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Understanding the impact of a condition from the patient's perspective is important, and different types of patient-reported outcomes or instruments are available to help with this. This review article summarises the current evidence on the impact of diabetic retinopathy (DR) and its associated vision impairment on patient-reported outcomes. We have included research that has used a range of outcome measures to assess the impact of DR on generic health-related quality of life, utility, vision-functioning and vision-specific quality of life. This review also offers clarification on frequently misused psychometric terminologies to help clinicians and researchers better understand the literature associated with patient-reported outcome research. Overall, the evidence suggests that DR, particularly in its vision-threatening stages, has a substantial, negative impact on the patient. However, our understanding of the impact of DR is currently restricted due to limitations inherent in currently available patient-reported outcome measures. We conclude by discussing potential directions for future research in this area, such as item banking and computer adaptive testing.

Purpose: Assessing the efficacy of treatment modalities for diabetic retinopathy (DR) from the patient’s perspective is restricted due to a lack of a comprehensive patient-reported outcome measure. We are developing a DR-specific quality of life (QoL) item bank, and we report here on the qualitative results from the first phase of this project. Methods: Eight focus groups and 18 semi-structured interviews were conducted with 57 patients with DR. The sessions were transcribed verbatim and iteratively analysed using the constant comparative method and NVIVO software Results: Participants had a median age of 58 years (range 27–83 years). Twenty-seven (47%) participants had proliferative DR in the better eye, and 14 (25%) had clinically significant macular oedema. Nine QoL domains were identified, namely visual symptoms, ocular surface symptoms, vision-related activity limitation, mobility, emotional well-being, health concerns, convenience, social, and economic. Participants described many vision-related activity limitations, particularly under challenging lighting conditions; however, socioemotional issues were equally important. Participants felt frustrated due to their visual restrictions, concerned about further vision loss and had difficulty coping with this uncertainty. Restrictions on driving were pervasive, affecting transport, social life, relationships, responsibilities, work and independence. Conclusions: Patients with DR experience many socioemotional issues in addition to vision-related activity limitations. Data from this study will be used to generate data for a DR-specific QoL item bank. Refereed/Peer-reviewed

BackgroundTo explore the hypothesis that sight restoring cataract surgery provided to impoverished rural communities will improve not only visual acuity and vision-related quality of life (VRQoL) but also poverty and social status.MethodsParticipants were recruited at outreach camps in Tamil Nadu, South India, and underwent free routine manual small incision cataract surgery (SICS) with intra-ocular lens (IOL) implantation, and were followed up one year later. Poverty was measured as monthly household income, being engaged in income generating activities and number of working household members. Social status was measured as rates of re-marriage amongst widowed participants. VRQoL was measured using the IND-VFQ-33. Associations were explored using logistic regression (SPSS 19).ResultsOf the 294 participants, mean age ± standard deviation (SD) 60 ± 8 years, 54% men, only 11% remained vision impaired at follow up (67% at baseline; pConclusionThese findings indicate the broad positive impact of sight restoring cataract surgery on the recipients' as well as their families' lives. Providing free high quality cataract surgery to marginalized rural communities will not only alleviate avoidable blindness but also - to some extent - poverty in the long run.

Purpose: To assess the impact of diabetic retinopathy (DR) and diabetic macular edema (DME) on diabetic macular edema (HRQoL) in type 1 and type 2 diabetes using the EuroQoL EQ-5D generic multi-attribute utility instrument (MAUI). Methods:. In this cross-sectional study, 577 patients with diabetes were recruited from specialized eye clinics in Melbourne, Australia. Each patient underwent clinical, biochemical, and anthropometric assessments. The severity of combined DR and DME (no DR/DME; mild NPDR [nonproliferative DR (NPDR)] and/or mild DME; moderate NPDR and/or moderate DME; and vision-threatening DR (VTDR) (severe NPDR or PDR and/or severe DME) in the worse eye was calculated. EQ-5D utility measures were the main outcome. Because the distribution of the utility measures was skewed, independent associations were explored using multivariate quantile regression models (five quintiles, namely 15th, 30th, 45th, 60th, 75th) ranging from poorest to highest HRQoL. Results: Median age of the participants was 66 years (range, 26-90 years). Of the 577 participants, 223 (38.7%) had no DR/DME, 35 (6.1%) had mild NPDR/DME, 127 (22.0%) had moderate NPDR/DME, and 192 (33.3%) had VTDR. In adjusted models, neither presence nor severity of DR/DME was significantly associated with any quantile of the EQ-5D. In contrast, the presence of diabetic complications (other than DR) (β = -0.153; SE = 0.052; P < 0.001), other nonocular comorbidities (β = -0.115; SE = 0.038; P < 0.01), and higher body mass index (β = -0.007; SE = 0.002; P < 0.001) were all associated with worse HRQoL. Conclusions: Using a generic MAUI, the EQ-5D, the authors found that the presence or severity of DR/DME and concomitant vision loss were not associated with any quantile of HRQoL. These findings suggest that the EQ-5D lacks sensitivity in assessing the impact of the severity of DR/DME on HRQoL parameters and that condition-specific instruments may better capture the full impact of the association. Refereed/Peer-reviewed

