Cross Sectional Study on Well-Being and Coping Strategies of Low Vision Patients Visiting Al-Shifa Eye Trust Hospital, Pakistan

Main Article Content

Azka Sadat
Ehtisham Malik


Background: Visual impairment significantly impacts individuals' lives, affecting their ability to perform daily activities and influencing their emotional well-being. The Global Burden of Disease study highlights vision impairment as a leading cause of disability worldwide, necessitating a deeper understanding of its impacts and the coping strategies employed by those affected.

Objective: This study aimed to assess the functional and emotional impacts of visual impairment on patients' well-being and explore the coping strategies used by individuals with low vision. The association between the severity of visual impairment and its impacts, alongside the effectiveness of various coping mechanisms, was examined.

Methods: A cross-sectional study was conducted in the Low Vision Department of a Tertiary Eye Care Hospital over six months. A total of 400 participants diagnosed with low vision were recruited through internal and external referrals. Data were collected using the Impact of Visual Impairment (IVI) tool and the Coping Strategy Indicator (CSI), alongside demographic information. The IVI tool assessed functional and emotional well-being, while the CSI evaluated the coping strategies employed. Statistical analyses were performed using SPSS version 25, focusing on mean scores and the significance of differences across demographic and clinical variables.

Results: The study found that the severity of visual impairment was significantly associated with worse functional (Mean±SD: 28.33±14.86) and emotional (Mean±SD: 14.92±7.14) well-being scores (P<0.001). Participants over 30 years and those residing in rural areas experienced a greater impact of visual impairment. Notably, employment status significantly correlated with the degree of impact, with unemployed individuals reporting higher functional and emotional distress. Avoidant coping strategies were linked with greater emotional distress, while problem-solving and seeking social support showed a mixed impact on patients' well-being.

Conclusion: The severity of visual impairment adversely affects both the functional abilities and emotional well-being of individuals, with avoidant coping strategies exacerbating these impacts. Encouraging active coping mechanisms and enhancing support systems could mitigate the negative effects of visual impairment on patients' lives. These findings underscore the need for holistic approaches in the care and support of individuals with low vision.

Article Details

How to Cite
Sadat, A., & Malik, E. (2024). Cross Sectional Study on Well-Being and Coping Strategies of Low Vision Patients Visiting Al-Shifa Eye Trust Hospital, Pakistan. Journal of Health and Rehabilitation Research, 4(1), 1450–1456.
Author Biographies

Azka Sadat, Pakistan Institute of Ophthalmology Rawalpindi Pakistan.

Pakistan Institute of Ophthalmology Rawalpindi, Pakistan.

Ehtisham Malik, Yichun University China.

Yichun University, China.


Sabel BA, Wang J, Cárdenas-Morales L, Faiq M, Heim C. Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine. EPMA J. 2018;9(2):133–60.

Sturrock BA, Xie J, Holloway EE, Lamoureux EL, Keeffe JE, Fenwick EK, et al. The influence of coping on vision-related quality of life in patients with low vision: A prospective longitudinal study. Investig Ophthalmol Vis Sci. 2015;56(4):2416–22.

James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.

Khorrami-Nejad M, Sarabandi A, Askarizadeh F. The Impact of Visual Impairment on Quality of Life. Available from:

Nangia V, Jonas JB, George R, Lingam V, Ellwein L, Cicinelli MV, et al. Prevalence and causes of blindness and vision impairment: Magnitude, temporal trends and projections in South and Central Asia. Br J Ophthalmol. 2019;103(6):871–7.

Hassan B, Ahmed R, Li B, Noor A, ul Hassan Z. A comprehensive study capturing vision loss burden in Pakistan (1990-2025): Findings from the Global Burden of Disease (GBD) 2017 study. PLoS One. 2019 May 7;14(5).

Rai P, Rohatgi J DU. Coping strategy in persons with low vision or blindness – an exploratory study. 2019;

Rees G, Xie J, Holloway EE, Sturrock BA, Fenwick EK, Keeffe JE, et al. Identifying distinct risk factors for vision-specific distress and depressive symptoms in people with vision impairment. Investig Ophthalmol Vis Sci. 2013;54(12):7431–8.

Bittner AK, Edwards L, George M. Coping strategies to manage stress related to vision loss and fluctuations in retinitis pigmentosa. Optometry. 2010 Sep;81(9):461–8.

Lazarus RS, Folkman S. Stress, Appraisal, and Coping. Springer Publishing Company; 1984.

Suls J, Fletcher B. The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychol. 1985;4(3):249–88.

Casten R, Rovner B. Depression in Age-Related Macular Degeneration. J Vis Impair Blind. 2019;102(10):591–9.

Horowitz A, Reinhardt JP, Kennedy GJ. Major and subthreshold depression among older adults seeking vision rehabilitation services. Am J Geriatr Psychiatry. 2005;13(3):180–7.

