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

Abstract

Introduction: Low vision profoundly influences mental health, with individuals who develop vision loss later in life often experiencing greater psychological distress than those born with the condition. Despite this impact, mental health needs in patients with low vision are frequently overlooked.

Objective: To assess how the age of onset of low vision—congenital versus acquired—affects vision-related quality of life (VR-QoL) and mental health, while accounting for educational and socioeconomic factors.

Methods: A 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. VR-QoL was evaluated using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Mental health was measured with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Educational level and socioeconomic status were documented. Independent t-tests and chi-square tests were applied for group comparisons.

Results: Patients with ALV had lower NEI VFQ-25 subscale and composite scores compared with those with CLV, though differences were not statistically significant. BDI and BAI scores were significantly higher in the ALV group (BDI: 13.42 ± 12.21 vs. 8.91 ± 9.78, P = 0.017; BAI: 10.23 ± 11.04 vs. 6.24 ± 7.62, P = 0.025). A greater proportion of ALV patients required professional evaluation for depression (P = 0.008). Lower education and socioeconomic status were associated with poorer VR-QoL and higher depression and anxiety scores (P < 0.05), particularly among ALV patients.

Conclusion: Acquired low vision is linked to significantly higher levels of depression and anxiety than congenital low vision. Socioeconomic disadvantage and limited education further worsen mental health and quality-of-life outcomes, especially in those with later-onset vision loss. Because congenital cases often develop coping mechanisms early, ALV represents a sudden life disruption that intensifies psychological burden. Routine mental health screening and integrated psychosocial support should be central to low-vision rehabilitation to address both visual and psychological needs.

Keywords: Low vision; Mental health; Anxiety; Depression; Rehabilitation