Table 3. Findings on the Association Between Vision Impairment or Eye Disease and Quality of Life by Systematic Review^a.

Systematic reviewa	Year	Country of lead author	Quality of life outcome or measure	Assessment instruments	Participants, No.b	Participant type	Studies, No.	Study type	Countries of primary studiesb	Results/findings
Systematic reviews of quantitative studies
Nyman, et al47	2010	UK	Mental health subscale in QOL questionnaires	NEI-VFQ-25 and SF-36	33 648	Working-age adults (18-59 y)	11	NR	The US, Korea, and India	Vision impairment was associated with modestly lower mental health scores on the NEI-VFQ-25 than control participants (average mean difference, 14.5% [range, 0.6%-35%]). The SF-36 was less sensitive than the NEI-VFQ-25 in detecting lower mental health among those with vision impairment vs controls (mean difference, 3%; 1 study only).
Nyman, et al47	2010	UK	QOL	NR	2622	Working-age adults (18-59 y)	3	NR	The US, Sweden, and Australia	Vision impairment was associated with lower QOL across a range of measures, such as higher odds of reporting “not feeling full of life” vs control participants (OR, 4.63 [95% CI, 2.1-9.8])
Tseng, et al49	2018	Taiwan	QOL	WHOQOL-BREF, CDCHRQOL, SF-36, IVI, NHVQOL, EQ-5D, NEI-VFQ-25, and WHO/PBD VF20	NR	Older adults	15	14 cross-sectional and 1 longitudinal study	Australia, Canada, Europe, Germany, Korea, Nepal, New Zealand, Nigeria, Philippines, Taiwan, and the US	Vision impairment was associated with lower QOL in 14 of 15 studies (eg, OR, 2.20 [95% CI, 1.10-4.90] in 1 study examining vision impairment and generic health-related QOL; in another study examining vision impairment among older adults, the difference in SF-36 scores was 6.7 (95% CI, 3.37-10.1; P < .001). An increase in vision impairment severity was associated with lower QOL (eg, β, 0.31 [95% CI, 0.11-0.52]; P = .003).
Schakel, et al48	2019	The Netherlands	Fatigue severity	SF-36 vitality subscale or Fatigue Assessment Scale	10 870	Adults	14	7 case-control and 7 cross-sectional studies	Australia, Brazil, China, Greece, Japan, Nepal, the Netherlands, Taiwan, and the US	Vision impairment was associated with higher levels of fatigue in affected participants vs control participants with normal sight (standardized mean difference [SMD], −0.36 [95% CI, −0.50 to −0.22]; I2 = 84%).
Schakel, et al48	2019	The Netherlands	Fatigue odds	SF-36 vitality subscale or Fatigue Assessment Scale	8053	Adults	4	2 cross-sectional and 2 case-control studies	Canada, Czech Republic, Germany, and the Netherlands	Vision impairment was associated with higher odds of fatigue in affected participants vs control participants with normally sight (pooled adjusted OR, 2.61 [95% CI, 1.69-4.04]; I2 = 90%).
Wang, et al50	2017	China	Disease-specific QOL	GQL-15 questionnaire	253	Individuals with glaucoma	2	NR	Australia and Nigeria	Glaucoma was associated with significantly higher (ie, poorer) QOL summary scores (SMD , 0.94 [95% CI, 0.73-1.16]; P < .001; I2 = 0%), and subscale scores for all 4 factors (central and near vision: SMD, 0.82 (95% CI, 0.61-1.04]; P < .001; peripheral vision: SMD, 0.74 [95% CI, 0.53-0.96]; P < .001; dark adaption and glare: SMD, 1.02 [95% CI, 0.80-1.24]; P < .001; outdoor mobility: SMD, 0.60 [95% CI, 0.39-0.81]; P < .001) vs control group without glaucoma.
Khoo, et al6	2019	Singapore	Psychosocial functioning	Depression or anxiety questionnaires and mental health QOL subscale scores	NR	Individuals with diabetic retinopathy	28	Cross-sectional	NR	Diabetic retinopathy was significantly associated with poor psychosocial functioning in 20 of 28 observational studies (measures of association not provided).
D’Amanda, et al53	2020	US	QOL	NEI-VFQ-25, VF-14, SF-12, HRQOL-14, WHOQOL-BREF, CHQ, SF-36, and PedsQL	905	Individuals with mendelian eye conditions	11	Cross-sectional	Brazil, Canada, France, Greece, Israel, Korea, the Netherlands, and the UK	Retinitis pigmentosa, Usher syndrome, mixed retinal dystrophies, and retinoblastoma (in children) were associated with lower overall QOL in 5 studies. CHARGE syndrome, albinism, retinoblastoma, and mixed retinal dystrophies were associated with lower QOL on certain subscales (not specified) in 6 studies (measures of association not provided).
