Many factors associated with employment in visually impaired working-age adults seemed to overlap with factors for work participation with chronic diseases in general.
Many factors associated with employment in visually impaired working-age adults seemed to overlap with factors for work participation with chronic diseases in general. Photo: NEI. Click image to enlarge.

Despite advances in vocational rehabilitation and assistive technology, visual impairment continues to be a hindrance to an affected patient’s career and livelihood. Dutch researchers recently observed only a slight increase in the employment rate of individuals who live in the world with visual impairment over time. Compared with populations having other sensory disabilities, such as hearing impairment, visually impaired people (in that country, and others) often have lower levels of work participation. The team found that several sociodemographic and disease-related factors may be associated with employment status in visually impaired people. Better odds for employment were identified for visually impaired people with higher education, male, married/with partner, no additional disability (nonvisual), no financial assistance, no use of a mobility aid, Caucasian ethnic background or having less visual impairment.

This meta-analysis explored the association between different variables and the employment status of working-age adults (>18 years old) with a visual impairment. Pooling results from 55 unique studies with a total of 1,326,091 participants. Most (66%) of the studies were conducted in North America (35 from the United States and three from Canada), followed by 10 studies from Europe, three studies from Australia and New Zealand, three studies from Asia and one study from South America. Almost all studies (98%) had population samples from high-income countries. The definition of employment as the outcome varied across studies and was frequently not described fully.

Sociodemographic factors associated with employment included higher education (odds ratio; [OR]: 3.34), being male (OR: 1.59), having a partner (OR: 1.73), Caucasian ethnicity (OR: 1.36) and having financial assistance (OR: 0.38). Disease-related factors included worse visual impairment (OR: 0.61) or having additional disabilities (OR: 0.55).

The meta-analysis also revealed that use of a mobility aid (e.g., cane, guide dog) was negatively associated with employment (OR: 0.35). The researchers believed that “this might be explained that having a mobility aid could be interpreted as a proxy for greater severity of the impairment.”

Both having an additional disability, other than visual, and receipt of financial assistance were negatively associated with employment. The team surmised that having financial assistance might indicate greater problems in functioning.

Ethnicity showed an association with employment in the study. However, the association with ethnicity was only reported by studies conducted in the United States; thus, the researchers believed that generalization to other geographical regions is difficult. Second, without adjustment for indicators related to societal context such as education level or socioeconomic status, the conclusion and interpretation regarding the association of ethnicity and employment may be limited.

Nevertheless, “the results should be interpreted with caution because of overall high heterogeneity,” the researchers wrote in their paper. “The synthesis of available evidence could benefit from more well-designed high-quality studies, i.e., cohort studies with long-term follow-up moments, standardization of definitions for employment outcomes and study population characteristics such as severity of visual impairment definitions.”

The meta-analysis confirmed that level of education across studies was the most consistent modifiable predictor for employment in visually impaired persons, as confirmed in this study. Therefore, the research team is convinced that interventions should provide more attention towards education for visually impaired people.

“There should be more focus in future research on the effects of other (modifiable) factors on employment, for example, types of work (place) and conditions with the use of possible (assistive technological) adjustments, ability to perform visual tasks and types of vocational rehabilitation services,” they concluded in their paper.

Daniëls R, van Nispen RM, de Vries R, et al. Predictors for work participation of people with visual impairments: a systematic review and meta-analysis. Ophthalmic Physiol Opt. July 14, 2023. [Epub ahead of print].