Depression, anxiety, and stress indicators for patients who are blind or visually impaired
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 4 (2024),
2 March 2025
,
Page 152-159
https://doi.org/10.51329/mehdioptometry210
Abstract
Background: Severe visual impairment is reportedly detrimental to mental health. Blind individuals are expected to have poorer mental health status compared to those with low vision. However, most mental health studies have focused on people with low vision, leaving a substantial gap in our understanding of the mental health status of the blind. Therefore, this study compared the mental health status of individuals with low vision to that of blind individuals.Methods: This cross-sectional, questionnaire-based investigation involved individuals with low vision or blindness who were registered with the Social Welfare Department, Federal Territory of Kuala Lumpur, Malaysia. Participants were recruited using a simple random sampling method. The medical records of each participant were screened. Participants were individually interviewed, and their socio-demographic details, education level, working status, marital status, type and duration of impairment, and rehabilitation status were collected. Additionally, the Depression, Anxiety, and Stress Scale (DASS-21) was administered to each individual.
Results: Of the 30 participants, 20 (66.7%) had low vision and 10 (33.3%) had blindness, 16 (53.3%) were men, and most participants were single (n = 20, 66.7%). Congenital and acquired causes of visual impairment each accounted for 50% of cases. Most participants (n = 26, 86.7%) had not received psychosocial rehabilitation. The mean DASS-21 scores for the depression, anxiety, and stress subscales were significantly higher in patients with low vision than in those with blindness (all P < 0.05). Considering the clinical cut-off increments to determine emotional states for the DASS-21 subscales, individuals with low vision were in the mild, moderate, and mild categories for the depression, anxiety, and stress subscales, respectively. Individuals with blindness were categorized as normal in all subscales. The mean DASS-21 scores for the depression, anxiety, and stress subscales among individuals with congenital and acquired causes of visual impairment were comparable (all P > 0.05). Individuals with congenital visual impairment were in the normal, moderate, and normal categories for the depression, anxiety, and stress subscales, respectively. Those with acquired visual impairment were categorized as mild, moderate, and normal for the depression, anxiety, and stress subscales, respectively.
Conclusions: Individuals with low vision experienced mild to moderate levels of mental health issues, which may consist of depression, anxiety, stress, or a combination of these. The blind individuals in this study demonstrated no similar mental health issues. The small number of participants in certain racial and age groups prevents us from concluding how these factors might influence mental health. Further research with a larger sample size should consider the severity of visual impairment, age groups, and ethnicity, as these factors may impact the outcomes.
Keywords:
- mental hygiene
- low vision
- blind person
- legal blindness
- habilitation
- emotional depression
- social anxiety
- psychological stress
References
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12. Court H, McLean G, Guthrie B, Mercer SW, Smith DJ. Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC Med. 2014 Oct 17;12:181. doi: 10.1186/s12916-014-0181-7. PMID: 25603915; PMCID: PMC4200167.
13. Bowers A, Peli E, Elgin J, McGwin G Jr, Owsley C. On-road driving with moderate visual field loss. Optom Vis Sci. 2005 Aug;82(8):657-67. doi: 10.1097/01.opx.0000175558.33268.b5. PMID: 16127330.
14. Crews JE, Campbell VA. Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning. Am J Public Health. 2004 May;94(5):823-9. doi: 10.2105/ajph.94.5.823. PMID: 15117707; PMCID: PMC1448344.
15. 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 May 9;9(2):133-160. doi: 10.1007/s13167-018-0136-8. PMID: 29896314; PMCID: PMC5972137.
16. Omar R, Rahman MH, Knight VF, Mustaphal M, Mohammed Z. Mental health state and quality of life questionnaire in low vision assessment: a case report. BMC Res Notes. 2014 Sep 23;7:667. doi: 10.1186/1756-0500-7-667. PMID: 25245590; PMCID: PMC4190380.
17. Watanabe N, Hunot V, Omori IM, Churchill R, Furukawa TA. Psychotherapy for depression among children and adolescents: a systematic review. Acta Psychiatr Scand. 2007 Aug;116(2):84-95. doi: 10.1111/j.1600-0447.2007.01018.x. PMID: 17650269.
18. Renaud J, Bédard E. Depression in the elderly with visual impairment and its association with quality of life. Clin Interv Aging. 2013;8:931-43. doi: 10.2147/CIA.S27717. Epub 2013 Jul 19. PMID: 23888110; PMCID: PMC3722036.