PURPOSE. To investigate the relationship between anthropometric parameters and diabetic retinopathy (DR) in adults with diabetes. METHODS. Five hundred participants with diabetes were recruited prospectively from ophthalmology clinics in Melbourne, Australia. Each underwent an eye examination, anthropometric measurements, and standardized interview-administered questionnaires, and fasting blood glucose and serum lipids were analyzed. Two-field fundus photographs were taken and graded for DR. Height; weight; body mass index (BMI); waist, hip, neck, and head circumferences; and skinfold measurements were recorded. RESULTS. A total of 492 patients (325 men, 66.1%) aged between 26 and 90 years (median, 65) were included in the analysis: 171 (34.8%), 187 (38.0%), and 134 (27.2%) with no DR, nonproliferative DR (NPDR), and proliferative DR (PDR), respectively. After multiple adjustments, higher BMI (odds ratio [OR], 1.06; 95% confidence interval [CI],1.01‐1.11; P 0.02) was significantly associated with any DR. Obese people were 6.5 times more likely to have PDR than were those with normal weight (OR, 6.52; 95% CI, 1.49‐28.6; P 0.013). Neck circumference (OR, 1.05; 95% CI, 1.00‐1.10; P 0.03) and waist circumference (OR, 1.12; 95% CI, 1.03‐1.22; P 0.01) were significantly associated with any DR. BMI (OR, 1.04; 95% CI, 1.00‐1.08; P 0.04) and neck circumference (OR, 1.04 95% CI, 1.01‐1.08; P 0.04) were also positively associated with increasing severity levels of DR. CONCLUSIONS. Persons with diabetes with higher BMI and larger neck circumference are more likely to have DR and more severe stages of DR. These data suggest that obesity is an independent risk factor for DR. (Invest Ophthalmol Vis Sci. 2011;52:4416‐4421) DOI:10.1167/iovs.11-7208

This review summarizes the recent literature of the impact of cataract surgery from the patient's perspective, with a focus on second-generation patient reported outcome (PRO) measures that used Rasch analysis to explore their data.Irrespective of the instrument utilized, the overriding conclusion is that cataract surgery unequivocally improves vision-specific functioning and several aspects of vision-specific quality of life. The benefit of cataract surgery, however, on generic health is less clear, due to limited vision-related items. Evidence suggests that cataract surgery also improves visual functioning in comorbid eye disease, especially in the early stages. Similarly, second eye cataract surgery appears to improve visual ability beyond that achieved with first eye surgery. Recently, there has been a shift toward second-generation, Rasch-validated PROs to assess cataract surgery outcomes and large gains in visual function have been demonstrated. Importantly, measurement precision is dramatically improved compared with the original first-generation instruments.Cataract surgery-induced improvements in visual acuity are translated by considerable gains in real life activities, emotional and social life components. The utilization of second-generation instruments and modern psychometric methods, however, appears to be the best current strategy to optimize the impact of cataract surgery on health-related quality of life.

