Evaluation of Functional Impacts of Vision Impairment: Progress, Challenges and Future Directions.

Vision impairment has profound consequences for everyday functioning and quality of life. This review summarises recent evidence on the impact of vision impairment in three functional domains: mobility and falls risk, driving, and the interaction between vision impairment and hearing. Individuals with vision impairment often adopt more cautious gait and visual search behaviours; however, they remain less stable and at increased falls risk, dependent on the type and severity of vision impairment. Wearable technologies enable continuous measurement of movement in naturalistic settings. Future research should leverage these tools to examine daily mobility patterns, fatigue and environmental exposure, and evaluate interventions in real-world contexts. Both central and peripheral vision play critical roles in driving. However, the impact of vision impairment on driving outcomes depends on the severity of loss as well as drivers' insight into their vision impairment and adoption of behavioural and compensatory strategies. Future studies should incorporate naturalistic driving methods and advanced vehicle technologies to explore compensatory behaviours and interventions and their impact on real-world safety. Hearing abilities may improve or decline following vision loss, depending on the task. Musical perception and pitch discrimination are often enhanced in early-onset blindness, possibly reflecting recruitment of visual cortical areas by auditory processing, while performance on complex spatial hearing tasks can be poorer, as vision calibrates auditory spatial representations. Future research should determine how cross-modal plasticity impacts performance and explore how auditory training or multisensory rehabilitation may enhance functional adaptation. In summary, research highlights the importance of both central and peripheral vision and behavioural adaptations and compensatory strategies, with key challenges being the ability to measure real-world function and understand individual variability. Future work should integrate advanced assessment technologies and interdisciplinary approaches to better characterise functional outcomes and inform interventions to enable functional independence.