COVID-19 Shows Limited Impact on Quality of Life in Seniors with Eye Diseases

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Overall quality of life appeared good during the COVID-19 pandemic, but the presence of retinal disease and the number of nonocular comorbidities were linked to negative impacts on vision-related quality of life.

The COVID-19 pandemic did not appear to have a significant impact on the quality of life in older individuals with eye diseases, as measures of both preference-based health-related (HRQoL) and vision-related quality of life (VRQoL) were reported as high, according to new research.1

Cross-sectional analyses showed only a slight loss in VRQoL impacting visual performance during the COVID-19 pandemic period; however, the presence of retinal disease and the number of nonocular comorbidities each had a significant, negative impact on VRQoL.

“Overall quality of life and wellness among seniors with eye diseases appeared to be good during the COVID-19 pandemic,” wrote the investigative team, led by Monali Malvankar-Mehta, PhD, department of ophthalmology, Schulich School of Medicine and Dentistry, the University of Western Ontario. “However, the presence of retinal disease and the number of nonocular comorbidities both appeared to negatively impact VRQoL and social support and community integration.”

The onset of the COVID-19 pandemic accelerated the heavy burdens faced by the healthcare system and impacted patient care globally. Those with ophthalmological conditions were greatly affected, due to average patient age and preexisting comorbid conditions. Due to these vulnerabilities, the risk of transmission during ophthalmological care was perceived as relatively high.

Malvankar-Mehta and colleagues suggested the “delicate balance” between the risk of exposure to the disease and visual loss stemming from lack of care was a psychological stressor to the patient and their care team. The inability to access care may have increased nonadherence, made patients less likely to follow guidance for their disease, and reduced overall quality of life.2

The analysis identified a convenience sample of 90 patients with an underlying ocular disease from 4 ophthalmologic practices in Ontario from November 2021 to May 2022.1 Patients were 65 years or older and diagnosed with an eye disease by an experienced ophthalmologist.

Relevant questionnaires were presented to participants, including the Time Trade-Off (TTO) questionnaire, the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), the Hospital Anxiety and Depression Scale-Anxiety Subscale (HADS-A), the Center for Epidemiologic Studies–Depression Scale (CES-D), Pittsburgh Sleep Quality Index (PSQi), and Community Integration Questionnaire (CIQ).

Upon analysis, the average utility score from the TTO questionnaire, ranging from 0 (stage of death) to 1 (perfect visual health), was reported as 0.88. This result suggests most patients were willing to trade 12% of their remaining life for perfect vision.

The NEI VFQ-25, measured from 0 (worst) to 100 (best), showed an average score of 84.71. The presence of retinal disease significantly changed the NEI VFQ-25 score (–7.92; 95% CI, –12.81 to –3.05; P = .002). For each increase in the number of nonocular comorbidities, the NEI VFQ-25 score also significantly changed (–1.66; 95% CI, –30.1 to –0.31; P = .033).

Self-reported symptoms measured in the CES-D, from 0 to 60, revealed the average CES-D score was 6.79. The multivariable regression model revealed both the presence of retinal disease and the use of a mobility aid were predictive of CES-D score. Still, the increase was not significant for the presence of retinal disease (P = .094), while the use of a mobility aid significantly increased the CES-D score (4.20; 95% CI, 0.46 - 7.94; P = .028).

Measures of anxiety in the HADS-A subscale, ranging from 0 to 21, showed an average score of 2.83. The use of mobility aid increased the score (0.58; 95% CI, –0.87 to 2.04), but the change was not significant (P = .428).

Sleep quality was measured in the PSQi with a score from 0 to 21 and showed the average score in the patient population was 6.58. This model showed, again, the use of a mobility age significantly increased the PSQi score (1.73; 95% CI, 0.05 to 3.41; P = .044).

Measuring social support and community integration on a scale from 0 to 29, the average CIQ total score was 14.46. Analyses showed the presence of retinal disease (–3.10; 95% CI, –4.77 to –1.43; P <.001) and each increase in the number of nonocular comorbidities (–0.68; 95% CI, –1.15 to –0.22; P = .004) significantly changed the CIQ score. Education level also significantly changed the CIQ score (–1.79; 95% CI, –1.15 to –0.22; P = .004).

“Based on the key measures of QoL such as preference-based HRQoL, VRQoL levels of depression and anxiety, and access to social support and community integration, the above findings indicate that the QoL and wellness of the elderly with eye diseases appear to be good,” investigators wrote.


  1. Yu BE, Ali S, Jang H, et al. The quality of life of seniors with eye diseases during COVID-19. Journal of Ophthalmology. September 26, 2023. Accessed October 2, 2023.
  2. N. Salari, A. Hosseinian-Far, R. Jalali et al., “Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis,” Globalization and Health, vol. 16, no. 1, pp. 57–11, 2020.