies reporting humanistic burden

Study	Design	Location	Sites/centers	Period	Follow-up	Sample size		Age (years), mean ± SD	Female, %	Astigmatism (D), mean ± SD
						Eyes	Patients
Knorz et al^Citation43	Prospective	Europe and South America	Multicenter	NR	6 months	88	44	62.5	68.2	NR
Lane et al^Citation37	RCT	USA	Multicenter	NR	6 months	62	62	Toric IOL: 69.1±11.9 Spherical IOL: 74.5±9.2	50	NR
Mingo-Botín et al^Citation38	Prospective	Spain	Single-center	May 2008–June 2009	3 months	40	40	Toric IOL: 71.5±11.1 Spherical IOL: 75.6±5.9	NR	Toric IOL: 1.82±0.37 Spherical IOL: 2.17±1.03
Holland et al^Citation39	RCT	USA	Multicenter	NR	12 months	NR	517	71	55.1	NR
Ahmed et al^Citation40	Single-arm	Canada	Multicenter	NR	6 months	240	120	68±11	65.8	1.7±0.4
Visser et al^Citation41	RCT	the Netherlands	Multicenter	February 2010–March 2012	6 months	172	86	74	48.8	Toric IOL: 2.02±0.95 Nontoric IOL: 2±0.84
Mencucci et al^Citation42	Prospective	Italy	NR	NR	3 months	120	120	Toric IOL: 73.9±11.4 Monofocal IOL: 77.1±6.7 Control: 75.05±8.7	65.8	Toric IOL: −2.42±0.77 Monofocal IOL: −2±1.07 Control: −0.68±0.24
Supuk et al^Citation44	Single-arm	UK	Multicenter	July 2012–July 2013	6 months	NR	287	76.5±6.3	55	NR

Abbreviations: IOL, intraocular lens; NR, not reported; RCT, randomized controlled trial.

Table 5 Instruments used to evaluate quality of life in astigmatic patients with cataract

Instrument	Summary
NEI RQL-42	This is a 42-item questionnaire that measures patients’ satisfaction with distance vision, clarity of vision, and severity and frequency of glare symptoms, along with the need for spectacles. The scale ranges 0–100, with higher scores indicating better QoL and less dependence on corrective wear (such as spectacles or contact lenses).
VISTAS questionnaire	The questionnaire has three sections. Section I has questions related to subjective experience with tasks at a range of distances with and without corrective wear. The near-task section comprises ten questions to assess visual acuity less than 50 cm from the patient. The intermediate-task section comprises 12 questions to assess the patient’s vision at distances of 50–90 cm. The near-distance-task section comprises 13 questions to assess the patient’s vision from 90 cm to 4 m. The distance-task section comprises 15 questions to assess vision from more than 4 m away. Section II of the questionnaire evaluates the patient’s use of corrective wear and reliance on it. Section III of the questionnaire evaluates vision without corrective wear, and includes an assessment of patient satisfaction for daytime and nighttime vision. Potential responses for section I of the questionnaire are 1= no difficulty, 2= minor difficulty, 3= moderate difficulty, 4= major difficulty, 5= cannot accomplish, and 6= not applicable. A response of “not applicable” could be selected if participants did not perform a task for reasons other than poor vision or if corrective wear was not worn for the task. Responses for section II, assessing use of corrective wear, are “none of the time”, “some of the time”, “half of the time”, “most of the time”, and “all the time”.
VF-14	The VF-14 is a brief questionnaire designed to measure functional impairment on patients due to cataract. It consists of 18 questions covering 14 aspects of visual function affected by cataracts.

Abbreviations: NEI RQL-42, National Eye Institute Refractive Error Quality of Life; VF, Visual Function (index); QoL, quality of life; VISTAS, Visual Tasks Difficulty Assessment.

BehndigAMontanPSteneviUKugelbergMZetterströmCLundströmMAiming for emmetropia after cataract surgery: Swedish National Cataract Register studyJ Cataract Refract Surg20123871181118622727287

 PubMed Web of Science ®Google Scholar

ChenWZuoCChenCPrevalence of corneal astigmatism before cataract surgery in Chinese patientsJ Cataract Refract Surg201339218819223141077

 PubMed Web of Science ®Google Scholar

CuiYMengQGuoHBiometry and corneal astigmatism in cataract surgery candidates from southern ChinaJ Cataract Refract Surg201440101661166925149557

 PubMed Web of Science ®Google Scholar

CuiYMengQGuoHBiometry and corneal astigmatism before phacoemulsification in southern ChinaPoster presented at: American Academy of Ophthalmology Annual MeetingNovember 10–13, 2012Chicago, IL

 Google Scholar

De BernardoMZeppaLCennamoMIaccarinoSZeppaLRosaNPrevalence of corneal astigmatism before cataract surgery in Caucasian patientsEur J Ophthalmol201424449450024366768

 PubMed Web of Science ®Google Scholar

ErcegovićABrajkovićJSuraćIKHaluzanMBPrevalence, distribution and types of corneal astigmatism in cataract surgery patients in Sibenik CountyActa Clin Croat201251227527823115955

 PubMed Web of Science ®Google Scholar

Ferrer-BlascoTMontes-MicoRPeixoto-de-MatosSCGonzalez-MeijomeJMCervinoAPrevalence of corneal astigmatism before cataract surgeryJ Cataract Refract Surg2009351707519101427

 PubMed Web of Science ®Google Scholar

GuanZYuanFYuanYZNiuWRAnalysis of corneal astigmatism in cataract surgery candidates at a teaching hospital in Shanghai, ChinaJ Cataract Refract Surg201238111970197723079313

