Visual impairment (low vision or blindness) is often regarded as a physical issue, but its psychological impact is easily overlooked. Reduced vision leads to financial burden, decreased quality of life, and social isolation, significantly increasing the risk of developing depression and anxiety.
Prevalence of depression in adults with visual impairment: 10.7% (normal vision 6.8%)
Approximately 1/3 of older adults with visual impairment have some degree of depression (about twice that of older adults with normal vision)
81.2% of patients with neuro-ophthalmic disorders present with mild to severe symptoms of depression, anxiety, or stress
Pooled prevalence of depression in visually impaired patients attending ophthalmology clinics is approximately 25% (meta-analysis of 27 studies, Parravano et al. 2021)
In patients with irreversible vision loss, depression 21% and anxiety 22% (meta-analysis of 76,561 and 25,616 individuals, Shah et al. 2025)
Self-reported visual impairment at baseline was significantly associated with future depression (HR 1.33, 7,548 participants)
Visual impairment is also associated with suicide risk. A meta-analysis of 31 population-based studies involving approximately 5.69 million people (Kim et al. 2024) reported suicidal behavior OR 2.49 (95% CI 1.71–3.63), suicidal ideation OR 2.01 (95% CI 1.62–2.50), and suicide death OR 1.89 (95% CI 1.32–2.71), with the highest risk in adolescents.
QAre people with visual impairment more likely to develop depression or anxiety?
A
The prevalence of depression in adults with visual impairment is 10.7%, about 1.6 times that of those with normal vision (6.8%). In older adults with visual impairment, it is approximately 33%, about twice that of older adults with normal vision. Among neuro-ophthalmic patients, 81.2% present with some psychiatric symptoms, and the association between visual impairment and mental health is epidemiologically clear.
In patients with thyroid eye disease (TED), a diagnosis of depression or anxiety is found in 36% (260/717). Breakdown: anxiety 26%, depression 18%, both 8%. In moderate TED, the proportion of anxiety is significantly higher than in severe TED (28% vs 14%, OR 2.50), and the impact on QOL “psychological well-being” score is the highest (mean 4.1).
Young patients with vision loss have a 5 times higher risk of depression and anxiety compared to older patients (CDC study). In patients with NMOSD (neuromyelitis optica spectrum disorder), 39.8% have depression, of which 51.5% are moderate to severe.
In idiopathic intracranial hypertension (IIH), psychiatric comorbidities are also prominent. In a prospective cohort of 111 newly diagnosed IIH patients (Korsbæk et al. 2022), 45% had psychiatric comorbidities, with depression and emotionally unstable personality disorder being frequent. Patients with psychiatric comorbidities had significantly worse visual fields at baseline and at 6 months, serving as a prognostic marker for visual function.
QCan I still be anxious even if my vision is still good?
A
35% of newly diagnosed glaucoma patients reported anxiety, nervousness, or stress, even though all had good visual function with visual acuity of 20/40 or better. Even when current visual function is not impaired, the diagnosis of a chronic progressive disease itself creates concerns about future vision loss and contributes to anxiety.
Various factors lead to worsening mental health due to visual impairment.
Type of visual impairment: Pseudoexfoliation glaucoma and primary angle-closure glaucoma have higher rates of depression than primary open-angle glaucoma. Diseases with faster progression and poorer treatment response carry higher risk.
Severity of visual impairment: There is a positive correlation between severity and the incidence and severity of psychiatric symptoms.
Age: Younger patients with vision loss have a 5 times higher risk of depression and anxiety compared to older patients. The risk of suicidal behavior is highest in adolescence.
Anxiety about the future: Even if current visual function is normal, the diagnosis of a chronic progressive disease itself contributes to anxiety.
Economic and social burden: Difficulty working, financial burden, and limited social participation increase the risk of depression. Acquiring a visual impairment is considered to combine the two major factors of suicide: health problems and financial problems.
