Assessing the Psychological and Functional Impact of Low Vision in a Developing Country: Congenital vs. Acquired Cases

Abstract

Introduction: Low vision significantly affects mental health, with acquired cases often leading to greater psychological distress than congenital ones. Despite its impact, mental health in low-vision patients remains under-addressed.

Objective: To evaluate the impact of the age of onset of low vision on vision-related quality of life (VR-QoL) and mental health, considering educational and socioeconomic factors.

Methods: This cross-sectional study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, including 225 participants: 75 with congenital low vision (CLV), 75 with acquired low vision (ALV), and 75 controls with normal vision. Patients were categorised based on the age of onset. VR-QoL was assessed using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), while mental health was evaluated with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Educational level and socioeconomic status were recorded. Group comparisons were performed using independent t-tests and chi-square tests.

Results: ALV patients had lower NEI VFQ-25 subscale and composite scores than CLV patients, though differences were not statistically significant. However, BDI and BAI scores were significantly higher in ALV patients (13.42 ± 12.21 vs. 8.91 ± 9.78, P = 0.017; 10.23 ± 11.04 vs. 6.24 ± 7.62, P = 0.025). The proportion of ALV patients requiring expert consultation for depression was also significantly higher (P = 0.008). Lower educational levels and socioeconomic status were associated with significantly worse mental health scores and poorer VR-QoL (P < 0.05), particularly in the ALV group.

Conclusion: ALV patients experience greater psychological distress than CLV patients, with higher levels of depression and anxiety. Socioeconomic and educational disparities were more pronounced in the ALV group, where financial instability and lower education correlated with poorer VR-QoL and mental health outcomes. Age of onset is a crucial factor, as CLV patients develop coping mechanisms from an early age, whereas ALV patients face a sudden disruption in daily life, leading to a significant psychological burden. While objective measures assess visual function, they do not capture the full impact of low vision. Integrating mental health assessment and psychosocial support into rehabilitation programs is essential for improving patient well-being. A comprehensive, multidisciplinary approach addressing both visual and psychological aspects is critical for successful low-vision rehabilitation.

Keywords: Low Vision, mental health, anxiety, rehabilitation