To validate the German-translated VF-14, a vision-specific scale, and determine the relationship between the severity of vision impairment, ocular conditions, and visual functioning.This was a clinic-based, cross-sectional study with 184 patients with low vision and 90 normal-sighted controls recruited from a German eye hospital. Participants underwent a clinical examination and completed the German VF-14 scale. The validity of the VF-14 scale was assessed using Rasch analysis. The main outcome measure was the visual functioning overall score.The participants' mean ± SD [standard deviation] age was 59.4 ± 21.8 years ,and there were more female (58.4%) than male participants. The main cause of vision loss was age-related macular degeneration [AMD] (n = 54, 19.7%). Rasch analysis substantiated the German VF-14 to be a valid scale to assess visual functioning in the sample. Visual functioning consistently declined with worsening vision. In adjusted-multivariate analysis models, compared to control participants, those with mild, or moderate/severe vision impairment recorded significantly poorer visual functioning scores (p0.05). The independent association was clinically significant for those with moderate/severe vision impairment. The main ocular conditions were also found to be independently associated with worse visual functioning, with clinical significance found for AMD, diabetic retinopathy, and other retinal diseases.Using a psychometrically valid German-translated VF-14, even mild vision impairment was independently associated with poor visual functioning. These findings reinforce the importance of early preventative and rehabilitative efforts to prevent longitudinal deterioration in vision loss.

Understanding the impact of a condition from the patient's perspective is important, and different types of patient-reported outcomes or instruments are available to help with this. This review article summarises the current evidence on the impact of diabetic retinopathy (DR) and its associated vision impairment on patient-reported outcomes. We have included research that has used a range of outcome measures to assess the impact of DR on generic health-related quality of life, utility, vision-functioning and vision-specific quality of life. This review also offers clarification on frequently misused psychometric terminologies to help clinicians and researchers better understand the literature associated with patient-reported outcome research. Overall, the evidence suggests that DR, particularly in its vision-threatening stages, has a substantial, negative impact on the patient. However, our understanding of the impact of DR is currently restricted due to limitations inherent in currently available patient-reported outcome measures. We conclude by discussing potential directions for future research in this area, such as item banking and computer adaptive testing.

Depression is common in people with vision impairment and further reduces levels of functioning independent of vision loss. However, depression most often remains undetected and untreated this group. Eye health professionals (EHPs) (ophthalmic nurses, ophthalmologists, optometrists, and orthoptists) and rehabilitation workers (RWs) may be able to play a role in detecting depression. This study aimed to identify current practice and investigate factors associated with depression management strategies.A self-administered cross-sectional survey of EHPs and RWs assessed current practice including confidence in working with depressed people with vision impairment; barriers to recognition, assessment, and management of depression; beliefs about the consequences, duration, and efficacy of treatment for depression in individuals with vision impairment.Ninety-four participants aged 23 to 69 years took part. Thirty-seven participants (39.8%) stated that they attempted to identify depression as part of patient management, with RWs significantly more likely to do so (n = 17, 60.7%) than EHPs (n = 20, 30.8%; p = 0.007). Intention to identify depression was not associated with sociodemographic factors, professional experience in eye care services, or the length and number of patient consultations, but a significant relationship was found for confidence, barriers, and beliefs about depression (p0.05). No consistent depression management strategy emerged and a range of barriers were highlighted.Training programs are needed to provide EHPs and RWs with the skills and resources to address depression in people with vision loss under their care and to support the development of procedures by which concerns about depression can be identified objectively, documented, and included as part of a referral to appropriate services.

Falls are an alarming health problem and a major cause of injury among the elderly. The healthcare cost associated with falls is considerable. Visual acuity has been found to be an independent risk factor for falls; however, the results are not unanimous. Moreover, other aspects of visual function such as visual field, contrast sensitivity and depth perception have not been adequately investigated in relation to falls. The aim of this study, therefore, was to determine the relationship between visual function, duration, and main causes of visual impairment, and falls in individuals with low vision. This was a cross-sectional study involving participants attending a public tertiary eye care hospital. Participants were mobile, aged 60 years or above, and had low vision (visual acuity >0.3 LogMAR in the better eye). Details about falls in the previous 12 months and other information were collected, and patients completed a questionnaire about activities of daily living. The duration and main causes of visual impairment, visual acuity, contrast sensitivity, depth perception, and visual field were assessed. Descriptive statistical analyses were performed to characterize the participants’ sociodemographic and clinical data. One hundred and twenty seven patients (53%; 67 males) with a mean age of 76.3 ± 8.3 years were recruited. Thirty seven percent of the participants (n = 47) had mild, 50% (n = 64) moderate and 13% (n = 16) severe visual impairment (>0.3–0.5; >0.5–1.0; and >1.0 LogMAR respectively). The frequencies of single and multiple falls were 42.5% and 12.6% respectively. Visual acuity, contrast sensitivity, depth perception, visual field, main cause, and duration of visual impairment were not significantly associated with falls (p > 0.05). In multiple regression analyses, physical inactivity remained the only variable independently associated with falls in all models except for visual field. Overall, visually impaired people were three times more likely to fall if they were physically inactive. Visual function, duration and main causes of visual impairment are not independently associated with falls in people with low vision. However, a significant relationship between non-participation in physical activity and falls was found. Further work is required to investigate the association between vision-related factors and falls in older people with visual impairment.

