Activities Of Daily Vision Scale Research Articles

The Unified Visual Function Scale Assessments Show Inter- and Intraobserver Agreement and Correlate with Patient Quality of Life in Skull Base Parasellar Tumors.

Introduction The authors have previously described the Unified Visual Function Scale (UVFS). Here, we assessed intra- and interobserver reliability of the scale, and investigated correlations with patient quality of life (QoL). Methods Eight healthcare practitioners independently applied the UVFS in 20 representative cases from our parasellar meningioma series. Scoring was compared with consensus grades assigned by lead authors. Inter- and intraobserver agreement was measured using intraclass correlation coefficient (ICC), Fleiss's κ, and Cohen's κ, respectively. Patient QoL was assessed Visual Function Questionnaire 25 (VFQ-25) or Activities of Daily Vision Scale (ADVS), and correlated with UVFS grades for each eye. Results The interobserver ICC was 0.734 (95% confidence interval [CI]: 0.652-0.811), with Fleiss's κ of 0.758, 0.691, and 0.899 for grades A, B, and C, respectively. The intraobserver ICC was 0.758 (95% CI: 0.638-0.872), and Fleiss's κ was 0.604, 0.268, and 0.910 for grades A, B, and C respectively. The Cohen's κ for agreement between UVFS category grades and consensus grades was 0.816 (95 CI: 0.698-0.934). Survey response rate was 51% (27/53). The UVFS demonstrated strong correlation with VFQ-25 subdivisions general vision ( r = 0.7712), near activities ( r = 0.7262), peripheral vision ( r = 0.6722), and driving ( r = 0.6608), and also demonstrated strong correlation with the overall ADVS score ( r = 0.5902). Conclusion This study shows that the UVFS is valid within a small subset of observers, and accurately reflects patient QoL. It is robust and practical, which make it suitable for broad implementation.

Impact of binocular integrated visual field defects on healthy related quality of life in glaucoma.

To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients’ quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.

A pilot study for development of a novel tool for clinical decision making to identify fallers among ophthalmic patients.

BackgroundFalls in the elderly is a major problem. Although falls have a multifactorial etiology, a commonly cited cause of falls in older people is poor vision. This study proposes a method to discriminate fallers and non-fallers among ophthalmic patients, based on data-mining algorithms applied to health and socio-demographic information.MethodsA group of 150 subjects aged 55 years and older, recruited at the Eye Clinic of the Second University of Naples, underwent a baseline ophthalmic examination and a standardized questionnaire, including lifestyles, general health, social engagement and eyesight problems. A subject who reported at least one fall within one year was considered as faller, otherwise as non-faller. Different tree-based data-mining algorithms (i.e., C4.5, Adaboost and Random Forest) were used to develop automatic classifiers and their performances were evaluated by assessing the receiver-operator characteristics curve estimated with the 10-fold-crossvalidation approach.ResultsThe best predictive model, based on Random Forest, enabled to identify fallers with a sensitivity and specificity rate of 72.6% and 77.9%, respectively. The most informative variables were: intraocular pressure, best corrected visual acuity and the answers to the total difficulty score of the Activities of Daily Vision Scale (a questionnaire for the measurement of visual disability).ConclusionsThe current study confirmed that some ophthalmic features (i.e. cataract surgery, lower intraocular pressure values) could be associated with a lower fall risk among visually impaired subjects. Finally, automatic analysis of a combination of visual function parameters (either self-evaluated either by ophthalmological tests) and other health information, by data-mining algorithms, could be a feasible tool for identifying fallers among ophthalmic patients.

