The association between self-reported vision and mental wellbeing: A secondary analysis of Health Survey for England data

Abstract Objectives Eye disease and vision impairment are known to be associated with reduced mental wellbeing but less is known about the wellbeing of people with near-normal levels of vision. Here we examined the association between self-reported eyesight and mental wellbeing, controlling for eye disease, mental ill-health and demographic factors, for adults with a wide range of age and vision. Design Population-based cross-sectional study. Participants 7705 adults aged 16+ who participated in Health Survey for England 2013, self-reported their eyesight status and completed the Warwick Edinburgh Mental Wellbeing Scale. Primary outcome measure Mental wellbeing, controlling for the presence of self-reported mental ill health, self-reported eye disease, age, sex, socioeconomic group and ethnic origin. Results Poorer self-reported eyesight was strongly associated with lower mental wellbeing ( F (4, 7700) = 94.7, p < 0.0001). This association remained significant after controlling for self-reported mental ill health, self-reported eye disease, age, sex, socioeconomic group and ethnic origin. Conclusions Self-reported eyesight is strongly associated with mental wellbeing, irrespective of whether people have vision impairment or a diagnosed eye disease. This relationship exists in people with and without mental ill-health. Mental wellbeing should be considered in people with reduced eyesight, regardless of whether they have a diagnosed eye disease or mental ill-health. Interventions which improve vision may have a positive impact on mental wellbeing. Strengths and weaknesses This is the first study to investigate the relationship between eyesight and mental wellbeing in a large cohort of adults with a wide range of age and level of vision. We have corrected for multiple potentially confounding factors including mental ill-health, demographic and socioeconomic characteristics. We rely on self-report of eyesight, eye disease and mental ill-health. The cross-sectional nature of Health Survey for England means we are unable to determine causality, particularly whether reduced eyesight directly leads to reduced wellbeing, whether those with lower wellbeing underestimate their vision, or whether people with lower wellbeing experience poorer vision (perhaps due to differences in health behaviours) Funding statement This work was supported by the Macular Society (research grant 22-RG-1) and by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.