Positive feedback loop between vision-related anxiety and self-reported visual difficulty

ABSTRACT

Background

Patients with Inherited Retinal Diseases typically experience progressive, irreversible vision loss resulting in low vision and blindness. As a result, these patients are at high risk for vision-related disability and psychological distress, including depression and anxiety. Historically, the relationship between self-reported visual difficulty (encompassing metrics of vision-related disability and quality of life, among others) and vision-related anxiety has been regarded as an association and not a causal relationship. As a result, there are limited interventions available that address vision-related anxiety and the psychological and behavioral components of self-reported visual difficulty.

Materials and Methods

We applied the Bradford Hill criteria to evaluate the case for a bidirectional causal relationship between vision-related anxiety and self-reported visual difficulty.

Results

There is sufficient evidence to satisfy all nine of the Bradford Hill criteria of causality (strength of association, consistency, biological gradient, temporality, experimental evidence, analogy, specificity, plausibility, and coherence) for the relationship between vision-related anxiety and self-reported visual difficulty.

Conclusions

The evidence suggests that there is a direct positive feedback loop—a bidirectional causal relationship—between vision-related anxiety and self-reported visual difficulty. More longitudinal research on the relationship between objectively-measured vision impairment, self-reported visual difficulty, and vision-related psychological distress is needed. Additionally, more investigation of potential interventions for vision-related anxiety and visual difficulty is needed.

KEYWORDS:

• Anxiety
• disability
• quality of life
• low vision

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ Note: Various PRO tools are used to measure anxiety and visual difficulty in the studies referenced in this article. Because there are different degrees of validation (ex. in a population of interest, for a particular condition or set of conditions, content validation vs. construct validation, variation in methods, including checking for aspects such as differential item functioning, etc.), elaborating on the PROs used in these studies is beyond the scope of this review.

Additional information

Funding

Research reported in this publication was supported by the National Institutes of Health under award number K23 EY026985-01.