The present study compared psychological adjustment of 158 adolescents with vision impairment and 158 sighted adolescents with a matched-pair design using the Strengths and Difficulties Questionnaire. Adolescent self-reports and teacher reports on emotional problems, peer problems, and total difficulties showed higher scores in students with vision impairment than in sighted students. However, the size of between-group differences was small, and adolescents who are blind and their peers with low vision showed similar levels of psychological adjustment. In addition, older students reported more emotional problems than younger students. Furthermore, differences between self-reported emotional problems of students with and without vision impairment were stronger in older participants. In both groups, girls showed more emotional problems and less conduct problems than boys. We conclude that most students with vision impairment are well adjusted but a minority may benefit from psychological interventions. (Contains 2 tables.)