PURPOSE: To determine the longitudinal impact of specific coping strategies on vision-related quality of life (VRQoL) in patients with low vision. METHODS: This was a single-group, longitudinal study utilizing telephone-administered interviews conducted at baseline and at 3 and 6 months with patients (visual acuity < 6/12 in the better eye) recruited from low vision services. The Coping Strategy Indicator (CSI) assessed three strategies used specifically in relation to vision-related problems: avoidant coping, problem-solving coping, and seeking social support. Vision-related quality of life was assessed using the Impact of Vision Impairment (IVI) questionnaire, which comprises two domains: vision-related functioning and vision-related emotional well-being. We used multivariable mixed linear regression including time as an independent variable to assess change in VRQoL. RESULTS: The study comprised 162 patients (mean age = 69.8 years, 66% female), most with age-related macular degeneration (42%) and moderate vision impairment (41%

PurposeTo assess the impact of VA loss on patient reported utilities taking both eyes into account compared to taking only the better or the worse eye into account.MethodsIn this cross-sectional study 1085 patients and 254 controls rated preferences with the generic health-related (EQ-5D; n = 868) and vision-specific (Vision and Quality of Life Index (VisQoL); n = 837) multi-attribute utility instruments (MAUIs). Utilities were calculated for three levels of VA in the better and worse eyes, as well as for 6 different vision states based on combinations of the better and worse eye VA.ResultsUsing the VisQoL, utility scores decreased significantly with deteriorating vision in both the better and worse eyes when analysed separately. When stratified by the 6 vision states, VisQoL utilities decreased as VA declined in the worse eye despite stable VA in the better eye. Differences in VisQoL scores were statistically significant for cases where the better eye had no vision impairment and the worse seeing fellow eye had mild, moderate or severe vision impairment. In contrast, the EQ-5D failed to capture changes in better or worse eye VA, or any of the six vision states.ConclusionsCalculating utilities based only on better eye VA or using a generic MAUI is likely to underestimate the impact of vision impairment, particularly when the better eye has no or little VA loss and the worse eye is moderately to severely visually impaired. These findings have considerable implications for the assessment of overall visual impairment as well as economic evaluations within eye health.

PURPOSE To determine the relative importance and associated risk factors of vision-specific distress and depressive symptoms in people with visual impairments. METHODS In this cross-sectional study, 162 adult patients with visual acuity less than 6/12 were interviewed using telephone-administered questionnaires. Vision-specific distress was assessed with the emotional well-being scale of the Impact of Vision Impairment Questionnaire. Depressive symptoms were assessed with the Patient Health Questionnaire-9. Other measures including vision-specific functioning, coping, and social support were also assessed. Multiple regression and commonality analysis were used to determine the relative contribution of factors explaining variance in vision-specific distress and depressive symptoms. RESULTS Vision-specific distress and depressive symptoms were strongly associated. Vision-specific functioning (βs = 0.47, P < 0.001), avoidant coping (βs = -0.32, P < 0.001), social coping efficacy (βs = -0.17, P = 0.001), and depressive symptoms (βs = 0.18, P = 0.006) were significant determinants of vision-specific distress. Vision-specific functioning accounted for 37.7% of the unique variance in this model. Vision-specific distress was an important risk factor for depression, accounting for 36.6% of the unique variance in depressive symptoms. CONCLUSIONS Vision-specific distress is related to a person's ability to manage the practical and social challenges of vision impairment. Further work is required to distinguish vision-specific distress and depression and to examine what interventions are best to target vision-specific distress.

