A recent survey found more than half of low vision patients are unwilling to use assistive devices, even when they improve their visual performance. Researchers in India interviewed 413 low vision patients from their tertiary eye hospital to uncover the reasons 235 of them shy away from assistive technology.

They found cost and convenience weren’t necessary to blame. In fact, the biggest factor for patients older than age 40 was social stigma (cited by 41.3% of the patients). Those between the ages of 41 and 60 were most likely to avoid these tools due to a fear of losing their job (26.6% of patients). Of all patients younger than 60, 25% felt they didn’t need them, despite the fact that the researcher found 53% of those who felt there were not candidates actually had severe visual impairment.

Those older than 60 seem to have a harder time accepting their failing vision, as 16.5% were in denial about the magnitude of their condition, the researchers wrote. However, this statistic was somewhat dependent on the underlying etiology, considering only 39.6% of patients with macular disorders were in denial compared with a whopping 81% of patients with retinitis pigmentosa.

Additionally, the researchers note that magnifiers, whether hand-held or with a stand, were more readily accepted than other devices, with a non-acceptance rate of 41%. Patients almost never accepted the use of telescopes and electronic devices with non-acceptance rates of 92% and 89%, respectively.

While further research will help reveal the psychological and psycho-social underpinnings of these decisions, “knowledge of these barriers can help in creating content for awareness campaigns among patients, healthcare professionals and general society,” the researchers conclude.