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Relationship between vision impairment and employment
  1. Yi Xuen Chai1,
  2. Alfred Tau Liang Gan2,
  3. Eva K Fenwick2,3,
  4. Abraham Y Sui1,
  5. Benjamin Kye Jyn Tan1,
  6. Debra Q Y Quek2,
  7. Chaoxu Qian2,
  8. Tien Yin Wong2,3,
  9. Ching-Yu Cheng2,3,
  10. Ecosse Luc Lamoureux2,3,
  11. Ryan Eyn Kidd Man2,3
  1. 1 Yong Loo Lin School of Medicine (YLLSoM), National University of Singapore (NUS), Singapore
  2. 2 Singapore Eye Research Institute (SERI), Singapore National Eye Centre (SNEC), Singapore
  3. 3 Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Ecosse Luc Lamoureux, Singapore Eye Research Institute, Singapore, 169856, Singapore; ecosse{at}


Aims To examine the relationship between vision impairment (VI) and employment outcomes in a multiethnic Asian population.

Methods We included 7608 Asian individuals aged ≥40 years (mean (SD) age: 58.4 (10.3) years; 64.8% male) from the Singapore Epidemiology Eye Disease Study (response rate: 78.8%), a population-based cohort study (mean follow-up period: 6.2 years). Presenting visual acuity (VA) was assessed using a logarithm of the minimum angle of resolution (logMAR) chart, with VI defined as mild (VA >0.3 to <0.6 logMAR) and moderate to severe (VA ≥0.6 logMAR). Self-reported employment statuses at both baseline and follow-up were used as outcomes. Underemployment was defined as a decline in occupational skill level, categorised by International Standard Classification of Occupations, at follow-up compared with baseline. Multinomial logistic regression models were used to determine independent associations between VI and various employment outcomes, adjusted for variables that were found to significantly differ across employment statuses.

Results Presenting VI was prevalent in 20.2% (N=1536) of participants. Compared with those without VI, participants with mild and moderate to severe VI were more likely to be unemployed at baseline (OR 1.47, 95% CI 1.15 to 1.87, p=0.002 and 2.74, 95% CI 1.94 to 3.89, p<0.001, respectively). At follow-up, participants with any VI at baseline were more likely to be underemployed (OR 1.46, 95% CI 1.03 to 2.05, p=0.033).

Conclusion VI, even when mild, is associated with unemployment and underemployment. Future studies should investigate whether visual interventions could be used as part of a multipronged strategy to improve employment outcomes for the population.

  • vision
  • epidemiology

Data availability statement

Data are available on reasonable request. Data are available upon reasonable request.

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Data availability statement

Data are available on reasonable request. Data are available upon reasonable request.

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  • Contributors Conceptualisation: ELL and REKM. Data curation: ATLG, EKF, DQYQ, CQ, TYW, C-YC, ELL and REKM. Methodology: YXC, ATLG, AYS, BKJT and REKM. Formal Analysis and validation: ATLG, YXC, AYS, BKJT and REKM. Drafting of manuscript: YXC, AYS, BKJT, ATLG. Review and editing of manuscript: YXC, ATLG, EKF, AYS, BKJT, DQYQ, CQ, TYW, C-YC, ELL and REKM. Funding acquisition: TYW, C-YC and ELL. Supervision: ELL and REKM.

  • Funding ELL is supported by the National Medical Research Council (NMRC) Senior-Clinician Scientist Award (#NMRC/CSASI/0009/2016), and REKM is supported by the NMRC Transition Award (#MOH-TA19may-0002).

  • Disclaimer The funding bodies had no role in the design and conduct of this research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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