Under-reporting difficulties in seeing among older people with clinically assessed vision impairment: an exploration of 12 surveys from sub-Saharan Africa

People often delay seeking care if they do not recognise that they have a health issue, potentially risking a worsening of their condition. This article presents the results of a study that aimed to understand this tendency in eye health. Researchers analysed data from 12 studies across sub-Saharan Africa to see how accurately visually impaired individuals aged 50 and older reported their own difficulties seeing, compared to clinical diagnoses.

The study found a critical lack of awareness, especially among those with the most severe problems: while most people with no vision impairment reported accurately (83.8%), only 18.7% of participants who were clinically diagnosed as blind accurately reported their vision level. Overall, the agreement between clinical assessment and self-reported difficulty was low.

Furthermore, individuals were more likely to ignore or under-report their vision difficulties if their underlying problem was simply an unaddressed refractive error—meaning they needed glasses. This significant gap between actual vision loss and perceived problems means that health planners must design eye care programmes specifically to find and reach individuals who are unaware they need help.

This article is part of the supplement ‘Sightsavers at 75: delivering impact through health and inclusion research’ in the journal International Health, published in collaboration with the Royal Society of Tropical Medicine and Hygiene in celebration of Sightsavers’ 75th anniversary.