OBJECTIVE: To examine the effect of treating uncorrected refractive error through spectacle correction on vision-targeted health-related quality of life and depressive symptoms in nursing home residents. METHODS: Persons aged 55 years or older residing in nursing homes in Birmingham, Alabama, having uncorrected refractive error were randomly assigned to either immediate spectacle correction of uncorrected refractive error or delayed correction (after the 2-month follow-up visit). MAIN OUTCOME MEASURES: Vision-targeted health-related quality of life (measured with the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire and the VF-14) and depressive symptoms (measured with the Geriatric Depression Scale), assessed at baseline and at 2 months. RESULTS: At the 2-month follow-up, the immediate refractive error correction group as compared with the delayed correction group had higher scores on the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire subscales of general vision, reading, psychological distress, activities and hobbies, and social interaction (all P < .04) and the VF-14 (P < .001) as well as fewer depressive symptoms on the Geriatric Depression Scale (P = .003), adjusting for mental status and baseline outcome variables. CONCLUSIONS: Dispensing spectacles to treat uncorrected refractive error in nursing home residents leads to improved quality of life and decreased symptoms of depression. APPLICATION TO CLINICAL PRACTICE: This study demonstrates that older adults residing in nursing homes can personally benefit from access to the most basic of eye care services. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00347620.