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Research: visual impairment and employment

How does visual impairment, across its severity spectrum, affect employment outcomes? This question is especially relevant to Singapore, given the increase in life expectancy and retirement age, and many countries are exploring strategies to empower older adults to remain in the workforce. Previous studies have shown that low vision and blindness have an adverse effect on an individual’s employment opportunities, but the number of contemporary long-term studies available are limited, especially in older adults.

Recently, a longitudinal study of over 7,000 participants of Singapore’s multi-ethnic Asian population was conducted by Prof Ecosse Lamoureux’s group at the Singapore Eye Research Institute (SERI) to study how age-related vision loss affects employment outcomes over 6 years in older Singaporeans. This study, published in the British Journal of Ophthalmology, clearly shows the detrimental impact of vision loss on employment opportunities.

Says Dr Ryan Man, senior author of the study, “In this longitudinal cohort of Chinese, Malay and Indian Singaporeans aged ≥ 40 years, we found that even mild vision loss was associated with an approximately 50% likelihood of being unemployed at baseline. Even in working individuals, those with any form of vision loss followed up over 6 years were found to be at high risk of under-employment (i.e., a level of employment that is not commensurate with their education or skill levels). Importantly, over 90% of these vision loss were correctable with a pair of glasses. Future studies should evaluate whether visual interventions could be incorporated as part of a multi-pronged strategy to improve employment outcomes in the working elderly.”

Watch this video as Dr Ryan Man explains the relationship between vision impairment and employment:

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Comments from Prof Ecosse Lamoureux, Population Health, SERI

Why and how was this study conducted?
Existing studies about work-related impact of visual impairment has mostly been carried out in low vision or legally blind communities. The aim of this study was to determine how the projected increase in age-related vision loss would impact on the employment status of older adults in the population as a whole. For this study, Dr Man utilised the Singapore Epidemiology of Eye Disease (SEED) cohort studies, which had comprehensively assessed vision data and the participants’ employment status at both the baseline (2004-2011) and the 6-year follow-up (2010–2017) visits. Three motivated young National University of Singapore (NUS) medical students (Yi Xuen Chai, Abraham Sui and Benjamin Tan) carefully examined the SEED dataset and compare it with existing literature. 

Were there challenges in running the study?
Categorising the different job types and statuses for analyses was difficult due to the sheer number of options (total 22). Moreover, mapping the employment skill level for each participant was particularly challenging as only quantitative close-ended questions were asked. We overcame this difficulty by adopting a standardised international skill-based job categorisation system based on job type, widely used globally.  We also ran into some issues with longitudinal (baseline to follow-up) analyses related to unemployment as the numbers at follow-up were small. Moreover, because there was no qualitative confirmation from participants that any employment status changes at follow-up was due to vision loss, we had to be careful when interpreting our findings especially in terms of attributing cause-effect relationships to any significant associations found.

What do these results mean?
We were quite surprised that even mild vision loss was associated with such substantial deleterious impact on employment status. Even more staggering was the finding that the vast majority of these vision loss could be corrected with a pair of glasses. This suggests that visual interventions should be considered as part of a multi-pronged strategy to improve employment outcomes in older adults.

Are there plans to explore this topic further?
As principal investigator of a current longitudinal cohort study of older Singaporeans aged ≥ 60 years old (Population Health and Eye Disease Profile in Elderly Singaporean or PIONEER study), I am considering a more detailed evaluation in this cohort as participants undergo a detailed and structured interview on how vision loss impacts on their quality of life. Analyses are yet to start though, as we are still at the tail end of the baseline assessment phase for participants.

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