Vision-related quality of life among patients with diabetic retinopathy at the National Eye Hospital, Sri Lanka: A cross-sectional study

Abstract

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM), arising from retinal vascular damage due to prolonged hyperglycemia. It is a leading cause of vision loss among working-age adults globally. This study aimed to assess visionrelated quality of life (VRQoL) and its associated factors among patients with DR at the National Eye Hospital of Sri Lanka. A descriptive cross-sectional study was conducted among 289 DR patients attending the eye clinic, selected using convenience sampling. Data were collected using an interviewer-administered NEI-VFQ-25 questionnaire and analysed using SPSS version 25. Of the participants, 61% were female, 73.5% were aged above 60 years, 94.4% were Buddhist, and 94.4% were Sinhalese. Most were married (96.3%) and literate, with 35.8% educated up to O/L. More than half (54.5%) reported poor overall health, and 49.7% experienced ocular pain or discomfort. Difficulties were common in reading printed materials (49.7%), cooking/ sewing (49.7%), going down steps in dim light (32.8%), and matching clothes (54.5%). Driving limitations were substantial—59.7% had given up driving, and 62.8% reported extreme difficulty driving at night. The mean composite VRQoL score was 58.8±18.7, highest for social functioning (98.0±24.2) and lowest for driving (37.5±36.5). QoL declined significantly with age (p = 0.02) and was lower among patients with proliferative DR (32.1±16.3) compared to non-proliferative DR (51.6±21.5) (p < 0.001). Type II DM patients had significantly higher QoL scores (42.8±20.9) than those with Type I DM (31.0±17.8) (p = 0.01). Marital status (p< 0.001) and educational qualification (p = 0.02) were also significantly associated with QoL. Visual acuity and perimetry mean deviation in both eyes showed strong correlations with VRQoL scores (p<0.05). DR significantly impairs VRQoL, particularly in domains of driving, near/distant activities, and independence. Older age, advanced DR stage, Type I DM, and lower education are associated with poorer QoL. Routine VRQoL assessments and tailored interventions are recommended to optimise patient management, preserve functional independence, and improve overall well-being.