Case Reports

Humanistic and economic burden in patients with visually significant astigmatism and cataracts

Case Report Details

First Author: J.Domingo USA

Co Author(s):    T. Pastuck                    

Abstract Details

Purpose:

The objective of this global health case report is to identify the humanistic and economic burden in patients with the concomitant conditions such as ≥1.00 D of astigmatism and visually significant cataracts for application of evidenced-based practice principles to cataract surgeon’s management decisions.

Setting:

Compilation of published literature regarding the prevalence of astigmatism in patients with cataracts and the associated humanistic and economic burdens.

Report of Case:

The humanistic burden of astigmatism includes reduced distance and near visual acuity, contrast sensitivity, stereo acuity, and vision quality. Many of these burdens have been reported to increase the risk of falls for older adults. This is concerning as globally, up to 47% of cataract patients >60 years old have ≥1.00 diopter (D) of astigmatism. A retrospective study of 76,910 patients reported that the burden of astigmatism is not reduced after cataract surgery with implantation of a standard monofocal IOL. Conversely, implantation of toric IOLs were reported as the most predictable method to correct astigmatism in cataract surgery. A review of 8 studies reported uncorrected astigmatism post cataract surgery leads to higher spectacle dependence with an economic burden range between $2,151 - $3,440 (USD) in the US and $1,786 - $4,629 in Europe over the remainder of the patient’s lifetime. Moreover, the implantation of monofocal IOLs and use of multifocal (MF) spectacles may increase the safety risk for elderly patients with astigmatism. An epidemiologic report showed that individuals 63 to 90 years old who wear MF spectacles are more than twice as likely to fall than non-MF spectacle wearers. In addition, another study reported that MF spectacle wearers 62 to 80 years old are significantly more likely to trip compared to single-vision spectacle wearers. This coincides with the age group (≥ 65 years) where falls are the leading cause of fatal and non-fatal unintentional injuries, accounting for 40% of all injury-related deaths. Fall victims also have an economic burden with a mean range of $2,044 to $25,955 USD. When considering all fall related costs, the economic burden ranges between 0.85% to 1.5% of the total health care expenditure in North America, Australia, Europe and UK with estimates ranging from $54.9 (USD) to $67.7 billion by 2020.

Conclusion/Take Home Message:

Globally, there is a high prevalence of astigmatism in cataract patients. And the data underscores the meaningful sequalae humanistic and economic burdens pose on the lives of these patients. Nevertheless, in 2019 only 8.0% of potential patients with ≥1.00 D of astigmatism are projected to receive a toric IOL during cataract surgery. Greater access to astigmatism correction during cataract surgery has been reported to offer improved visual outcomes and possibly greater quality of life. This investigation is supportive of those findings. Additionally, the findings suggest that the humanistic and economic burdens of astigmatic patients with cataracts are multifactorial with multidisciplinary involvement and that clarity of vision becomes increasingly important for elderly patients.

Financial Disclosure:

... is employed by a for-profit company with an interest in the subject of the presentation