Association of objective and subjective far vision impairment with perceived stress among older adults in six low- and middle-income countries

Abstract

Objectives: To assess the association between far vision impairment (objective and subjective) and perceived stress among older adults from six low- and middle-income countries (LMICs, i.e., China, Ghana, India, Mexico, Russia, and South Africa).

Methods: Data from the WHO Study on global AGEing and adult health were analyzed. Objective visual acuity was measured using the tumbling E LogMAR chart and was used as a four-category variable (no, mild, moderate, and severe visual impairment). Subjective visual impairment referred to difficulty in seeing and recognizing an object or a person across the road. Using two questions from the Perceived Stress Scale, a perceived stress variable was computed, and ranged from 0 (lowest stress) to 100 (highest stress). Multivariable linear regression with perceived stress as the outcome was conducted.

Results: Data on 14,585 adults aged ≥65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Only severe objective visual impairment (versus no visual impairment) was significantly associated with higher levels of stress (b = 6.91; 95% CI = 0.94-12.89). In terms of subjective visual impairment, compared with no visual impairment, mild (b = 2.67; 95% CI = 0.56-4.78), moderate (b = 8.18; 95% CI = 5.84-10.52), and severe (b = 11.86; 95% CI = 9.11-14.61) visual impairment were associated with significantly higher levels of perceived stress.

Conclusions: This large study showed that far vision impairment was associated with increased perceived stress levels among older adults in LMICs. Increased availability of eye care services may reduce stress among those with visual impairment in LMICs, while more research is needed to better characterize the directionality of the far vision impairment-perceived stress relationship.

Fig. 1. Mean perceived stress score by severity of objective and subjective visual impairment.

Perceived stress (dependent variable) was based on a score ranging from 0 to 100 with higher scores representing higher levels of perceived stress. Categories of objective visual impairment referred to the following: no visual impairment (≥6/12); mild visual impairment (6/18–<6/12); moderate visual impairment (6/60–<6/18); and severe visual impairment (<6/60). Subjective visual impairment referred to the answer to the question “In the last 30 days, how much difficulty did you have in seeing and recognizing an object or a person you know across the road (from a distance of about 20 meters)?”. VI visual impairment. Bars denote standard error.