19. Rees G, Tee HW, Marella M, Fenwick E, Dirani M, Lamoureux EL. Vision-specific distress and depressive symptoms in people with vision impairment. Invest Ophthalmol Vis Sci. 2010 Jun;51(6):2891-6. doi: 10.1167/iovs.09-5080. Epub 2010 Feb 17. PMID: 20164466.
20. van der Aa HP, Margrain TH, van Rens GH, Heymans MW, van Nispen RM. Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis. Ophthalmic Physiol Opt. 2016 Sep;36(5):584-606. doi: 10.1111/opo.12313. PMID: 27580757.
21. van der Aa HP, Comijs HC, Penninx BW, van Rens GH, van Nispen RM. Major depressive and anxiety disorders in visually impaired older adults. Invest Ophthalmol Vis Sci. 2015 Jan 20;56(2):849-54. doi: 10.1167/iovs.14-15848. PMID: 25604690.
22. Stelmack JA, Stelmack TR, Massof RW. Measuring low-vision rehabilitation outcomes with the NEI VFQ-25. Invest Ophthalmol Vis Sci. 2002 Sep;43(9):2859-68. PMID: 12202503.
23. Kuyk T, Liu L, Elliott JL, Grubbs HE, Owsley C, McGwin G Jr, Griffin RL, Fuhr PS. Health-related quality of life following blind rehabilitation. Qual Life Res. 2008 May;17(4):497-507. doi: 10.1007/s11136-008-9336-3. PMID: 18392688; PMCID: PMC2705061.
24. Ramli M, Salmiah MA. Validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS) among diabetic patients. Malaysian Journal of Psychiatry. 2009 Dec 1;18(2):40-5. Link (https://journals.lww.com/mjp/abstract/2009/18020/VALIDATION_AND_PSYCHOMETRIC_PROPERTIES_OF_BAHASA.6.aspx)
25. Soria-Reyes LM, Alarcón R, Cerezo MV, Blanca MJ. Psychometric properties of the Depression Anxiety Stress Scales (DASS-21) in women with breast cancer. Sci Rep. 2024 Sep 3;14(1):20473. doi: 10.1038/s41598-024-68814-9. PMID: 39227677; PMCID: PMC11372162.
26. RAHMAN MH, TING KQ, MOHAMMED Z, FADZIL NM, SAHAR S, AHMAD M. Visual Impairment among Older Adults in Selangor State of Malaysia: The Grand Challenge Project. Journal of Clinical & Diagnostic Research. 2020 Jan 1;14(1):NC05 - NC09.doi: 10.7860/JCDR/2020/42998.13441 (https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&volume=14&issue=1&page=NC05&issn=0973-709x&id=13441).
27. Choi SU, Chun YS, Lee JK, Kim JT, Jeong JH, Moon NJ. Comparison of vision-related quality of life and mental health between congenital and acquired low-vision patients. Eye (Lond). 2019 Oct;33(10):1540-1546. doi: 10.1038/s41433-019-0439-6. Epub 2019 Apr 24. PMID: 31019263; PMCID: PMC7002576.
28. Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, Trierweiler SJ, Williams DR. The National Survey of American Life: a study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res. 2004;13(4):196-207. doi: 10.1002/mpr.177. PMID: 15719528; PMCID: PMC6878295.
29. Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006 Jun;21(6):547-52. doi: 10.1111/j.1525-1497.2006.00409.x. PMID: 16808734; PMCID: PMC1924626.
30. Li D, Chan VF, Wang H, Zhang H, Virgili G, Whitestone N, Xiao B, Singh MK, She X, Mackenzie G, Boswell M, Mavi S, Rozelle S, Congdon N. Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic. Front Public Health. 2024 Jan 24;11:1282826. doi: 10.3389/fpubh.2023.1282826. PMID: 38328549; PMCID: PMC10847594.
31. Moreira MCN, Steffen RE, Zin AA, Santos MDS, Costa ACCD, Campos DS, Barros LBP, Moreira MEL, Mendes CHF, Kuper H, Pinto M. Depressão, ansiedade, estresse e apoio social: estudo transversal com cuidadores de crianças com deficiência visual no Rio de Janeiro, Brasil - Views-QoL Study [Depression, anxiety, stress, and social support: a cross-sectional study with caregivers of visually impaired children in Rio de Janeiro, Brazil - Views-QoL Study]. Cad Saude Publica. 2023 Dec 15;39(11):e00247622. Portuguese. doi: 10.1590/0102-311XPT247622. PMID: 38126419; PMCID: PMC10727032.
