Author’s Disclosure Block: Arshia Eshtiaghi: none; Andrew Mihalache: none; Ryan Huang: none; Chris Zajner: none ; Marko Popovic: Financial support (to institution) – PSI Foundation, Fighting Blindness Canada.; Eryn Tong: Eryn Tong is supported by the Vanier Canada Graduate Scholarship by the Social Science and Humanities Research Council (#186866). ; Edward Margolin: none ; Peter Kertes: Honoraria: Amgen, Novartis, Bayer, Roche, Boehringer Ingelheim, RegenxBio, Apellis, Astellas; Advisory board – Novartis, Bayer, Roche, Apellis, Astellas, Novelty Nobility, Johnson and Johnson, Kriya Therapeutics, AdMare Bioinnovations; Financial support (to institution) – Roche, Novartis, Bayer, RegenxBio, Johnson and Johnson, Neuracle Genetics. ; Rajeev Muni: Consultant - Alcon, Apellis, AbbVie, Bayer, Bausch Health, Roche; Financial Support (to institution) - Alcon, AbbVie, Bayer, Novartis, Roche. ; Radha Kohly: Bayer, Novartis.

Abstract Body
Purpose: With an estimated 2.2 billion individuals living with visual impairment, the World Health Organization has called for concerted global efforts to mitigate its growing prevalence. Currently, the economic burden of mental health and vision loss in the United States are estimated at over $193 billion USD and $134 billion USD, respectively. However, psychosocial interventions targeted at improving mental health outcomes in individuals with visual impairments lack generalizability and are limited by low adherence. Given that compromised vision can have major biopsychosocial implications, this study aims to investigate associations between vision difficulties and mental health diagnoses in adults from a nationally representative sample. Study Design: Retrospective, population-based analysis. Methods: Using data from the 2022 United States National Health Interview Survey, we included adult participants aged ≥18 years old who provided data pertaining to their vision status. The primary outcome was the association between vision difficulty and diagnoses of an anxiety or depressive disorder. The secondary analysis explored associations between visual impairment related to symptom severity and whether participants received medications or therapy for mental health conditions. Multivariable regression models on Stata v17.0 were conducted, adjusting for sociodemographic confounders. Results: 27,640 adults (mean age: 53 ± 19 years) were included, of whom 5,210 (19%) reported vision difficulties. Adults self-reporting vision difficulty had a higher odds of having an anxiety disorder (OR=2.0, 95%CI=[1.83, 2.19], p<0.001) and more severe anxiety symptoms per the GAD-7 scale (OR=2.5, 95%CI=[2.3, 2.8], p<0.001). Likewise, adults with vision difficulty had a higher odds of having depression (OR=2.3, 95%CI=[2.12, 2.52], p<0.001) and more severe depressive symptoms per the PHQ-8 scale (OR=3.0, 95%CI=[2.7, 3.2], p<0.001). These findings were consistent across all
subgroups of age (18-25, 26-35, 36-49, 50-64, 65-74, 75+ years) and income brackets (<1x, 1-2x, 2-5x, >5x poverty threshold). Moreover, self-reported vision difficulty was associated with a higher odds of taking medication for a mental health condition (OR=1.69, 95%CI=[1.34, 2.14], p<0.001) and receiving therapy from a mental health professional (OR=1.70, 95%CI=[1.53, 1.90], p<0.001). Conclusion: There are robust associations between self-reported vision difficulty and psychosocial well-being, with vision difficulty predicting a greater severity of anxiety or depressive symptoms across all age groups and socioeconomic statuses. Public health policies must proactively address common comorbidities of vision impairment and mental health disorders, given their paramount burden. An increased multidisciplinary collaboration between eye care and mental health practices will be essential in providing comprehensive interventions to target these associations.