Julie Grutzmacher, MSW, MPH.

Visual impairment and its impact on mental health and overall quality of life both in adults and children presents many challenges for patients, health care providers and caregivers. Fortunately, it’s an issue that appears to be garnering much-needed attention of late, with resources being developed to aid in this ongoing battle for improved quality of life for patients and their families.

“Loss of vision—whether it happens suddenly or over time—can have a major impact on one’s mental and emotional health given its significant role in interpersonal connection and relationships, engaging in hobbies or interests, employment status, independently managing one’s daily activities, maintaining independence, and remaining physically active,” said Julie Grutzmacher, MSW, MPH, director of patient advocacy and population health initiatives at Prevent Blindness. “For some, it can result in acute identity paralysis whereby who they thought they were is now called into question as they face the fact that they may not be able to do those same activities they once did, or at least not in the same way.”

Photo courtesy of Orbis International
She added, “Children and adolescents may struggle with social connection and academic or athletic performance as a result of vision impairment. In addition, lack of social acceptance from using visual assistive devices (including eyeglasses) may deter children from adhering to eyecare treatment. Older adults may experience higher rates of falls and face a compounding risk in health status stemming from inability to adapt mentally and emotionally to changes in vision, leading to distress, anxiety, or depression that may cause them to disengage from physical activity (which could lead to chronic illness) and social isolation.”

Last year, Prevent Blindness convened a dedicated task force, including patients with vision loss and blindness, and professionals, not just to learn more about their varied experiences, but to develop real solutions and programs to help address the many challenges they face. In June, the group published a Vision Loss and Mental Health issue brief, dedicated an entire day of its Focus on Eye Health Summit to the topic in July, and produced a new episode in its Focus on Eye Health Expert Series, “Vision Impairment and Mental Wellness," featuring Dr. Connie Hills, a licensed clinical psychologist, who shared her perspective of being a psychologist as well as someone living with vision loss. Prevent Blindness also offers free resources for patients and their care partners at Living Well With Low Vision and the ASPECT Patient Engagement Program.

In the case of children, vision impairment can affect a multitude of development areas, both physical and emotional. A new study from Orbis International uncovered a concerning connection between vision impairment in children and a diminished quality of life. A key point highlighted by the study stresses the fact that children with vision impairment often experience a notable decline in their quality of life, thus underscoring the importance of early detection and intervention for pediatric vision problems. The study also notes that advocacy and resources are essential to improving the well-being of children affected by vision issues, and offers that by prioritizing early detection and intervention, “we can enhance the quality of life for these young individuals and empower them to reach their full potential.” Overall, the research shed light on the urgent need for increased support and awareness surrounding childhood vision issues.

 Nathan Congdon, MD.
"Maybe it's not a big surprise that poor vision affects a child's quality of life or can even lead to problems like anxiety and depression, especially in settings like China where there is a great deal of academic pressure on kids,” said professor Nathan Congdon, director of research, Orbis International. “But what really struck us is that something as simple as a pair of glasses can make such a big difference all by itself. It's really a very encouraging finding: sometimes inexpensive, simple things, like giving glasses to a child, can help a lot, even with complicated problems. We should be doing those things."

“Adults and children with vision impairment outscore their peers in rates of depression and anxiety. One of the challenges I frequently see in children with visual impairment face is their strong desire to assimilate leading to a disinterest in rehabilitative devices and services,” added Kelly Scherer, OD, director of clinical services at The Chicago Lighthouse, where she leads a team of seven ODs and practices low vision optometry on a multidisciplinary team of ODs, OTs, and mental health care providers. “I focus heavily on teaching children and adults alike self-advocacy, asking for things they need to support their success. It’s a skill essential in a society that does not understand vision loss well and is not structurally built for individuals with vision loss.

“Another important focus is community. I encourage my patients to connect with others who have walked a similar path by providing a multitude of resources including local organizations, social and support groups.”

While a comprehensive team of health care providers is often utilized to help patients with vision impairment and related mental and emotional issues, ODs are on the front lines and often play a key early role in their care.

Kelly Scherer, OD.
“ODs are well positioned to screen patients with vision impairment for mental health disease,” said Scherer. “There are many open access verified screening questionnaires available including the PHQ-9 (Patient Health Questionnaire Depression Module) that can be paired down to as little as two sensitive questions for screening. I also find open-ended questions regarding function and coping to be very effective in understanding the patient’s adjustment to vision loss.”

She continued, “Begin by creating your office protocol for screening, and screen every patient you see experiencing vision loss. Make no assumptions. The prevalence of significant depressive symptoms has been found to have no relation to the severity of vision loss nor the time since vision loss. Perceptions of visual impairment have a stronger correlation with depression, independent of treatment. Living with mental health disease and vision loss creates many barriers to seeking and coordinating care. Look for local mental health care providers to refer directly to, or develop a protocol to communicate with primary care providers. Most importantly, offer your patients psychological support.”