A new study from Tanzania has provided some of the first evidence from Africa on how diabetic retinopathy affects quality of life, finding that blindness caused by the condition is associated with a substantial reduction in both general health-related quality of life and vision-related quality of life. The findings provide important data for evaluating the cost-effectiveness of diabetic retinopathy screening and treatment programmes across the region.
Diabetic retinopathy is a leading cause of blindness among working-age adults worldwide. While screening and timely treatment can prevent most vision loss, economic evaluations of these services require robust information on how different stages of disease affect people’s lives. Until now, utility values used in African studies have generally been borrowed from populations in Europe, North America or Asia.
Researchers from the International Centre for Eye Health and Kilimanjaro Christian Medical Centre interviewed 278 adults with diabetes in northern Tanzania. Participants included 80 people with no diabetic retinopathy, 67 with non-sight-threatening diabetic retinopathy, 109 with sight-threatening diabetic retinopathy, and 22 who were blind from diabetic retinopathy. Health-related quality of life was assessed using the EQ-5D-5L questionnaire, while vision-related quality of life was measured using the WHO/PBD-VF20 instrument.
The study found that quality of life declined as diabetic retinopathy became more severe. Mean utility values fell from 0.75 among people with no diabetic retinopathy to 0.69 for non-sight-threatening disease and 0.61 for sight-threatening disease. The greatest impact was seen among people who were blind from diabetic retinopathy, whose mean utility value was just 0.23, indicating a profound reduction in health-related quality of life. After adjusting for other factors, blindness from diabetic retinopathy remained strongly associated with lower utility values.
Vision-related quality of life showed a similar pattern. Overall scores declined from 85.3 out of 100 among people with no diabetic retinopathy to 78.6 for non-sight-threatening disease, 64.8 for sight-threatening disease and just 21.4 among those blind from diabetic retinopathy. Unlike the generic quality-of-life measure, even non-sight-threatening diabetic retinopathy was associated with significantly worse vision-related quality of life.
The authors suggest this may indicate that generic tools such as EQ-5D can underestimate the impact of eye disease, particularly in its earlier stages. They argue that vision-specific quality-of-life measures should be considered alongside generic measures when assessing ophthalmic interventions.
The findings also highlight the wider consequences of diabetic retinopathy in low-resource settings. The utility value associated with blindness in this Tanzanian population was lower than values reported in comparable studies from India, Taiwan, Brazil and the UK. The authors suggest that limited social support and rehabilitation services for people with vision loss may contribute to the greater impact observed.
The researchers conclude that these estimates can be used in future economic evaluations of diabetic retinopathy screening and treatment programmes in Africa. As lower-cost retinal cameras and artificial intelligence-supported screening systems become more widely available, the data provide an important foundation for assessing the value of interventions designed to prevent avoidable blindness from diabetes.
Publication
Cleland C, Marques AP, Cairns J, Rwiza J, Mumba F, Makupa W, Bolter L, Macleod D, Bascaran C, Burton MJ. Quality-of-Life and Utility Values Associated With Diabetic Retinopathy in Tanzania. June 2026. https://doi.org/10.1016/j.vhri.2026.101655