Review of the impact of presbyopia on quality of life in the developing and developed world

Methodological quality of the review: Low confidence

Author: Ariana D. Goertz, William C. Stewart, William R. Burns, Jeanette A. Stewart and Lindsay A. Nelson

Region: Canada, France, Israel, Spain and the USA, Brazil, India, Nigeria, Saudi Arabia, Tanzania, Thailand and Timor-Leste

Sector: Presbyopia

Subsector: Presbyopia and quality of life

Equity focus: No

Study population: General population

Type of programme: Not applicable

Review type: Other review

Quantitative synthesis: Systematic review

Qualitative synthesis method: Not applicable

Background: Presbyopia is an age-related visual impairment that results from the gradual decrease in accommodation expected with age, and may affect quality of vision and quality of life (QoL). For a condition that affects every adult, with a potentially deep lifestyle impact, very little information is available about the QoL or financial impact of presbyopia on society.

Objectives: The objective of this study was to examine the public health impact of presbyopia regarding its effect on QoL and society in both the developed and developing worlds.

Main findings: This study showed that in the developed world, presbyopic subjects treated with reading glasses suffered a reduction in QoL parameters, compared with those who were younger and emmetropic. A small minority of subjects were assessed to be a candidate for additional non-spectacle treatment measures. In undeveloped areas, the manifestations of presbyopia were similar to the developed world in symptoms, age and reduced QoL. However, there was inadequate treatment of this condition, even with reading glasses. The availability of reading glasses ranged from 6 per cent to 45 per cent. Activities of daily living could not be accomplished as easily without near correction of reading. Reasons described for the lack of correction included: lack of access to medical care, poor awareness of decreased near vision, lack of motivation and cost. Overall, scant data exists regarding presbyopia and its impact, and how treatment affects QoL.

Methodology: Studies were accepted into the database if they addressed presbyopia and public health. The database was created (ADG) from articles published between 2002 and 28 February 2013 found on PubMed (pubmed.gov), ScienceDirect (www.sciencedirect.com) and the Cochrane Library (www.thecochranelibrary.com) using the following search terms: presbyopia, QoL, accommodation, economics, impact, cost, prevention, treatment and public health. Complete English language articles were retrieved. All articles meeting the above criteria were used in the analyses. Searches were quality checked by two of the other authors (LAN and WCS). The authors must have agreed that the article fulfilled the entry criteria. Data from articles meeting the study criteria data was entered into an Excel spreadsheet for each treatment.

Applicability/external validity: The authors highlighted some limitations which need to be considered when interpreting the result: this review was limited to reviewing past studies of QoL and cost measures, of which many were cross-sectional evaluations.

Geographic focus: Authors highlighted that the effect of presbyopia and its treatments on QoL remain poorly described and incompletely treated, especially in developing areas of the world.

Summary of quality assessment:

Overall, there is low confidence in the conclusions about the effects of this study, as important limitations were identified. Authors did not conduct thorough searches of the literature to ensure that all relevant studies were identified; in addition, language bias was not avoided as studies written in English only were in the review. Authors did not assess methodological quality of included studies, therefore it is not clear which study is subject to low or high risk of bias.