The relationship between the different refractive states and daily activity after cataract surgery in highly myopic eyes

Objective To evaluate postoperative daily visual activity of highly myopes after cataract surgery. Methods Data of studied 120 eyes of 60 cases with cataract surgery and high myopia who underwent cataract surgery in our hospital were retrospectively analyzed. The patients were divided into three groups based on postoperative diopters: group A (-1.0~-2.0D), group B (-2.25~-3.0D) and group C (-3.25~-4.0D). The questionnaires of Activities of Daily Vision Scale (ADVS) were collected to assess the vision three months after the cataract surgery. Results The numbers of patients who satisfied with the surgery were 11 in group A, 8 in group B, and 13 in group C, and the difference were not statistically significant among three groups (χ2=4.23, P=0.38). No statistically significant difference was observed among three groups in postoperative life self-care ability, mental state and interest survey (χ2=4.23, P=0.38). Depending on the postoperative visual qualities, there were no statistically significant differences in night vision (χ2=3.39, P=0.415) and the vision for watching TV among three groups (χ2=4.20, P=0.38). But for reading and writing capabilities, the vision of patients in group A was poorer than that of patients in group B and C (χ2=10.62, P=0.005; χ2=16.25, P=0.0015; χ2=4.64, P=0.2). Patients in group C had better fine resolution than those in group A and B (χ2=5.26, P=0.072; χ2=19.54, P<0.001; χ2=9.09, P=0.011). There was statistically significant difference in wearing glasses among three groups (χ2=29.67, P<0.001). For distant vision, the wearing rate were 40% in group A, 95% in group B and 100% in group C. For near vision, the wearing rate were 75% in group A, 40% in group B and 30% in group C. Conclusion Cataract surgery in highly myopic eyes can improve qualities of vision and life. For patients who are not used to wearing glasses and working at near distant, it's appropriated to reserve a minor degree of myopia. Conversely, for patients who require to work at near distant and can receive wearing moderate or low hyperopia mirror, higher degree of myopia can be reserved. Key words: Myopia, high; Cataract; Refraction, ocular; Activities of daily vision scale

Equating Visual Function Scales to Facilitate Reporting of Medicare Functional G-Code Severity/Complexity Modifiers for Low-Vision Patients

ObjectiveTo present a method of estimating and equating scales across functional assessment instruments that appropriately represents changes in a patient's functional ability and can be meaningfully mapped to changes in Medicare G-code severity modifiers. DesignPreviously published measures of patients' overall visual ability, estimated from low-vision patient responses to 7 different visual function rating scale questionnaires, are equated and mapped onto Medicare G-code severity modifiers. SettingOutpatient low-vision rehabilitation clinics. ParticipantsThe analyses presented in this article were performed on raw or summarized low-vision patient ratings of visual function questionnaire (VFQ) items obtained from previously published research studies. InterventionsPreviously published visual ability measures from Rasch analysis of low-vision patient ratings of items in different VFQs (National Eye Institute Visual Functioning Questionnaire, Index of Visual Functioning, Activities of Daily Vision Scale, Visual Activities Questionnaire) were equated with the Activity Inventory (AI) scale. The 39 items in the Self-Report Assessment of Functional Visual Performance (SRAFVP) and the 48 items in the Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ) were paired with similar items in the AI in order to equate the scales. Main Outcome MeasuresTests using different observation methods and indicators cannot be directly compared on the same scale. All test results would have to be transformed to measures of the same functional ability variable on a common scale as described here, before a single measure could be estimated from the multiple measures. ResultsBivariate regression analysis was performed to linearly transform the SRAFVP and VA LV VFQ item measures to the AI item measure scale. The nonlinear relationship between person measures of visual ability on a logit scale and item response raw scores was approximated with a logistic function, and the 2 regression coefficients were estimated for each of the 7 VFQs. These coefficients can be used with the logistic function to estimate functional ability on the same interval scale for each VFQ and for transforming raw VFQ responses to Medicare's G-code severity modifier categories. ConclusionsThe principle of using equated interval scales allows for comparison across measurement instruments of low-vision functional status and outcomes, but can be applied to any area of rehabilitation.

