Objective To evaluate the vision-related quality of life in the elderly patients with diabetic retinopathy (DR) and analyze its influencing factors. Methods A total of 330 elderly DR patients (DR group) and 310 elderly non-DR patients with type 2 diabetes mellitus (non-DR group) were selected from Department of Ophthalmology of the First Affiliated Hospital of Hebei North University from May 2020 to May 2023. The scores of 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) were compared between the two groups. The multivariate linear regression model was used to analyze the independent influencing factors of NEI-VFQ-25 scores in the DR patients, and the correlation between anxiety, depression, self-management ability and vision-related quality of life in them was analyzed. SPSS 22.0 was used for statistical analysis. and t- or F-test was used for comparison of quantitative data. Pearson correlation coefficient was used to analyze the correlation between anxiety, depression, self-management ability, and visual related quality of life. A multiple linear regression model was used to analyze the influencing factors of vision-related quality of life in the DR elderly patients. Results Totally, 640 questionnaires were distributed, and 560 valid questionnaires were collected. The analysis found that the total score of NEI-VFQ-25 in the DR group was (64.79±14.21) points, and the subscale scores and total score of NEI-VFQ-25 were lower than those in the non-DR group (P<0.05). Multivariate linear regression analysis showed that severe lesion (β=-0.253; P<0.001), complicated diabetic macular edema (DME) (β=-0.224; P<0.001), anxiety (β=-5.207; P=0.005), depression (β=-5.534; P=0.004), and low self-management ability (β=-6.942; P<0.001) could significantly negatively predict vision-related quality of life in the elderly DR patients, and that blood glucose control (β=4.406; P=0.009) could significantly positively predict vision-related quality of life in the DR elderly patients, and the regression equation was significant (F=24.817; P<0.001). Pearson correlation analysis showed that NEI-VFQ-25 score in the elderly DR patients was negatively correlated with Hamilton anxiety scale score and Hamilton depression scale score (r=-0.512, -0.488; P<0.001) and was positively correlated with the score of adult health self-management skill rating scale (r=0.652; P<0.001). Conclusion The vision-related quality of life in the elderly DR patients is reduced. The severity of lesion, DME, anxiety, depression and low self-management ability are negative predictors, and blood glucose control standard is a positive predictor.