PURPOSE: To develop a questionnaire assessing vision-targeted health-related quality of life in older adults residing in nursing homes. METHODS: Using content previously identified through structured interviews with nursing home residents, the 57-item Nursing Home Vision-Targeted Health-Related Quality of Life questionnaire (NHVQoL) was drafted with nine subscales - general vision, reading, ocular symptoms, mobility, psychological distress, activities of daily living, activities/hobbies, adaptation/coping and social interaction. Construct validity and internal consistency and test-retest reliability of subscales were evaluated in a sample of adults >or=60 years old residing in nursing homes in Birmingham, Alabama, who had Mini Mental State Exam (MMSE) scores of >or=13. RESULTS: Participants (n=189) had a mean age of 82 years (SD=7.7), were 84% women and 16% men, 24% African-American and 76% Caucasian and had resided in a nursing home for two years on average. All NHVQoL subscales were correlated with subscales from other vision-targeted and generic health-related quality of life instruments (ADVS, 0.43 to 0.85; VF-14, 0.46 to 0.84; SF-36, 0.19 to 0.43). Lower scores were associated with increased depressive symptomatology by the Geriatric Depression Scale (-0.23 to -0.59), increased mobility problems (-0.17 to -0.54), worse distance and near acuity (-0.21 to -0.51) and worse contrast sensitivity (0.20 to 0.50). All subscales had Cronbach alpha>0.95. Test-retest reliability (two-week period) for subscales ranged from 0.57 to 0.84. Subscale scores did not differ as a function of MMSE scores. CONCLUSIONS: The NHVQoL has subscales with good internal consistency reliability and validity. Test-retest reliability is comparable to other questionnaires designed for the nursing home population. This questionnaire may ultimately be useful in understanding the personal burden of visual impairment and eye disease on quality of life and mental health in older nursing home residents and for evaluating the impact of psychosocial and eye care interventions on health-related quality of life in this population.