Computer Measurement of Central Visual Acuity under Mesopic and Glare Conditions in Eyes with Nuclear Cataract

Purpose: The CVA is an interactive, automated computer device that rapidly thresholds central acuity under conditions mimicking customary photopic and mesopic activities. In sequence, the CVA may test up to 6 environments, in this series under 3 mesopic environments (98%, 50% MC against 1.6 cd/m2 background, 25% MC against 5 cd/m2), then 3 glare environments (98%, 10% and 8% MC, against 200 cd/m2). This report compares the CVA thresholded acuity with that measured with letter charts, as well as with C-Quant derived glare testing and patient responses to the Activities of Daily Vision Scale (ADVS) in eyes with nuclear cataract. Methods: In 33 eyes with nuclear cataract compared with 69 emmetropic eyes without lens opacity, best refracted acuity was measured under CVA modules and with ETDRS charts presenting similar contrast and luminance. Both groups were also tested with 15% MC charts placed outdoors with sun overhead and with sun at 15° off-axis and compared with the CVA acuty at 10% MC and 8% MC thresholded in a darkened room. In 22 of the eyes with nuclear cataract, C-Quant analysis of straylight glare was also performed along with the ADVS. Results: Acuities thresholded with CVA modules demonstrated high Pearson correlation coefficients, and Bland and Altman statistical similarity with the acuities measured from similar contrast charts. The acuities measured with CVA glare modules correlated significantly with charts placed in sun glare and with C-Quant measurements of straylight. Significant correlations were noted between CVA acuities and near vision as well as distance driving tasks. Conclusions: The CVA demonstrates the ability to accurately threshold the acuity of eyes with nuclear cataract compared with chart acuity under conditions of contrast, luminance and fixation times simulating normal photopic and mesopic activities and to provide the physician with glare evaluation and ability to function under multiple types of activities.

Associations Between Self-Rated Vision Score, Vision Tests, and Self-Reported Visual Function in the Salisbury Eye Evaluation Study

We attempt to understand the determinants of self-rated vision status by examining associations with vision tests, self-reported visual function, demographic, and health-status characteristics. Participants included 2467 individuals, aged 65 to 84 years, in a longitudinal, population-based cohort study. Participants rated their vision status from 0 to 10. Visual acuity, contrast sensitivity, stereoacuity, and visual fields were assessed. The Activities of Daily Vision Scale (ADVS) questionnaire was administered. Multivariate ordinal and multinomial logistic-regression models examined the association of demographic, health-status characteristics, vision tests, and ADVS subscales with self-rated vision status score. Odds ratios described the association of these characteristics with reporting better vision status. Better visual acuity, contrast sensitivity, stereoacuity, and visual fields were associated with increased odds of reporting better vision status. Among the vision tests, a 2-line increase in visual acuity was most likely to result in an individual reporting better vision status (odds ratio, 1.49; 95% confidence interval [CI], 1.30-1.70). A 5-point increase in the near vision and far vision ADVS subscale scores was associated with increased odds of reporting good versus poor vision status. A 5-point increase in the near vision subscale was most likely to result in an individual reporting good versus poor vision status (odds ratio, 1.38; 95% CI, 1.28-1.50). Self-rated vision status is a multidimensional measure. Near-vision visual function, visual acuity, and contrast sensitivity are important determinants of self-rated vision status in an elderly population. This understanding may improve the ability of eye care providers to maximize self-rated vision status among their patients.

Functional Improvement after One- and Two-Eye Cataract Surgery in the Salisbury Eye Evaluation

To determine the impact that cataract and cataract surgery have on clinical measurements of vision, reading speed, objective mobility performance, and subjective visual functioning. Prospective, population-based study. A total of 1739 Salisbury Eye Evaluation (SEE) participants without previous cataract surgery with bilateral baseline best-corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) ≤ 0.3 (≥ 20/40) or cataract surgery between rounds 1 and 2. Participants were categorized on the basis of cataract surgery by round 2 into no surgery, unilateral surgery, or bilateral surgery. Visual performance, mobility-based tasks, and the Activities of Daily Vision Scale (ADVS) were measured at baseline and 2 years. Mobility score was converted into a z score by subtracting the participant's time from the population baseline average and then dividing by the standard deviation. Comparisons were made between the no surgery and surgery groups using multivariate linear regression. Change in bilateral BCVA in logMAR, contrast sensitivity, reading speed in words per minute (wpm), mobility score, and ADVS. During the study period, 29 participants had cataract surgery on both eyes, 90 participants had unilateral surgery, and 1620 participants had no surgery. After adjusting for baseline value, demographics, depression, and mental status, the unilateral surgery group's BCVA improved 0.04 logMAR (P = 0.001) and the bilateral group's BCVA improved 0.13 compared with no surgery (P<0.001). Overall mobility declined in all groups. The unilateral group's z score decreased 0.18 more than that of the no surgery group (P = 0.02), whereas the bilateral group showed a 0.18 z score improvement compared with no surgery (P = 0.19). Change in reading speed significantly improved in the unilateral and bilateral groups compared with no surgery (12 and 31 wpm, respectively). The bilateral surgery group showed significant positive change in ADVS compared with no surgery (5 points of relative improvement; P = 0.01), whereas the unilateral group showed a 5-point relative decline (P<0.001). Cataract negatively affects both subjective quality of life and objective performance measures. Unilateral cataract surgery improves visual functioning, but the largest gains are found in patients who undergo second-eye cataract surgery. This finding supports second-eye cataract surgery for patients with visual or functional symptoms even after successful first-eye surgery. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Activities of Daily Vision Scale: What Do the Subscales Measure?

