Diabetic retinopathy: Repercussions of visual impairment on functionality and quality of life

Abstract

Introduction: Diabetic retinopathy is a complication of diabetes mellitus with repercussions that extend beyond ophthalmic changes, affecting functionality, independence, and quality of life. Visual impairment can lead to limitations in daily activities, mobility, and social participation, as well as psychological and emotional consequences, making a multidimensional assessment of affected individuals relevant. Objective: To analyze evidence regarding the impact of visual impairment associated with diabetic retinopathy on functionality and quality of life, considering its effects on visual function, activities of daily living, mobility, functional independence, social participation, and psychological aspects. Methods: This is an integrative literature review of a qualitative and descriptive nature, based on the methodological recommendations of Whittemore and Knafl, and Mendes, Silveira, and Galvão. The search was conducted on September 30, 2026, in the PubMed/MEDLINE, SciELO, and Virtual Health Library (VHL) databases. Selection was carried out by two independent reviewers through title and abstract screening followed by full-text reading; disagreements were resolved by consensus, with a third reviewer available if needed. Data extraction covered methodological characteristics, population, objectives, visual function and impairment, functional limitations, activities of daily living, mobility, social participation, psychological aspects, and quality of life. Results: Seventy records were identified, 20 of which were duplicates. Of the 50 records screened, 20 were excluded and 30 were fully evaluated. After excluding 18 publications, 12 studies comprised the final sample. The included studies employed various designs, predominantly observational research, alongside a qualitative study, a systematic review, and a systematic review with meta-analysis. Studies indicated that greater visual impairment and increased severity of diabetic retinopathy were associated with poorer visual function, limitations in near and distance vision activities and activities of daily living, reduced mobility and functional independence, lower social participation, and poorer quality of life—particularly vision-related quality of life. Psychological and emotional impacts were also identified, including anxiety, depressive symptoms, and concerns regarding vision loss. Studies evaluating clinical progression found that advanced forms of the disease (such as proliferative diabetic retinopathy) and more pronounced visual acuity deficits were linked to greater functional impairment and poorer quality of life, while diabetes duration and glycemic control were also associated with certain visual and functional outcomes. Collectively, these results highlight the multidimensional nature of the impact of diabetic retinopathy, encompassing ophthalmological, functional, psychological, and social dimensions. However, the heterogeneity of study designs, populations, and assessment tools limited direct comparisons between studies and the estimation of a single quantitative measure for the magnitude of these associations. The heterogeneity of designs and instruments used, along with the possibility of overlap between primary studies and secondary syntheses, must be considered when interpreting the evidence. Conclusion: Diabetic retinopathy is associated with impairments in functionality and quality of life, particularly in individuals with significant vision loss and more severe forms of the disease. Evidence indicates limitations in daily activities, mobility, functional independence, and social participation, as well as poorer vision-related quality of life and psychological impacts. However, results have not been consistent across studies, and methodological heterogeneity limits the ability to determine the magnitude of these associations. Therefore, longitudinal and more methodologically standardized studies are needed to clarify, with greater precision, how functional impacts and quality of life evolve as diabetic retinopathy progresses.