High Stress Levels Associated With Worse Visual Acuity

Senior Man Driving a Car.
The impact was seen across 6 low-to-middle income countries.

Far vision impairment is associated with increased perceived stress levels among older adults in low- and middle-income countries (LMIC), according to findings published in Eye.

Researchers conducted a cross-sectional study to assess the association between objective and subjective far vision impairment and perceived stress in older participants from 6 countries, including China, Ghana, India, Mexico, Russia, and South Africa. The study analyzed data from the WHO Study on global AGEing, as well as adult health, and it used the tumbling E LogMAR chart to measure objective visual acuity (VA). The chart was used as a 4-category variable (no, mild, moderate, and severe visual impairment). 

To measure subjective VA, participants described their difficulty in seeing and recognizing an object or person across the road. A perceived stress variable was computed using 2 questions from the Perceived Stress Scale, ranging from 0 to 100 (lowest to highest levels of stress). Researchers conducted multivariable linear regression with perceived stress as the outcome.

The study analyzed data on 14,585 adults aged 65 years and older. Compared with no visual impairment, only severe objective visual impairment was significantly associated with higher levels of stress (b=6.91). Additionally, mild (b=2.67), moderate (b=8.18), and severe (b=11.86) visual impairment were associated with significantly higher levels of perceived stress in terms of subjective visual impairment. 

Of the study’s participants, 25.1% and 33.2%, respectively, had moderate to severe objective and subjective far visual impairment. The researchers attribute the association between levels of visual impairment and stress to several factors, including limited ability to engage in certain activities, difficulty recognizing people, fear of becoming blind, and reduced social interaction, which may lead to loneliness. Additionally, the study explains that the high cost of treatment for visual impairment may contribute to stress levels as well.

“For example, a study of 298 patients with moderate-to-severe visual impairment from China revealed that the annual direct costs related to visual impairment averaged $6989 per patient, with only a small proportion of these costs being covered by medical insurance,” researchers note.

The researchers also acknowledge the possibility of factors such as visual impairment due to inflammation, increased intraocular pressure, chronic physical disorders, and unhealthy behaviors contributing to high levels of perceived stress.

Study strengths include large sample size and the use of data from 6 different LMICs. Limitations include its 2-question method of assessing perceived stress, possible confounding due to its cross-sectional nature, and lack of data on underlying causes of visual impairment.


Jacob L, Kostev K, Smith L, et al. Association of objective and subjective far vision impairment with perceived stress among older adults in six low- and middle-income countries. Eye. Published online June 18, 2021. doi:10.1038/s41433-021-01634-7