Previous Rasch analysis of the Activities of Daily Vision Scale (ADVS) did not address psychometric properties of its subscales or provide detailed assessment of dimensionality (whether the ADVS measures one or multiple constructs). This study was designed to examine these properties. Two hundred thirty-two participants (mean age, 74.2 years) awaiting cataract surgery self-administered the ADVS. Rasch analysis was used to assess the ADVS and its five subscales for unidimensionality (by principal components analysis, [PCA]), precision by person separation (discrimination between strata of participant ability), and targeting (matching of item difficulty to participant ability). Adequate person separation (minimum acceptable value, 2.0) is the fundamental requirement for measurement. Only the near vision subscale had adequate measurement properties (person separation, 2.30). The entire ADVS showed a misfit to the Rasch model and lacked unidimensionality. PCA confirmed the presence of two additional traits-driving and glare disability-but neither possessed adequate person separation when assessed individually. Deleting these traits restored unidimensionality, but additional items misfit, necessitating item reduction. Finally, an eight-item ADVS-Near Vision Scale showed good fit and unidimensionality. Its contents were identical with the original near vision subscale. Targeting was suboptimal (2.30 logits). Only one subscale, near vision, met the criteria for measurement. The revised eight-item ADVS-Near Vision subscale is a unidimensional measure of visual disability in cataract patients with mild visual disability. However, it is limited by measurement of near visual ability only. For more comprehensive measurement of visual disability, other questionnaires such as Catquest-9SF are preferable for cataract surgery outcomes assessment.

Comparative study of aspheric intraocular lenses with negative spherical aberration or no aberration

To compare the quality of vision with an aspheric intraocular lens (IOL) with no aberration and an IOL with negative spherical aberration. Bretonneau University Hospital, Tours, France. Patients scheduled for cataract surgery were randomly chosen to bilaterally receive a SofPort Advanced Optics IOL with no aberration (no-aberration IOL group) or a Tecnis Z9000 IOL with negative spherical aberration (negative-aberration IOL group). Six-month postoperative outcomes included patient-centered visual disability assessed with the Activities of Daily Vision Scale (ADVS), contrast sensitivity testing, and wavefront aberration analysis. There was no difference in the overall ADVS score between the 2 groups (P = 0.07); however, the negative-aberration IOL group had a better night-driving score (mean 82.7 +/- 15.1 [SD] versus 66.4 +/- 7.6) (P<.001) and the no-aberration IOL group had a better corrected near-vision score (mean 96.5 +/- 6.2 versus 86.2 +/- 13.2) (P<.001). Mesopic contrast sensitivity was significantly better in the negative-aberration IOL group at intermediate and high frequencies; the no-aberration IOL group performed better under photopic conditions at intermediate frequencies. There was significantly higher spherical aberration (mean 0.11 +/- 0.05 microm versus 0.01 +/- 0.06 microm; P = .001) and lower 3rd-order coma (mean 0.09 +/- 0.06 microm versus 0.15 +/- 0.06 microm; P<.001) in the no-aberration IOL group than in the negative-aberration IOL group, which had better MTF. Bilateral implantation of an IOL with no aberration resulted in better quality of near vision. A negative spherical aberration IOL provided better night-driving vision and improvements in mesopic contrast sensitivity and MTF.