32. Magdalene D, Bhattacharjee H, Deshmukh S, Mohapatra SD, Ali A, Paidi RR, Multani PK. Assessment of quality of life, mental health and ocular morbidity in children from schools for the blind in North-East India. Indian J Ophthalmol. 2021 Aug;69(8):2040-2044. doi: 10.4103/ijo.IJO_3071_20. PMID: 34304174; PMCID: PMC8482933.
33. Wolffsohn JS, Cochrane AL. Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation. Am J Ophthalmol. 2000 Dec;130(6):793-802. doi: 10.1016/s0002-9394(00)00610-3. PMID: 11124300.
34. Rees G, Xie J, Chiang PP, Larizza MF, Marella M, Hassell JB, Keeffe JE, Lamoureux EL. A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services. Patient Educ Couns. 2015 Feb;98(2):174-81. doi: 10.1016/j.pec.2014.11.008. Epub 2014 Nov 20. PMID: 25481576.
35. 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. Invest Ophthalmol Vis Sci. 2006 Nov;47(11):4732-41. doi: 10.1167/iovs.06-0220. PMID: 17065481.
36. Brunes A, Hansen MB, Heir T. General self-efficacy in individuals with visual impairment compared with the general population. PLoS One. 2021 Jul 2;16(7):e0254043. doi: 10.1371/journal.pone.0254043. PMID: 34214108; PMCID: PMC8253439.
37. Hernandez Trillo A, Dickinson CM. The impact of visual and nonvisual factors on quality of life and adaptation in adults with visual impairment. Invest Ophthalmol Vis Sci. 2012 Jun 28;53(7):4234-41. doi: 10.1167/iovs.12-9580. PMID: 22599581.
38. Jackson ML, Schoessow KA, Selivanova A, Wallis J. Adding access to a video magnifier to standard vision rehabilitation: initial results on reading performance and well-being from a prospective, randomized study. Digit J Ophthalmol. 2017 Mar 31;23(1):1-10. doi: 10.5693/djo.01.2017.02.001. PMID: 28924412; PMCID: PMC5596951.
2. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012 May;96(5):614-8. doi: 10.1136/bjophthalmol-2011-300539. Epub 2011 Dec 1. PMID: 22133988.
3. Zainal M, Ismail SM, Ropilah AR, Elias H, Arumugam G, Alias D, Fathilah J, Lim TO, Ding LM, Goh PP. Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996. Br J Ophthalmol. 2002 Sep;86(9):951-6. doi: 10.1136/bjo.86.9.951. PMID: 12185113; PMCID: PMC1771293.
4. Chew FLM, Salowi MA, Mustari Z, Husni MA, Hussein E, Adnan TH, Ngah NF, Limburg H, Goh PP. Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII). PLoS One. 2018 Jun 26;13(6):e0198799. doi: 10.1371/journal.pone.0198799. PMID: 29944677; PMCID: PMC6019397.
5. Quartilho A, Simkiss P, Zekite A, Xing W, Wormald R, Bunce C. Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013. Eye (Lond). 2016 Apr;30(4):602-7. doi: 10.1038/eye.2015.288. Epub 2016 Jan 29. PMID: 26821759; PMCID: PMC5108547.
6. Taylor HR, Keeffe JE. World blindness: a 21st century perspective. Br J Ophthalmol. 2001 Mar;85(3):261-6. doi: 10.1136/bjo.85.3.261. PMID: 11222327; PMCID: PMC1723903.
7. Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group of the Global Burden of Disease Study. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017 Dec;5(12):e1221-e1234. doi: 10.1016/S2214-109X(17)30393-5. Epub 2017 Oct 11. PMID: 29032195.
8. Michaud PA, Fombonne E. Common mental health problems. BMJ. 2005 Apr 9;330(7495):835-8. doi: 10.1136/bmj.330.7495.835. PMID: 15817553; PMCID: PMC556080.
9. Chisholm D. Investing in mental health. East Mediterr Health J. 2015 Sep 28;21(7):531-4. PMID: 26442896.
10. Oei TP, Sawang S, Goh YW, Mukhtar F. Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures. Int J Psychol. 2013;48(6):1018-29. doi: 10.1080/00207594.2012.755535. Epub 2013 Feb 21. PMID: 23425257.
