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Abstract Background Administering and interpreting intelligence tests for adults with visual impairment (VI) presents practical and methodological challenges, because standard test batteries rely heavily on visual tasks and lack specific norm-groups tailored to this population. This study examined practical adaptations and interpretation strategies currently used in intelligence testing based on international literature and input from Dutch low vision service (LVS) providers. Methods A mixed-method design was applied. An exploratory literature review was conducted using PubMed, PsycINFO, Google Scholar and Web of Science to identify studies published in the past ten years addressing adaptations and/or interpretation of intelligence tests. Additionally, semi-structured interviews were held with nine healthcare professionals (HCPs) from Dutch LVS organizations to explore current practices and perceived needs. Results Eight publications met inclusion criteria. All reported use of intelligence tests; six described task adaptations, which varied considerably. One addressed interpretation of results for adults with VI. None reported norm-groups adapted for people with VI. Interviews highlighted challenges due to absence of accessible tests, leading HCPs to solely rely on the assessment of verbal subtests, mainly of the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) or making adaptations to the assessment of performance tasks for observational purposes. Approaches to administering tests varied widely. Conclusion Both literature and interviews with HCPs indicate that no specific intelligence tests tailored for adults with VI have been developed in the past decade, making accurate Total Intelligence Quotient (TIQ) measurement currently impossible. There is an urgent need for tailored tests with corresponding norm-groups and/or standardized protocols to ensure validity and consistency. Until then, HCPs should select predominantly verbal subtests tailored to the individual, observe performance closely, and explicitly report considerations. Strengths and limitations of this study Mixed-methods design combining an exploratory literature review with qualitative interviews enabled methodological triangulation and a comprehensive understanding of current practices. Systematic and transparent review procedures, including dual independent screening, use of JBI critical appraisal tools, and PROSPERO registration, enhanced methodological rigor. A final strength was the use of established qualitative data collection and analysis approaches (semi-structured interviews, reflexive thematic analysis, and double coding), which enhanced the depth and credibility of the findings. The exploratory (non-systematic) nature of the literature review, including broad database searches and absence of a fully reproducible search strategy, may limit reproducibility and increase the risk of selection bias. Lastly, qualitative sampling through snowball recruitment within a single national context (Dutch LVS) and a relatively small sample size may limit transferability and increase the risk of selection bias. Key messages - Recent literature on intelligence testing in adults with Visual Impairment (VI) provides no evidence of valid and reliable tools for accurately measuring Total Intelligence Quotient (TIQ); - Healthcare professionals (HCPs) working with adults with VI primarily administer verbal subtests from the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV); - More research should be performed on the development of specific intelligence tests and adapted norm-groups tailored to adults with VI to assess valid TIQ.