The identification of comorbid conditions associated with severe infection with the novel coronavirus (SARS-CoV-2, COVID-19) has been instrumental in guiding public health response, including prioritizing diagnostic testing and vaccines to educating and protecting those at the highest risk. Many chronic conditions, including hypertension, diabetes, heart disease, and cancer have been associated with a higher likelihood of severe COVID-19.
Although visual impairment is a major cause of disability worldwide and associated with several comorbidities, its impact on an individual's risk of contracting COVID-19 or developing severe disease has not been studied.
In 2021, with the emergence of SARS-CoV-2 Delta variant and subsequent rise COVID-19 cases and hospital admissions, identifying populations at high risk of severe disease and hospitalization continues to be important for protecting the most vulnerable. Low vision, specifically, may increase an individual’s risk of contracting COVID-19, due to factors such as a reliance on public transportation, less access to public health messaging, and use of touch for navigation, especially when accessing public spaces.
However, these associations have not previously been studied. “The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment,” by Wesem S. Shalaby, MD, et al, published in the American Journal of Ophthalmologyin July 20211, takes the first steps in understanding these questions by evaluating the effects of the pandemic on individuals with visual impairment.
A novel study seeks initial understanding of COVID-19 in the context of visual impairment
This prospective cross-sectional study was conducted at the Aravind Eye Care System in Pondicherry, India with established patients using telephone surveys. Participants were divided into four groups of 58 subjects based on the degree of visual impairment (VI): moderate VI, severe VI, blindness, and a control group. When evaluating their participants, the researchers found that degree of visual impairment correlated with older age, and participants in the control group were more likely to have a graduate degree.
These two findings represent potentially important variables, as older age is known to be associated with poor prognosis for COVID-19, and education level may affect an individual’s perception of the pandemic, understanding of the disease, and access to available resources.
A further significant finding from this study concerns that participants with blindness were least likely to wear a mask and participants in the control group were most likely to practice frequent hand hygiene.
The authors offer several potential explanations for these discrepancies in practicing preventative measures, such as these measures are visually demanding, mobility issues are more prevalent among patients with severe VI, and severe VI may put individuals at risk for incomplete information about the pandemic.
While the researchers found similar levels of awareness of the pandemic between the four groups, they reported significant differences in ways participants with blindness received the news, as they were more likely to depend on television audio or word-of-mouth. It’s important to note that awareness of the pandemic only refers to whether participants had heard of the COVID-19 pandemic.
Further research could help clarify whether reliance on television audio and word-of-mouth actually impacts understanding of the pandemic beyond awareness of its existence and if individuals with blindness are more affected by misinformation. The researchers note that access to care is not a confounding factor in this study because it was conducted in India, where healthcare is available regardless of financial means.
However, the survey results demonstrated that blind participants are significantly more concerned about healthcare access, especially with a large shift towards telemedicine.
Future research in supporting patients with visual impairment during a pandemic
The significant findings from the aforementioned study illustrate the negative effects of COVID-19 on individuals with visual impairment. Further research on this relationship and how to include considerations for visual impairment as part of a larger pandemic response is now needed. Education is undoubtedly a major part of promoting public health, especially during a pandemic, when information needs to be delivered rapidly and accurately.
Public health messaging frequently takes the form of posters placed in physician’s offices, pharmacies, and public spaces as well as graphics disseminated through the internet. Some of these messages, such as hand-washing posters next to the sink, are common-sense but useful reminders, and some relay essential, novel information, including specific symptoms to look for and when to seek medical care.
Others prompt us to protect ourselves and others, like signs with pictures of masks taped to entrances or markers on the floor placed six feet apart. These forms of messaging are designed to be efficient and easy to understand, but they exclude individuals with visual impairment who instead rely much more on those around them to relay information.
Without visual reminders, it can be easy to forget to take these precautions, and without direct access to a widely used method of sharing information as it evolves, individuals with visual impairment may be more susceptible to misinformation.
Given this article shows that individuals with higher degrees of visual impairment are less likely to take preventive measures, it may be important to consider the impact of healthcare professionals in educating patients who are not able to access all public health messaging first-hand and preventing the spread of misinformation.
As part of the larger pandemic response and the goals to protect the most vulnerable, further research is needed to understand whether visual impairment actually makes an individual more susceptible to COVID-19 infection. If increased susceptibility becomes evident through additional studies, pandemic guidelines, both current, and future, must use this information to better address the needs of individuals with visual impairment by improving information access, increasing compliance with guidelines, and prioritizing their safety as a vulnerable population.
- Shalaby WS, Odayappan A, Venkatesh R, et al. The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment [published online ahead of print, 2021 Mar 26]. Am J Ophthalmol. 2021;S0002-9394(21)00129-X. doi:10.1016/j.ajo.2021.03.016