PURPOSE: To examine the impact of depression in older adults on responses to the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) independent of demographics, vision, and general health. DESIGN: Cross-sectional. PARTICIPANTS: We took the opportunity of an ongoing study on older drivers to address the specific aim stated above. The recruitment population consisted of 6342 older adults (> or =60 years) who were licensed drivers residing in Birmingham, Alabama; who had been involved in a crash in the prior year, as identified by Alabama Department of Public Safety records; and whose phone numbers could be located. Additional eligibility criteria were visual acuity impairment, slowed visual processing speed, or both, and a Mini-Mental State Examination score of > or =23. Persons in the recruitment population who met these eligibility criteria and agreed to enroll in a study on driver safety (purpose of the main study) numbered 403. METHODS: The following questionnaires were interviewer administered in person and scored per standard procedures: the NEI VFQ-25, the Center for Epidemiological Studies Depression Scale (CES-D), a general health questionnaire, and a review of demographic information. Depressed persons were defined as those with CES-D scores of > or =16. There were complete data on 397 persons. MAIN OUTCOME MEASURE: Reduced score on the NEI VFQ-25 (defined by a score of <87.5) on the total questionnaire and 12 subscales. RESULTS: After adjusting for demographics, vision, mental status, and general health, depression was significantly associated with a reduced NEI VFQ-25 score for total score and the subscales of distance vision, peripheral vision, role difficulties, dependencies, and mental health. Odds ratio point estimates in these adjusted associations ranged from 2.9 to 4.6. CONCLUSIONS: The results imply that older persons who are depressed may have reduced scores on the NEI VFQ-25 independent of the impact of vision problems. Depression in the elderly could be influencing their self-perception of the burden of eye disease and treatment effectiveness in clinical and epidemiologic studies.