Social stigma: Stigma against visual impairment hinders social participation and deepens isolation.
Emotional stress and intraocular pressure: Acute emotional stress may cause a sharp rise in intraocular pressure, which is particularly important in glaucoma patients.
In ophthalmology practice, screening tools tailored to the purpose are used for mental health assessment.
Depression Assessment
PHQ-9: 9 items, evaluates symptom frequency over the past 2 weeks on a 0–3 scale. Widely used in non-psychiatric settings. Also identifies suicide risk.
GDS (Geriatric Depression Scale): 30 items (GDS-30) or 15 items (GDS-15) in yes/no format. Scores >5 suggest depression, >10 almost always indicate depression. Worsening vision is associated with higher GDS-15 scores.
CES-D: 20 items, past week. Cutoff score ≥16.
Anxiety Assessment
GAD-7 (Generalized Anxiety Disorder-7): 7 items, rated 0–3 over the past 2 weeks. A widely used anxiety screening scale.
STAI (State-Trait Anxiety Inventory): 20 items for state anxiety + 20 items for trait anxiety. Useful for distinguishing anxiety from depression.
Combined Screening
HADS (Hospital Anxiety and Depression Scale): 14 items, excluding physical symptoms. 7 depression items + 7 anxiety items. A score of ≥8 on each subscale is significant. Particularly useful in managing low-vision patients.
GADS (Goldberg Anxiety and Depression Scale): 18 yes/no items. Anxiety ≥5 or depression ≥2 indicates a 50% probability of clinical significance.
Suicide Risk Assessment
C-SSRS (Columbia-Suicide Severity Rating Scale): Systematically assesses suicidal ideation and suicidal behavior. It starts with two baseline questions and adds questions based on risk.
Patient-side barriers: Many patients hesitate to discuss symptoms due to the social stigma of mental health.
Clinician-side barriers: Lack of confidence in screening knowledge and skills, and unfamiliarity with appropriate referral pathways.
After training, clinicians’ actions significantly increase and perceived barriers decrease.
QCan I receive mental health screening during an eye exam?
A
Screening tools such as PHQ-9 and HADS can be used in ophthalmology settings, and guidelines for neuro-ophthalmology and retinal diseases recommend that ophthalmologists check for depressive symptoms and refer patients to appropriate specialists. However, screening should be conducted in facilities with established treatment and follow-up systems.
The goal is to maximize remaining vision and reduce vision-related disabilities. Through the use of assistive devices, mobility training, and learning compensatory strategies, it improves patients’ mental health outcomes.
Only 5–10% of eligible patients actually receive LVR services
Barriers: denial of need, poor physical health, lack of transportation, lack of referral
Fewer than 25% of LVR providers in the US offer psychological treatment
Patients with mental health issues are less likely to use LVR and require a prioritized approach
In an AMD RCT (Rovner et al. 2014, n=188), the depression incidence was 12.6% in the behavioral activation + LVR group vs. 23.4% in the control group. NNT=9, showing preventive efficacy of integrating mental health intervention with LVR
The purpose of counseling by an ophthalmologist is to encourage patients to face themselves, spontaneously reach new understanding and insights, and proactively address real-life problems.
Counseling should be conducted in a separate time slot from medical examinations and should be carried out over multiple sessions rather than just once.
Initial stage: The most important thing is to avoid leaving the patient alone as much as possible.
Repeatedly provide support information at each regular checkup.
Hands-on experience with assistive devices deepens understanding and enhances effectiveness.
If sudden visual impairment makes it difficult to continue working, early intervention is especially necessary.
Bridge to rehabilitation as early as possible
Ophthalmologists themselves should dispel negative images of visual impairment and educate all staff
Since acquiring a visual impairment combines two major suicide factors—health problems and economic problems—a stepwise approach following the psychological process (denial → grief → anger → depression) is required.
Recommendations from various AAO (American Academy of Ophthalmology) PPP guidelines are shown below.