11. Kok T, de Haan HA, van der Meer M, Najavits LM, De Jong CA. Screening of current post-traumatic stress disorder in patients with substance use disorder using the Depression, Anxiety and Stress Scale (DASS-21): a reliable and convenient measure. Eur Addict Res. 2015;21(2):71-7. doi: 10.1159/000365283. Epub 2014 Nov 19. PMID: 25413311.
12. Court H, McLean G, Guthrie B, Mercer SW, Smith DJ. Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC Med. 2014 Oct 17;12:181. doi: 10.1186/s12916-014-0181-7. PMID: 25603915; PMCID: PMC4200167.
13. Bowers A, Peli E, Elgin J, McGwin G Jr, Owsley C. On-road driving with moderate visual field loss. Optom Vis Sci. 2005 Aug;82(8):657-67. doi: 10.1097/01.opx.0000175558.33268.b5. PMID: 16127330.
14. Crews JE, Campbell VA. Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning. Am J Public Health. 2004 May;94(5):823-9. doi: 10.2105/ajph.94.5.823. PMID: 15117707; PMCID: PMC1448344.
15. 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 May 9;9(2):133-160. doi: 10.1007/s13167-018-0136-8. PMID: 29896314; PMCID: PMC5972137.
16. Omar R, Rahman MH, Knight VF, Mustaphal M, Mohammed Z. Mental health state and quality of life questionnaire in low vision assessment: a case report. BMC Res Notes. 2014 Sep 23;7:667. doi: 10.1186/1756-0500-7-667. PMID: 25245590; PMCID: PMC4190380.
17. Watanabe N, Hunot V, Omori IM, Churchill R, Furukawa TA. Psychotherapy for depression among children and adolescents: a systematic review. Acta Psychiatr Scand. 2007 Aug;116(2):84-95. doi: 10.1111/j.1600-0447.2007.01018.x. PMID: 17650269.
18. Renaud J, Bédard E. Depression in the elderly with visual impairment and its association with quality of life. Clin Interv Aging. 2013;8:931-43. doi: 10.2147/CIA.S27717. Epub 2013 Jul 19. PMID: 23888110; PMCID: PMC3722036.
19. Rees G, Tee HW, Marella M, Fenwick E, Dirani M, Lamoureux EL. Vision-specific distress and depressive symptoms in people with vision impairment. Invest Ophthalmol Vis Sci. 2010 Jun;51(6):2891-6. doi: 10.1167/iovs.09-5080. Epub 2010 Feb 17. PMID: 20164466.
20. van der Aa HP, Margrain TH, van Rens GH, Heymans MW, van Nispen RM. Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis. Ophthalmic Physiol Opt. 2016 Sep;36(5):584-606. doi: 10.1111/opo.12313. PMID: 27580757.
21. van der Aa HP, Comijs HC, Penninx BW, van Rens GH, van Nispen RM. Major depressive and anxiety disorders in visually impaired older adults. Invest Ophthalmol Vis Sci. 2015 Jan 20;56(2):849-54. doi: 10.1167/iovs.14-15848. PMID: 25604690.
22. Stelmack JA, Stelmack TR, Massof RW. Measuring low-vision rehabilitation outcomes with the NEI VFQ-25. Invest Ophthalmol Vis Sci. 2002 Sep;43(9):2859-68. PMID: 12202503.
23. Kuyk T, Liu L, Elliott JL, Grubbs HE, Owsley C, McGwin G Jr, Griffin RL, Fuhr PS. Health-related quality of life following blind rehabilitation. Qual Life Res. 2008 May;17(4):497-507. doi: 10.1007/s11136-008-9336-3. PMID: 18392688; PMCID: PMC2705061.
24. Ramli M, Salmiah MA. Validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS) among diabetic patients. Malaysian Journal of Psychiatry. 2009 Dec 1;18(2):40-5. Link (https://journals.lww.com/mjp/abstract/2009/18020/VALIDATION_AND_PSYCHOMETRIC_PROPERTIES_OF_BAHASA.6.aspx)
25. Soria-Reyes LM, Alarcón R, Cerezo MV, Blanca MJ. Psychometric properties of the Depression Anxiety Stress Scales (DASS-21) in women with breast cancer. Sci Rep. 2024 Sep 3;14(1):20473. doi: 10.1038/s41598-024-68814-9. PMID: 39227677; PMCID: PMC11372162.