PURPOSE To evaluate the validity, reliability, and measurement characteristics of the Visual Function 14 (VF-14) in a German sample using Rasch analysis. METHODS This was a clinic-based, cross-sectional study with 184 patients with low vision recruited from an outpatient clinic at a German eye hospital. Participants underwent a clinical examination and completed the German VF-14 scale. The validity of the VF-14 scale was assessed using Rasch analysis. The main outcome measure was the overall functional score provided by the VF-14. RESULTS After collapsing two response categories for items 13 and 14, the VF-14 scale satisfied fundamental criteria to achieve fit to the Rasch model, namely, ordered thresholds, the ability to distinguish between different strata of participant ability, absence of misfitting items, no evidence of unidimensionality, and no significant differential item functioning for key sociodemographic covariates. The VF-14 is able to discriminate between participants with different levels of vision impairment and across different cultural groups. CONCLUSIONS The VF-14 is a valid, reliable, and unidimensional questionnaire for use in a German population. These findings contribute to the growing evidence base for second generation patient reported outcome measures in ophthalmology, and support the use of the German VF-14 in tertiary eye clinics in Germany to capture the impact of visual impairment on visual function from the patient's perspective and to inform low vision rehabilitation and interventions.

PURPOSE To validate the German-translated Low Luminance Questionnaire (LLQ), a vision-related quality of life scale assessing mainly mesopic and scotopic functioning, and to determine the relationship between the severity of vision impairment, ocular conditions, and low luminance-related visual functioning. METHODS In all, 274 participants, 184 patients with visual acuity

PURPOSE. To assess the association of serum lipids with diabetic retinopathy (DR), diabetic macular edema (DME), and macular thickness in adults with diabetes. METHODS. Diabetic patients aged 18 years were prospectively recruited from specialized eye clinics in Melbourne, Australia. Fasting total-C (cholesterol), triglyceride, HDL-C, non-HDL-C, and LDL-C were assessed. DR was graded from fundus photographs and classified into mild, moderate, severe nonproliferative, and proliferative DR and separately graded for the presence of DME, including clinically significant macular edema (CSME). Macular thickness was assessed using optical coherence tomography (OCT). RESULTS. A total of 500 participants (median age, 65 years) were examined. DR, DME, and CSME were present in 321 (66.2%), 149 (33.0%), and 68 (15.0%) patients, respectively. Serum lipid levels were not related to DR or DME. In multivariate models adjusted for traditional risk factors and lipid medications, persons with higher total-, LDL-, and non-HDL-C were more likely to have CSME (odds ratio of 1.54, 1.49, and 1.63 per 1-SD increase, respectively; all P 0.05). No association was found for serum lipids with macular thickness, as assessed by OCT. The pattern of these associations remained similar in both type 1 and type 2 diabetes, although it was statistically significant only in type 2 diabetes. CONCLUSIONS. Serum lipids are independently associated with the CSME, but not with DR, mild or moderate DME, or macular thickness. These data reflect the different impact of hyperlipidemia in the pathogenesis of DR and DME and may explain the discrepancies in previous studies. (Invest Ophthalmol Vis Sci. 2011;52:7464‐7469) DOI:10.1167/iovs.11-7598

PURPOSE: To validate the German-translated Impact of Vision Impairment (IVI) questionnaire, a vision-specific quality of life (QoL) scale, and determine the relationship between the severity of vision impairment, ocular conditions, and VRQoL. METHODS: This cross-sectional study was clinic based, with 184 patients with low vision recruited from an outpatient clinic at a German eye hospital. Participants underwent a clinical examination and completed the German IVI scale. The validity of the IVI scale was assessed using Rasch analysis. The main outcome measure was the overall functional and emotional score provided by the IVI. RESULTS: Overall, there were more female (n = 111, 60.3%) than male participants. Participants' mean ± SD age and visual acuity in the better eye were 69.0 ± 15.5 years and. 0.41 ± 0.35 logMAR, respectively. The main cause of vision loss was age-related macular degeneration (n = 54, 29.3%). Rasch analysis demonstrated the validity of the German IVI to assess VRQoL through two subscales: vision-specific functioning and emotional well-being. In adjusted multivariate analysis models, those with mild or moderate/severe vision impairment reported significantly poorer vision-specific functioning (mean change, -6.5, P = 0.018 and -11.98, P < 0.001 for mild and moderate to severe VI, respectively) and emotional well-being (mean change, -2.35; P = 0.043 and -3.13, P = 0.004 for mild and moderate/severe VI respectively) compared with non-visually impaired patients. CONCLUSIONS: Using a psychometrically valid German IVI, even mild vision impairment was independently associated with poor VRQoL. These findings reinforce the importance of early preventative and rehabilitative efforts to prevent longitudinal deterioration in vision loss.

