Visual Acuity and Beyond: Sociodemographic Determinants of Quality of Life in Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is a leading cause of vision-related disability worldwide. Evidence on how clinical and sociodemographic factors jointly shape vision-related quality of life (VRQoL) in Eastern European settings remains limited. Methods: We conducted a cross-sectional study of 151 adults with ophthalmologically confirmed DR attending a tertiary ophthalmology clinic in Northeastern Bulgaria (June 2023–February 2025). Best-corrected visual acuity (BCVA; decimal, better-seeing eye), glycated hemoglobin (HbA1c; ordinal categories), duration of diabetes, age, sex, DR subtype, and education were recorded. VRQoL was assessed using the NEI VFQ-25 questionnaire. Non-parametric tests were applied as appropriate; multiple linear regression identified independent predictors of NEI VFQ-25 composite scores. Results: Median age was 62 years (IQR 12.5); 53.0% were female. NEI VFQ-25 median was 77.2 (IQR 37.8). BCVA correlated positively with VRQoL (Spearman’s ρ = 0.455, p < 0.001). VRQoL differed by educational level (Kruskal–Wallis χ2 = 37.3, p < 0.001, ε2 = 0.249), but not by sex (Mann–Whitney U = 2740, p = 0.711); a trend was observed across DR subtypes (H = 5.386, p = 0.067). The multivariable model was significant (F(7, 132) = 10.64, p < 0.001; adjusted R2 = 0.336). Higher VRQoL was independently associated with better BCVA (B = 35.38, 95% CI 25.81–44.95, p < 0.001), higher educational attainment (B = −10.15, 95% CI from −13.92 to −6.38, p < 0.001; coded such that lower education predicts lower scores), and DR subtype (B = 6.63, 95% CI 1.91–11.36, p = 0.007). Age, sex, HbA1c, and diabetes duration were not significant. Conclusions: In this Bulgarian cohort, functional vision (BCVA), education, and DR subtype are the principal determinants of VRQoL, highlighting the need for patient-centered strategies that integrate clinical and social factors.