Systematic reviews of qualitative studies
Nyman, et al7	2012	UK	Emotional well-being	NA	NR	Older adults	NR	Qualitative	NR	Diagnosis of vision impairment was identified as a traumatic event in 8 studies. An array of emotions was reported around the time of diagnosis, including feelings of shock, fear, panic, distress, helplessness, and frustration.
Nyman, et al7	2012	UK	General functioning	NA	NR	Older adults	NR	Qualitative	NR	Vision impairment had a dramatic outcome on individuals’ daily lives and functioning. People reported having to relinquish independence (11 studies) and leisure pursuits (8 studies).
Bennion, et al51	2012	UK	Emotional well-being	NA	121	Individuals with age-related macular degeneration	5	Qualitative	NR	The diagnosis of age-related macular degeneration was described as a shocking even by participants. Some accepted the diagnosis, while others felt powerless and in despair. Negative thoughts and depression symptoms were not confined to those with the most severe cases.
D’Amanda, et al53c	2020	US	General and visual functioning	NA	430	Individuals with mendelian eye conditions	9c	Qualitative	Australia, the Netherlands, Ireland, Sweden, Tanzania, the UK, the US, and Zimbabwe	Vision impairment had a considerable association with visual and global daily functioning and specific aspects of life, such as education, employment, and relationships among people with mendelian eye conditions (albinism, mixed retinal dystrophies, Leber hereditary optic neuropathy, retinitis pigmentosa, Alstrom syndrome, and retinoblastoma).
Garip, et al52	2019	UK	Emotional well-being	NA	223	Individuals with retinitis pigmentosa	10c	Qualitative	Australia, the US, Republic of Korea, Ireland, the Netherlands, and the UK	The diagnosis of retinitis pigmentosa was commonly accompanied by shock, negative emotional states, and a loss of confidence. Participants reported fatigue, fear, isolation, and vulnerability as they coped with the disease and dealt with their own judgements and perceived stigma.
Garip, et al52	2019	UK	Visual functioning	NA	223	Individuals with retinitis pigmentosa	10c	Qualitative	Australia, the US, Republic of Korea, Ireland, the Netherlands, and the UK	The diagnosis of retinitis pigmentosa was accompanied by loss of visual acuity, hobbies, pastimes, and social support. Participants reported difficulty performing day-to-day tasks, such as reading, seeing in changing light conditions, shopping, driving, playing sports, taking part in leisure activities, and doing household chores.

Abbreviations: CDCHRQOL, Centers for Disease Control and Prevention Health-Related Quality of Life; CHARGE syndrome, coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities; CHQ, Children’s Health Questionnaire; EQ-5D, EuroQoL–5 Dimension; GQL-15 questionnaire, Glaucoma Quality of Life–15 questionnaire; HRQOL-14, Health-Related Quality of Life–14; IVI, impact of vision impairment; NA, not applicable; NEI-VFQ-25, National Eye Institute 25-Item Visual Function Questionnaire; NHVQoL, Nursing Home Vision-Targeted Health-Related Quality of Life; NR, not reported; OR, odds ratio; PedsQL, Pediatric Quality of Life Inventory; QOL, quality of life; SF-12, 12-Item Short Form Survey; SF-36, 36-Item Short Form Health Survey; VF-14, Visual Function Index; WHOQOL-BREF, World Health Organization Quality of Life BREF; WHO/PBD VF20, World Health Organization Prevention of Blindness and Deafness Visual Function–20.

^aQuality of evidence ratings were not reported for any study.

^bInforming the specific outcome (a given systematic review may have included more studies for other outcomes).

^cTwo identical primary studies were included in both reviews.