AMD PPP: Ophthalmologists should ask about symptoms of depression and, if appropriate, recommend referral to a specialist. Depression may worsen the impact of AMD.
DR, retinal vein occlusion, RAO PPP: For patients with depression or anxiety, consider referral to counseling, vocational rehabilitation, and peer support groups.
QIs low vision rehabilitation also effective for mental health?
A
Low vision rehabilitation also contributes to improving mental health outcomes by supporting the use of residual vision and functional independence. However, only 5–10% of eligible patients actually use these services. Patients with mental health issues tend to avoid LVR in particular, so active referral by ophthalmologists is important.
The pathways through which visual impairment leads to worsening mental health are multifactorial.
Pathway via QOL and functional decline: Activity limitations and functional decline due to vision loss are direct causes of depression and anxiety. This also leads to secondary health problems such as nursing home admission and increased fall risk.
Pathway via economic burden: Difficulty working, high medical costs, and loss of social roles increase the risk of depression.
Pathway via social isolation and stigma: Stigma against visual impairment hinders social participation, and isolation exacerbates anxiety and depression.
Psychological impact of chronic disease: The event of diagnosis itself triggers a psychological process of “denial → grief → anger → depressive state.”
Bidirectional worsening: Depression may worsen the effects of eye diseases such as AMD, and eye disease and mental health influence each other bidirectionally.
Vicious cycle of emotional stress and intraocular pressure: Acute emotional stress can cause a sharp rise in intraocular pressure, potentially accelerating the progression of glaucoma. This further worsens visual function and increases stress, forming a vicious cycle.
Kim CY, Ha A, Shim SR, Hong IH, Chang IB, Kim YK. Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis. JAMA Network Open. 2024;7(4):e247026. PMID: 38630473
A meta-analysis of 31 population-based studies (approx. 5.69 million people). Visual impairment is significantly associated with suicidal behavior (OR 2.49, 95% CI 1.71–3.63), suicidal ideation (OR 2.01, 95% CI 1.62–2.50), and death by suicide (OR 1.89, 95% CI 1.32–2.71), with the highest risk in adolescents.
Parravano M, Petri D, Maurutto E, et al. Association Between Visual Impairment and Depression in Patients Attending Eye Clinics: A Meta-analysis. JAMA Ophthalmology. 2021;139(7):753-761. PMID: 34042966
眼科クリニックを受診する視覚障害患者27研究のメタ解析。プールされたうつ病有病率は0.25（95% CI 0.19–0.33）で、約4人に1人が抑うつを有する。
Shah N, Tran E, Aly M, Phu V, Laughlin E, Malvankar-Mehta MS. Depression and Anxiety in Patients With Irreversible Vision Loss: Meta-Analysis and Systematic Review. International Journal of Psychiatry in Medicine. 2025. PMID: 41061694
In 76,561 patients with irreversible vision loss, the prevalence of depression was 21%, and in 25,616 patients, the prevalence of anxiety was 22%. Depression was more common in diabetic retinopathy (48%) than in AMD (27%) or glaucoma (23%).
Yin J, Li H, Guo N. Prevalence of Depression and Anxiety Disorders in Patients with Glaucoma: A Systematic Review and Meta-Analysis Based on Cross-Sectional Surveys. Actas Españolas de Psiquiatría. 2024. PMID: 38863056
横断研究15件・24,334人のメタ解析。緑内障患者はうつ病リスク（RR 5.92、95% CI 3.29–10.66）と不安リスク（RR 2.99、95% CI 1.93–4.64）が有意に上昇。
Korsbæk JJ, Jensen RH, Beier D, Hagen SM, Molander LD, Høgedal L, Andresen M, Hamann S. Psychiatric Comorbidities in Patients With Idiopathic Intracranial Hypertension: A Prospective Cohort Study. Neurology. 2022;99(2):e199-e208. PMID: 35473759
