OBJECTIVES: To identify published literature on epidemiology, patient, and the economic burden of astigmatism through a systematic literature review (SLR). 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 ophthalmology 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. The literature search yielded 6,804 citations, of which 125 met the inclusion criteria and were summarized in this SLR.

RESULTS: The prevalence of astigmatism varies across regions, with higher rates in the elderly. The prevalence of with-the-rule astigmatism was higher in younger populations, while against-the-rule and oblique astigmatism increased with age. Astigmatic patients experienced decreased visual quality, increased glare, halos, night-time driving difficulties, risk of falls, and spectacle dependence. Astigmatic patients performed vision-related tasks slower (-1 D: 8.9%, -2 D: 28.7% slower) and made more errors (-1 D: 38.1%, -2 D: 370% more errors) compared to fully corrected patients. Post-operative spectacle, outpatient visits, travel, and informal care costs contributed to the economic burden for astigmatic patients post cataract surgery.

CONCLUSIONS: Astigmatism is a common refractive error, affecting the population globally. This systematic literature review summarized the available literature and found that 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.