The goals of this study were to examine the impact of spirituality on both generic and vision-specific health-related quality of life (HRQOL) and the role of spirituality in the linkage between vision impairment and HRQOL outcomes among Chinese older adults with visual problems. A sample of 167 urban older adults with visual problems were interviewed using a structured questionnaire to assess self-reported visual functioning, general health, spirituality and both generic and vision-specific HRQOL. Objective visual function was clinically measured by ophthalmologists in terms of distance visual acuity. It was found in the study that spirituality was positively associated with both general physical health and general mental health, with a higher correlation with general mental health than that with general physical health. Moreover, spirituality was associated significantly with vision-specific HRQOL, including multiple domains. The results showed that spirituality played a mediating role in the linkage between vision impairment and general mental health. These results suggest that spirituality is significantly associated with multiple domains of HRQOL and may play an important role in the process of adaptation to age-related vision loss among Chinese older adults with vision impairment.