Glaucoma and Quality of Life: The Salisbury Eye Evaluation

To examine whether glaucoma status or measures of visual function affected by glaucoma are associated with self-reported difficulty with vision-intensive tasks in a population-based study. Cross-sectional study. One thousand one hundred sixty individuals who participated in the fourth round of the Salisbury Eye Evaluation study and who did not have visual acuity worse than 20/40 due to a primary cause other than glaucoma. Glaucoma was assessed using optic nerve head appearance, visual field (VF) testing, gonioscopy, and physician opinion. Vision-related quality of life was assessed using the Activities of Daily Vision Scale (ADVS), whose scores were trichotomized into the following categories: the least difficulty with visual tasks, some difficulty, and the most difficulty. Data on confounders were collected by questionnaire and clinical examination. Multinomial logistic regression was used to adjust for demographic and health factors. Reported difficulty on the ADVS. Individuals with bilateral glaucoma were more likely to report the most difficulty on the ADVS than those without glaucoma (odds ratio [OR], 3.25; 95% confidence interval [CI], 1.56-6.76), whereas those with unilateral glaucoma were not more likely to report the most difficulty (OR, 1.05; 95% CI, 0.38-2.91). Worse binocular VF scores were associated with increased odds of the most difficulty on the ADVS after adjusting for acuity and contrast sensitivity (OR, 1.48; 95% CI, 1.29-1.85). Individuals with bilateral glaucoma reported more difficulty on the ADVS than those without glaucoma. This finding, in conjunction with findings demonstrating decreased mobility in patients with bilateral glaucoma, points to the fact that glaucoma affects the report of difficulty with a variety of visual tasks.

Quality of vision after cataract surgery after Tecnis Z9000 intraocular lens implantation: Effect of contrast sensitivity and wavefront aberration improvements on the quality of daily vision

To compare ocular performance and quality of vision in pseudophakic eyes with an aspherical intraocular lens (IOL) or a conventional spherical IOL. Bretonneau University Hospital, Tours, France. Twenty patients (40 eyes) were randomly divided in 2 equal groups to bilaterally receive the aspherical Tecnis Z9000 IOL (AMO) or the spherical CeeOn Edge 911 IOL (AMO). Contrast sensitivity was measured and ocular wavefront analysis performed before surgery and 6 months after. Patients completed the Activities of Daily Vision Scale (ADVS) to evaluate patient-centered visual outcomes. Other examinations included refraction before and after mydriasis and pupil diameter. The mean postoperative best corrected visual acuity (logMAR) was 0.03 +/- 0.05 (SD) in the Tecnis group and 0.01 +/- 0.05 in the CeeOn Edge group (P = .41). Refractive evaluation with mydriasis showed a mean myopic shift as low as -0.02 +/- 0.36 diopter (D) in the Tecnis group and -0.51 +/- 0.37 D in the CeeOn Edge group (P = .001). Mesopic contrast sensitivity at high spatial frequencies was significantly better in the Tecnis group (P<.001), while contrast sensitivity under photopic and glare conditions was not different between the 2 groups. Spherical aberration was significantly lower in the Tecnis group, which had a mean Z(4)(0) of 0.01 +/- 0.06 microm, than in the CeeOn Edge group, which had a mean Z(4)(0) of 0.16 +/- 0.12 microm (P<.001). The global score on the ADVS was not statistically different between groups; however, quality of distance vision was better in the Tecnis group than in the CeeOn Edge group (mean 99.0 +/- 2.0 versus 89.2 +/- 3.4) (P<.001). Implantation of an aspherical IOL with a negative spherical aberration resulted in reduced ocular spherical aberration and improved mesopic contrast sensitivity and led to better subjective quality of vision.

