Self-reported visual difficulty limited as a measure for visual impairment
Key takeaways:
- Patients can get frustrated when personal experience does not match objective measurements.
- Self-reported visual difficulty may be limited in identifying objective visual impairment.
Self-reported visual difficulty had a limited ability to identify adults with objectively measured visual impairment, according to an analysis of data from a nationally representative sample of Medicare beneficiaries.
In a study published in Ophthalmology, Taylor Potter, of Meharry Medical College, Nashville, Tennessee, and colleagues sought to explore the ability of self-reported visual difficulty (VD) to accurately predict which older adults had objective visual impairment (VI).
“The usefulness of self-reported data in assessing VI is based on the assumption that what is reported, or what individuals perceive as their vision status, will align with objective measures to affirm the presence of a visual condition,” Potter and colleague wrote. “However, previous studies have reported discrepancies between objective and subjective measurements of VI.”
The cross-sectional analysis of the 2022 National Health and Aging Trends Study included data from 4,999 adults. Those who reported blindness or difficulties with distance or near vision were characterized as having VD, while objective VI was defined as having a distance or near visual acuity worse than 20/40 or having a contrast sensitivity worse than 1.55 logCS.
Potter and colleagues found that VD achieved an area under the curve of 56 (95% CI; 55.2-56.9) in predicting VI, with sensitivity of 15.8 (95% CI; 14.2-17.5) and specificity of 96.3 (95% CI; 95.5-96.9).
Factors such as Hispanic ethnicity, female gender, higher income, depressive symptoms and having at least four comorbidities were associated with not reporting VD in adults with VI. Hispanic ethnicity, higher income and anxiety symptoms were associated with self-reporting VD without objective VI, according to the study.
Potter and colleagues said that when objective measurements do not line up with personal experience, patients can get frustrated.
“Indeed, in many cases reporting difficulty ‘without’ VI may reflect the presence of conditions such as ocular surface disease, which is more prevalent in those with comorbid disease and those with anxiety/depression,” the authors wrote. “For clinicians, taking patient reports seriously and trying diligently to understand the reason behind subjective/objective discordance remain hallmarks of good care.”
Perspective
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The study highlights the limited utility of self-reported visual difficulty in accurately identifying objective VI in older adults. For eye care providers, this finding reinforces the importance of objective assessments, such as visual acuity and contrast sensitivity.
Clinically, the results underscore that relying solely on subjective measures may lead to underdiagnosis, as more than 85% of adults with objective VI in the study did not report visual difficulty. From the study, this discordance, associated with characteristics such as female gender, Hispanic ethnicity and mental health status, suggests that self-reports often reflect perceived functional limitations rather than actual visual performance.
Discrepancies in self-reporting can also lead to errors in survey data that may influence policy decisions, potentially underestimating the prevalence of VI and contributing to inequities in vision health. Patients who do not self-report their impairment might experience delays in vision-restoring services or receive less intensive evaluations for sight-threatening conditions.
While subjective reports remain useful for assessing perceived vision-related disability, they should complement, not replace, objective testing. These findings advocate for comprehensive eye exams, especially in at-risk populations, to ensure accurate detection and appropriate care for VI.
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