PURPOSE To determine the longitudinal impact of idiopathic macular telangiectasia (MacTel) type 2 on vision-specific quality of life (QoL). METHODS Participants with MacTel type 2 and controls with no vision impairment were recruited at baseline. All underwent a full ophthalmic examination and the interview-administered 28-item Impact of Vision Impairment (IVI) questionnaire at baseline, to gather information on sociodemographic factors and vision-specific QoL. The MacTel patients were reassessed at 24 months. RESULTS For the MacTel participants (n = 22), the median (range) age and visual acuity were 64 years (45-87) and 20/32 (20/13-20/63) in the better eye, respectively. The corresponding median values in the control group (n = 38) were 57 years (41-68) and 20/25 or better in both eyes, respectively. Rasch analysis showed that the IVI and its three subscales had sufficient psychometric validity and possessed interval level estimates. The control group had almost twice the level of vision-specific QoL than did the MacTel group at baseline on all IVI scores (P < 0.001 for all). At 24 months, we found no significant change in any of the IVI scores in the MacTel group. Similarly, there was no significant difference in visual acuity in the better or worse eyes in that group after 2 years. CONCLUSIONS Persons with MacTel type 2 had poorer overall vision-related QoL than did healthy controls. Several aspects of vision-related QoL and distance visual acuity did not significantly change after 24 months. Longer follow-up assessment periods are needed to determine the longitudinal impact of this condition on vision-related QoL.

Objective To investigate the impact of pseudoxanthoma elasticum (PXE), a rare hereditary disease of concurrent vision impairment (VI) and cardiovascular complications (CVCs), on vision-related (VRQoL) and health-related quality of life (HRQoL). Methods VRQoL and HRQoL were assessed using the Impact of Vision Impairment (IVI) questionnaire and the Short Form Health Survey (SF-36) in 107 PXE patients. Patients were stratified into four groups: A = no VI or CVC; B = CVCs only; C = VI only; and D = both VI and CVCs. Results Following Rasch analysis, the IVI was found to function as a vision-specific functioning and emotional well-being subscale, and the SF-36 as a health-related physical functioning and mental health subscale. The presence of VI and CVC were significant predictors of vision-specific functioning and emotional well-being (p < 0.001), with a clinically meaningful decrement in vision-specific functioning in patients with VI. No associations were found for the SF-36 Physical Functioning and Mental Health scores between any groups. Conclusions Vision impaired patients with PXE report significantly poorer vision-specific functioning than PXE patients without VI. In contrast, the relative impact of PXE on reported general HRQoL was much less. Our results suggest that vision impairment has the larger impact on QoL in this sample.

PURPOSE To determine the unique contribution of vision-specific distress in predicting depressive symptoms in people with vision impairment attending a tertiary eye care clinic. METHODS In this cross-sectional study, interview-administered surveys were conducted with 143 adult patients who had presenting visual acuity

To determine the relationship between the severity of distance and near-vision impairment on vision-specific quality of life (QoL) and depression in residential care residents.Residents from three low-level residential care facilities in Victoria (Australia) were recruited. All participants were assessed for cognitive impairment, distance and near-vision impairment (VI), and depression. Sociodemographic and other clinical data were also collected. The subscales of the Nursing Home Vision-Targeted Health-Related Quality-of-Life questionnaire (NHVQoL) were the main outcome measures and were validated by Rasch Analysis.Seventy-six residents were enrolled. The mean +/- SD of the participants' age was 83.9 +/- 9.9 years, and most were women (n = 44; 60%); 46.4% (n = 35) had binocular presenting VI (6/12), and 59% (n = 44) had at least mild near VI (worse than N8); 16% (n = 14) recorded depression symptoms, although depression was not associated with VI (P0.05). In linear regression models, distance and near VI was independently associated with poorer QoL on seven of the eight subscales of the NHVQoL scale (P0.05). The beta coefficients ranged from -12.3 to -80.2, which suggests that, on average, people with vision loss had poorer QoL, ranging between 12 and 80 points (scale range: 0-100) than did those with no VI. The QoL aspects most affected by vision loss were related to general vision, reading, hobbies, emotional well-being, and social interaction.VI remains a major form of disability in individuals living in residential care facilities and affects vision-specific functioning and socioemotional aspects of daily living. A larger study is needed to confirm these findings.