Dynamic Measures of Visual Function and Their Relationship to Self-Report of Visual Functioning

The purpose of this analysis was to determine whether dynamic measures of vision, such as dynamic acuity and motion threshold, are independently associated with self-reported difficulty in activities involving vision. Data were used from the third round of the Salisbury Eye Evaluation (n = 1198), a longitudinal, population-based study of older adults. Multiple measures of visual function were tested, including dynamic acuity, motion threshold, visual acuity, contrast sensitivity, visual fields, and stereoacuity. Difficulty was assessed using the Activities of Daily Vision Scale (ADVS). Polytomous logistic regression procedures were used to determine log odds ratios for the dynamic measures of vision while adjusting for demographic, health, and other measures of vision. In fully adjusted models including other vision variables, worse dynamic acuity was associated with greater difficulty on the near-vision ADVS subscale (beta = 0.68, P < 0.01), but not with the overall ADVS or the far-vision or night-driving subscales (P > 0.05). Motion threshold was not associated with the overall ADVS or any of the subscales after controlling for other vision variables, although it was associated when no other vision variables were in the models. Motion threshold was not independently associated with any ADVS difficulty. Dynamic acuity was independently associated with self-reported difficulty with near-vision tasks only. Other studies should confirm this association. If confirmed, strategies to improve dynamic acuity could be developed to try to reduce difficulty with tasks involving near vision.

Quality of Life After Iodine 125 Brachytherapy vs Enucleation for Choroidal Melanoma

To describe health- and vision-targeted quality of life following treatment with iodine 125 brachytherapy vs enucleation for choroidal melanoma in a subgroup of patients who were treated and observed prospectively as part of a large randomized clinical trial. Difficulty with driving, near vision activities, and activities using stereopsis or binocularity; anxiety; and depression. Two hundred nine patients who enrolled in the Collaborative Ocular Melanoma Study trial for medium-sized tumors between March 1995 and July 1998 and gave informed consent prior to randomization to participation in an ancillary study of quality of life. Patients were interviewed by telephone by a trained interviewer from the Collaborative Ocular Melanoma Study Coordinating Center at baseline (prior to randomization), at 6 months, and on annual anniversaries of enrollment. The questionnaire battery included the Medical Outcomes Study Short Form 36, the Activities of Daily Vision Scale, the National Eye Institute Visual Function Questionnaire, and the Hospital Anxiety and Depression Scale. Additional questions concerning satisfaction with posttreatment appearance and concerns about cancer recurrence also were included in posttreatment interviews. There was a significant increase in both treatment groups in levels of reported difficulty for most vision-oriented activities, and in bodily and ocular pain, 6 months following treatment. Differences in visual function between treatment groups reported during follow-up were relatively small, but significant differences favoring brachytherapy-treated patients were observed for driving during the first year of follow-up and for peripheral vision during the first 2 years of follow-up. Anxiety levels in both groups decreased significantly following treatment, but patients treated with brachytherapy with symptoms of anxiety were less likely to report later resolution of symptoms than patients with symptoms of anxiety who were treated with enucleation. This study was unable to assess impact of treatment on satisfaction with appearance and concern about cancer recurrence during the first year after treatment, but no treatment-related differences were found on these measures at 2 years and later follow-up times. Patients treated with brachytherapy reported significantly better visual function than patients treated with enucleation with respect to driving and peripheral vision for up to 2 years following treatment. Differences between treatments in visual function diminished by 3 to 5 years posttreatment, paralleling decline in visual acuity in brachytherapy-treated eyes. Patients treated with brachytherapy were more likely to have symptoms of anxiety during follow-up than patients treated with enucleation. Given that no significant differences in survival between enucleation and brachytherapy have been found, the differences demonstrated here for driving and anxiety will allow the individual patient and physician to make informed choices regarding treatment based on personal preferences.

Is Cataract Surgery Cost-Effective Among Older Patients With a Low Predicted Probability for Improvement in Reported Visual Functioning?

Although cataract surgery has been demonstrated to be effective and cost-effective, 5% to 20% of patients do not benefit functionally from the procedure. This study examines the cost-effectiveness of cataract surgery versus watchful waiting in a subgroup of patients who had less than a 30% predicted probability of reporting improvements in visual function after surgery. Randomized trial (first eye surgery vs. watchful waiting) of 250 patients who based on a cataract surgery index (CSI) were felt to have less than a 30% probability of reporting improvements in visual functioning after surgery. Cost was estimated using monthly resource utilization surveys and Medicare billing and payment data. Effectiveness was evaluated at 6 months using the Activities of Daily Vision Scale (ADVS) and the Health Utilities Index, Mark 3 (HUI3). In terms of overall utility, the incremental cost-effectiveness of surgery was Dollars 38,288/QALY. In the subgroup of patients with a CSI score > 11 (< 20% probability of improvement), the cost-effectiveness of cataract surgery was Dollars 53,500/QALY. Sensitivity analysis demonstrated that often this population of patients may not derive a utility benefit with surgery. Cataract surgery is cost-effective even in a subpopulation of patient with a lower, < 30%, predicted probability of reporting improved visual functioning after surgery. There may be a subgroup of patients, CSI > 11, for whom a strategy of watchful waiting may be equally effective and considerably less expensive.