Garip G, Kamal A. Systematic review and meta-synthesis of coping with retinitis pigmentosa: Implications for improving quality of life. BMC Ophthalmol. 2019 Aug 13;19(1).

Garip G. Coping strategies, vision-related quality of life, and emotional health in managing retinitis pigmentosa: a survey study. BMC Ophthalmol. 2018;18(1):217.

World Health Organization. ICD-10 Version. World Health Organization. 2016.

Tidbury LP, Dain SJ. Fiat Lux: the effect of illuminance on acuity testing. Graefes Arch Clin Exp Ophthalmol. 2016;(Apr 22).

Lamoureux EL, Pallant JF, Pesudovs K, Hassell JB, Keeffe JE. The impact of vision impairment questionnaire: An evaluation of its measurement properties using Rasch analysis. Investig Ophthalmol Vis Sci. 2006;47(11):4732–41.

Lamoureux EL, Pallant JF, Pesudovs K, Rees G, Hassell JB, Keeffe JE. The impact of vision impairment questionnaire: An assessment of its domain structure using confirmatory factor analysis and Rasch analysis. Investig Ophthalmol Vis Sci. 2007;48(3):1001–6.

Ratanasukon M, Tongsomboon J, Bhurayanontachai P. The Impact of Vision Impairment (IVI) Questionnaire; Validation of the Thai-Version and the Implementation on Vision-Related Quality of Life in Thai Rural Community. PLoS One. 2016;11(11):e0165793.

American Academy of Ophthalmology Vision Rehabilitation Committee. Vision rehabilitation for adults. Prefer Pract Pattern Guidel. US Dep Heal Hum Serv. 2008. Available from:

Fenwick EK, Man REK, Rees G, Keeffe JE, Lamoureux EL. Reducing respondent burden: validation of the Brief Impact of Vision Impairment questionnaire. Qual Life Res. 2017;26(2):479–88.

Gothwal VK, Reddy SP, Fathima A, Bharani S, Sumalini R, Bagga DK, et al. Assessment of the impact of keratoconus on vision-related quality of life. Investig Ophthalmol Vis Sci. 2013;54(4):2902–10.

Amir Khan JH. Criterion Validity of a Coping Measure, Journal of Personality Assessment. J Pers Assess. 1994;62(2):242–61.

Amir Khan J, Auyeung B. Coping with stress across the lifespan: Absolute vs. relative changes in strategy. J Appl Dev Psychol. 2007 Jul;28(4):298–317.

Desmond DM, Shevlin M, MacLachlan M. Dimensional analysis of the coping strategy indicator in a sample of elderly veterans with acquired limb amputations. Pers Individ Dif. 2006 Jan;40(2):249–59.

Finger RP, Fenwick E, Marella M, Dirani M, Holz FG, Chiang PPC, et al. The impact of vision impairment on vision-specific quality of life in Germany. Investig Ophthalmol Vis Sci. 2011; 52(6):3613–9.

Broman AT, Munoz B, Rodriguez J, Sanchez R, Quigley HA, Klein R, et al. The impact of visual impairment and eye disease on vision-related quality of life in a Mexican-American population: Proyecto VER. Investig Ophthalmol Vis Sci. 2002;43(11):3393–8.

Nirmalan PK, Tielsch JM, Katz J, Thulasiraj RD, Krishnadas R, Ramakrishnan R, et al. Relationship between vision impairment and eye disease to vision-specific quality of life and function in rural India: The Aravind Comprehensive Eye Survey. Investig Ophthalmol Vis Sci. 2005;46(7):2308–12.

Hirai FE, Tielsch JM, Klein BEK, Klein R. Relationship between retinopathy severity, visual impairment and depression in persons with long-term type 1 diabetes. Ophthalmic Epidemiol. 2012;19(4):196–203.

Park Y, Shin JA, Yang SW, Yim HW, Kim HS, Park YH. The relationship between visual impairment and health-related quality of life in Korean adults: The Korea national health and nutrition examination survey (2008-2012). PLoS One. 2015;10(7):e0132779.

Martin-Fernandez J, Gomez-Gascon T, Beamud-Lagos M, Cortes-Rubio JA, Alberquilla-Menendez-Asenjo A. Professional quality of life and organizational changes: A five-year observational study in Primary Care. BMC Health Serv Res. 2007;7:101.

Nejati V, Ashayeri H. Health related quality of life in the elderly in Kashan. Iran J Psychiatry Clin Psychol. 2008;14(1):56-61.

Reinhardt JP, Boerner K. Personal and social resources and adaptation to chronic vision impairment over time. J Pers Soc Resour Adapt to Chronic Vis Impair over Time. 2009;19(4):374–97.