26. RAHMAN MH, TING KQ, MOHAMMED Z, FADZIL NM, SAHAR S, AHMAD M. Visual Impairment among Older Adults in Selangor State of Malaysia: The Grand Challenge Project. Journal of Clinical & Diagnostic Research. 2020 Jan 1;14(1):NC05 - NC09.doi: 10.7860/JCDR/2020/42998.13441 (https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&volume=14&issue=1&page=NC05&issn=0973-709x&id=13441).
27. Choi SU, Chun YS, Lee JK, Kim JT, Jeong JH, Moon NJ. Comparison of vision-related quality of life and mental health between congenital and acquired low-vision patients. Eye (Lond). 2019 Oct;33(10):1540-1546. doi: 10.1038/s41433-019-0439-6. Epub 2019 Apr 24. PMID: 31019263; PMCID: PMC7002576.
28. Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, Trierweiler SJ, Williams DR. The National Survey of American Life: a study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res. 2004;13(4):196-207. doi: 10.1002/mpr.177. PMID: 15719528; PMCID: PMC6878295.
29. Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006 Jun;21(6):547-52. doi: 10.1111/j.1525-1497.2006.00409.x. PMID: 16808734; PMCID: PMC1924626.
30. Li D, Chan VF, Wang H, Zhang H, Virgili G, Whitestone N, Xiao B, Singh MK, She X, Mackenzie G, Boswell M, Mavi S, Rozelle S, Congdon N. Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic. Front Public Health. 2024 Jan 24;11:1282826. doi: 10.3389/fpubh.2023.1282826. PMID: 38328549; PMCID: PMC10847594.
31. Moreira MCN, Steffen RE, Zin AA, Santos MDS, Costa ACCD, Campos DS, Barros LBP, Moreira MEL, Mendes CHF, Kuper H, Pinto M. Depressão, ansiedade, estresse e apoio social: estudo transversal com cuidadores de crianças com deficiência visual no Rio de Janeiro, Brasil - Views-QoL Study [Depression, anxiety, stress, and social support: a cross-sectional study with caregivers of visually impaired children in Rio de Janeiro, Brazil - Views-QoL Study]. Cad Saude Publica. 2023 Dec 15;39(11):e00247622. Portuguese. doi: 10.1590/0102-311XPT247622. PMID: 38126419; PMCID: PMC10727032.
32. Magdalene D, Bhattacharjee H, Deshmukh S, Mohapatra SD, Ali A, Paidi RR, Multani PK. Assessment of quality of life, mental health and ocular morbidity in children from schools for the blind in North-East India. Indian J Ophthalmol. 2021 Aug;69(8):2040-2044. doi: 10.4103/ijo.IJO_3071_20. PMID: 34304174; PMCID: PMC8482933.
33. Wolffsohn JS, Cochrane AL. Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation. Am J Ophthalmol. 2000 Dec;130(6):793-802. doi: 10.1016/s0002-9394(00)00610-3. PMID: 11124300.
34. Rees G, Xie J, Chiang PP, Larizza MF, Marella M, Hassell JB, Keeffe JE, Lamoureux EL. A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services. Patient Educ Couns. 2015 Feb;98(2):174-81. doi: 10.1016/j.pec.2014.11.008. Epub 2014 Nov 20. PMID: 25481576.
35. 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. Invest Ophthalmol Vis Sci. 2006 Nov;47(11):4732-41. doi: 10.1167/iovs.06-0220. PMID: 17065481.
36. Brunes A, Hansen MB, Heir T. General self-efficacy in individuals with visual impairment compared with the general population. PLoS One. 2021 Jul 2;16(7):e0254043. doi: 10.1371/journal.pone.0254043. PMID: 34214108; PMCID: PMC8253439.
37. Hernandez Trillo A, Dickinson CM. The impact of visual and nonvisual factors on quality of life and adaptation in adults with visual impairment. Invest Ophthalmol Vis Sci. 2012 Jun 28;53(7):4234-41. doi: 10.1167/iovs.12-9580. PMID: 22599581.
38. Jackson ML, Schoessow KA, Selivanova A, Wallis J. Adding access to a video magnifier to standard vision rehabilitation: initial results on reading performance and well-being from a prospective, randomized study. Digit J Ophthalmol. 2017 Mar 31;23(1):1-10. doi: 10.5693/djo.01.2017.02.001. PMID: 28924412; PMCID: PMC5596951.
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