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

Louis Jacob, Karel Kostev, Lee Smith, Guillermo F. López-Sánchez, Shahina Pardhan, Hans Oh, Jae Il Shin, Adel S. Abduljabbar, Josep Maria Haro, Ai Koyanagi

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1274-1280
Number of pages7
JournalEye (Basingstoke)
Issue number6
Publication statusPublished - 2022 Jun

Bibliographical note

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

All Science Journal Classification (ASJC) codes

  • Ophthalmology
  • Sensory Systems


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