 PubMed Web of Science ®Google Scholar

HoffmannPCHützWWAnalysis of biometry and prevalence data for corneal astigmatism in 23,239 eyesJ Cataract Refract Surg20103691479148520692558

 PubMed Web of Science ®Google Scholar

KhanMIMuhtasebMPrevalence of corneal astigmatism in patients having routine cataract surgery at a teaching hospital in the United KingdomJ Cataract Refract Surg201137101751175521840163

 PubMed Web of Science ®Google Scholar

LekhanontKWuthisiriWChatchaipunPVongthongsriAPrevalence of corneal astigmatism in cataract surgery candidates in Bangkok, ThailandJ Cataract Refract Surg201137361361521333886

 PubMed Web of Science ®Google Scholar

LyallDASrinivasanSNgJKerrEChanges in corneal astigmatism among patients with visually significant cataractCan J Ophthalmol201449329730324862779

 PubMed Web of Science ®Google Scholar

MiyakeTKamiyaKAmanoRShimizuKCorneal astigmatism before cataract surgeryNippon Ganka Gakkai Zasshi2011115544745321706838

 PubMedGoogle Scholar

OhEHKimHLeeHSHwangKYJooCKAnalysis of anterior corneal astigmatism before cataract surgery using power vector analysis in eyes of Korean patientsJ Cataract Refract Surg20154161256126326189381

 PubMed Web of Science ®Google Scholar

OstriCFalckLBoberg-AnsGKesselLThe need for toric intra-ocular lens implantation in public ophthalmology departmentsActa Ophthalmol2015935e396e39725377632

 PubMed Web of Science ®Google Scholar

PrakairungthongNCharukamnoetkanokPIsipraditSPrevalence of preoperative corneal astigmatism in patients undergoing cataract surgery at Mettapracharak Hospital, ThailandJ Med Assoc Thai201598987888226591398

 PubMedGoogle Scholar

RileyAFGrupchevaCNMalikTYCraigJPMcGheeCNThe Auckland Cataract Study: demographic, corneal topographic and ocular biometric parametersClin Exp Ophthalmol200129638138611778808

 PubMed Web of Science ®Google Scholar

WestinOKoskelaTBehndigAEpidemiology and outcomes in refractive lens exchange surgeryActa Ophthalmol2015931414524889146

 PubMed Web of Science ®Google Scholar

YuanXSongHPengGHuaXTangXPrevalence of corneal astigmatism in patients before cataract surgery in northern ChinaJ Ophthalmol2014201453641224991429

 PubMed Web of Science ®Google Scholar

LaurendeauCLafumaABerdeauxGModelling lifetime cost consequences of toric compared with standard IOLs in cataract surgery of astigmatic patients in four European countriesJ Med Econ200912323023719728838

 PubMedGoogle Scholar

PinedaRDenevichSLeeWCWaycasterCPashosCLEconomic evaluation of toric intraocular lens: a short- and long-term decision analytic modelArch Ophthalmol2010128783484020625042

 PubMedGoogle Scholar

OchoaFSimbaquebaERomeroMLopezAAnalysis of cost-effectiveness of use of toric intraocular lenses compared with traditional monofocal lenses in patients with cataracts and pre-existing corneal astigmatismValue Health2014173A286

 Web of Science ®Google Scholar

ColinXLafumaABerdeauxGCataract surgery cost in patients with and without astigmatism: a French national DRG database analysisValue Health2009127A454

 Web of Science ®Google Scholar

KimHLimSChoBAstigmatism and cost of post-cataract surgery spectacle wear in KoreaValue Health2010137A563

 Web of Science ®Google Scholar

KnorzMCRincónJLSuarezESubjective outcomes after bilateral implantation of an apodized diffractive +3.0 D multifocal toric IOL in a prospective clinical studyJ Refract Surg2013291176276724203808

 PubMed Web of Science ®Google Scholar

LaneSSErnestPMillerKMHilemanKSHarrisBWaycasterCRComparison of clinical and patient-reported outcomes with bilateral AcrySof toric or spherical control intraocular lensesJ Refract Surg2009251089990119835331

 PubMed Web of Science ®Google Scholar

Mingo-BotínDMuñoz-NegreteFJKimHRMorcillo-LaizRRebolledaGOblancaNComparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgeryJ Cataract Refract Surg201036101700170820870116

 PubMed Web of Science ®Google Scholar

HollandELaneSHornJDErnestPArleoRMillerKMThe AcrySof toric intraocular lens in subjects with cataracts and corneal astigmatism: a randomized, subject-masked, parallel-group, 1-year studyOphthalmology2010117112104211120846724

 PubMed Web of Science ®Google Scholar

AhmedIIRochaGSlomovicARVisual function and patient experience after bilateral implantation of toric intraocular lensesJ Cataract Refract Surg201036460961620362853

 PubMed Web of Science ®Google Scholar

VisserNBeckersHJBauerNJToric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trialJAMA Ophthalmol2014132121462146825256624

 PubMed Web of Science ®Google Scholar

MencucciRGiordanoCFavuzzaEGicquelJJSpadeaLMenchiniUAstigmatism correction with toric intraocular lenses: wavefront aberrometry and quality of lifeBr J Ophthalmol201397557858223467788

 PubMed Web of Science ®Google Scholar

SupukEAldersonADaveyCJDizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changesOphthalmic Physiol Opt201636218319026549158

 PubMed Web of Science ®Google Scholar