The economic burden of visual impairment and blindness: a systematic review

Abstract

ObjectivesVisual impairment and blindness (VI&B) cause a considerable and increasing economic burden in all high-income countries due to population ageing. Thus, we conducted a review of the literature to better understand all relevant costs associated with VI&B and to develop a multiperspective overview.DesignSystematic review: Two independent reviewers searched the relevant literature and assessed the studies for inclusion and exclusion criteria as well as quality.Eligibility criteria for included studiesInterventional, non-interventional and cost of illness studies, conducted prior to May 2012, investigating direct and indirect costs as well as intangible effects related to visual impairment and blindness were included.MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement approach to identify the relevant studies. A meta-analysis was not performed due to the variability of the reported cost categories and varying definition of visual impairment.ResultsA total of 22 studies were included. Hospitalisation and use of medical services around diagnosis and treatment at the onset of VI&B were the largest contributor to direct medical costs. The mean annual expenses per patient were found to be US$ purchasing power parities (PPP) 12 175–14 029 for moderate visual impairment, US$ PPP 13 154–16 321 for severe visual impairment and US$ PPP 14 882–24 180 for blindness, almost twofold the costs for non-blind patients. Informal care was the major contributor to other direct costs, with the time spent by caregivers increasing from 5.8 h/week (or US$ PPP 263) for persons with vision >20/32 up to 94.1 h/week (or US$ PPP 55 062) for persons with vision ≤20/250. VI&B caused considerable indirect costs due to productivity losses, premature mortality and dead-weight losses.ConclusionsVI&B cause a considerable economic burden for affected persons, their caregivers and society at large, which increases with the degree of visual impairment. This review provides insight into the distribution of costs and the economic impact of VI&B.

The Relationship Between Plasma Concentrations of Lutein and Zeaxanthin with Self-Reported and Actual Prevalence of AMD in an Irish Population-Based Sample

“…The financial burden of vision loss and/or impairment may be classed as direct or indirect. 10 The indirect costs include the loss of the patient's income, the cost of care-givers, nursing homes and other costs (e.g. transport, etc.).…”

“…transport, etc.). 10 Direct costs include hospital care, outpatient and office visits, optometry costs, drugs and other direct expenses. 10 Currently, there is no effective treatment for atrophic AMD, whereas neovascular AMD is treated by intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) therapy, which has been shown to dramatically reduce the risk of vision loss, 11 but at an average annual cost per eye per year of $24,000.…”

“…10 Direct costs include hospital care, outpatient and office visits, optometry costs, drugs and other direct expenses. 10 Currently, there is no effective treatment for atrophic AMD, whereas neovascular AMD is treated by intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) therapy, which has been shown to dramatically reduce the risk of vision loss, 11 but at an average annual cost per eye per year of $24,000. 12 Established risk factors for AMD include increasing age, family history of disease (genetic background), and tobacco use; whereas, exposure to short-wavelength (blue) light, obesity, cardiovascular disease and diet (antioxidant status) are described as putative risk factors for this condition.…”

Adjustment to acquired vision loss in adults presenting for visual disability certification

“…[12] Like most other chronic disorders, it can cause psychosocial distress leading to maladjustment. [3] Maladjustment, a negative outcome, can further reduce the quality of life.…”

Reliability and Validity of the Visual, Musculoskeletal, and Balance Complaints Questionnaire

“…These problems may limit participation in work, leisure, and social activities, which can result in increased isolation and decreased quality of life. In addition, the costs of these problems to the individuals, as well as to the health services and social insurance providers, are substantial 6. The prevalence of these problems has clinical implications, such as management and treatment of people with visual impairments, often requiring highly specialized services.…”