Abstract
PurposeIn clinical ophthalmology as in other fields, measuring patient-reported outcomes imposes a burden on patients. To decrease that burden, we used item-response theory (IRT) to develop and test a short version of the National Eye Institute's Visual Function Questionnaire (VFQ).MethodsWe analyzed VFQ data from 276 adults in Japan. Most of them had glaucoma, cataract, or macular degeneration. Their visual acuity (Snellen fraction) averaged 20/120 (range: 20/13 to 20/2000) for the better eye, and 20/200 (range: 20/13 to 20/2000) for the worse eye. We used a polytomous IRT model, the Generalized Partial Credit Model as implemented in software for parameter scaling of rating data (PARSCALE). To select items for inclusion in the short version we examined each item's location on the latent-trait continuum, its slope, and its frequency of missing data. We also ensured representation of all 7 domains that are important in Japan. To examine the characteristics of the resulting scale, we computed its test information (an index of precision that can vary with the value of the latent trait), and carried out validation testing.ResultsFrom 32 of the original VFQ items, we selected 11. The scale comprising those 11 items (the VFQ-J11) had test information greater than 9 for values of the latent trait between −2.0 and +0.8. The item thresholds were well-targeted for patients with vision problems. Scores on the VFQ-J11 correlated strongly and in the expected direction with measures of visual field and corrected visual acuity. As expected for a valid measure, those scores also improved by a large amount (almost one standard deviation) after cataract surgery.ConclusionThis 11-item instrument can provide reliable and the valid data on visual functioning in patients with ophthalmic problems. It is expected to be less of a burden on respondents, while it maintains good psychometric properties.
Highlights
The Visual Function Questionnaire (VFQ) was originally developed by the National Eye Institute [1,2,3]
For the Japanese version of the VFQ, Suzukamo, et al [10] pointed out that the ‘‘driving’’ domain might not be appropriate, because the activity it asks about is relatively unimportant to some patients in Japan
They found that the VFQ could be unidimensional only if it did not include the ‘‘color vision,’’ ‘‘peripheral vision,’’ and ‘‘ocular pain’’ domains
Summary
While the items were not optimally targeted to the patients, based on the fit of the data to the Rasch model, Pesudovs et al [9] were able to recommend versions with fewer items than the original: a 6-item visual functioning scale and a 7-item socioemotional scale. For the Japanese version of the VFQ, Suzukamo, et al [10] pointed out that the ‘‘driving’’ domain might not be appropriate, because the activity it asks about is relatively unimportant to some patients in Japan. They found that the VFQ could be unidimensional only if it did not include the ‘‘color vision,’’ ‘‘peripheral vision,’’ and ‘‘ocular pain’’ domains.
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