Visual functioning questionnaires are commonly used as patient-reported outcome measures to estimate visual ability. Performance measures, on the other hand, provide a direct measure of visual ability. For individuals with ultra-low vision (ULV; visual acuity (VA) <20/1600), the ultra-low vision visual functioning questionnaire (ULV-VFQ) and the Wilmer VRI-a virtual reality-based performance test-estimate self-reported and actual visual ability, respectively, for activities of daily living. But how well do self-reports from ULV-VFQ predict actual task performance in the Wilmer VRI? We administered a subset of 10 matching items from the ULV-VFQ and Wilmer VRI to 27 individuals with ULV. We estimated item measures (task difficulty) and person measures (visual ability) using Rasch analysis for ULV-VFQ and using latent variable signal detection theory for the Wilmer VRI. We then used regression analysis to compare person and item measure estimates from self-reports and task performance. Item and person measures were modestly correlated between the two instruments, with r2 = 0.47 (P = 0.02) and r2 = 0.36 (P = 0.001), demonstrating that self-reports are an imperfect predictor of task difficulty and performance. While self-reports impose a lower demand for equipment and personnel, actual task performance should be measured to assess visual ability in ULV. Visual performance measures should be the preferred outcome measure in clinical trials recruiting individuals with ULV. Virtual reality can be used to standardize tasks.

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