Impact of cataract surgery upon functional capacity of the elderly

To determine the impact of cataract intervention on visual function of the elderly and on autonomy in daily activities, analyzing the influence of clinical and sociodemographic variables. Observational and longitudinal study. 185 elderly patients having undergone cataract surgery were compared with 179 elderly patients on a surgical waiting list. The first group was evaluated prior to surgery and at 4 months post-intervention. Control group patients were evaluated at the same times, without having received surgery. For all subjects, the state of visual function was determined by the Activities of Daily Vision Scale (ADVS). Degree of dependence in carrying out basic daily activities, cognitive state and self-perception of vision were also measured. Other variables were visual acuity, other ocular diseases and sociodemographic characteristics. Amongst the elderly patients having undergone surgery, the proportion of subjects able to carry out basic activities 4 months post-intervention (60.7%) was very similar to the initial pre-intervention figure (62.2%). However, in the control group, the proportion (63.1%) diminished significantly at the 4-month mark (48.8%) (p= 0.0001). Of the intervened subjects, 75.7% demonstrated improved self-perception of vision after 4 months as opposed to 15.4% of the non-intervened patients (p= 0.00001). Post-intervention, the mean score on the ADVS rose from 51.0 S.D. 28.4 to 76.0 S.D. 25.4 (p < 0.001). In contrast, the control group's mean score dropped from 54.8 S.D. 24.8 to 46.5 S.D. 27.1 (p < 0.001). Cataract surgery in the elderly improves visual function and prevents loss of autonomy, delaying dependency in carrying out basic daily activities.

Older Drivers and Cataracts: Measures of Driving Performance Before and After Cataract Surgery

Cataracts are the main cause of reversible vision impairment in older adults. An investigation examined how cataracts and cataract surgery affected driving performance and determined whether any changes in driving performance could be predicted by self-reported perceptions of driving and vision. Twenty-eight older participants with bilateral cataracts and eighteen age-matched control participants with normal vision were tested. All were licensed drivers. Driving and vision performance were measured before cataract surgery, after first-eye surgery, and again after second-eye surgery for the cataract participants and on three separate occasions for the control group. Driving performance was assessed on a closed-road circuit. Visual acuity and contrast sensitivity were also measured at each test session. Self-perceptions of vision and driving were assessed with the Activities of Daily Vision Scale (ADVS). The participants with cataracts had significantly poorer ( p &lt;.05) driving performance at the first visit compared with the control participants for a range of measures of driving performance, which significantly improved to the level of the control participants following cataract extraction. Self-perceived changes in driving performance assessed with the ADVS were not strongly related to the actual changes in driving performance recorded. Together these findings indicate that participants with cataracts have poorer driving and vision performance than age-matched control participants and that cataract surgery can result in significant improvements in driving, which are not predicted by self-reported measures such as the ADVS.

The Activities of Daily Vision Scale for cataract surgery outcomes: re-evaluating validity with Rasch analysis.

The Activities of Daily Vision Scale (ADVS) has been extensively validated by traditional methodology. In the current study, Rasch analysis was used to explore further the validity of the ADVS and to determine whether improvements could be made. Forty-three patients with cataract underwent visual acuity (VA) and contrast sensitivity (CS) testing and completed the ADVS. The data were Rasch analyzed and the value of response scale and item reduction explored. A shortened version and the original ADVS were tested for criterion validity by determining correlations with VA and CS. The ADVS data contained abnormally distributed items and items with ceiling effects and empty response categories. Therefore, items benefited from shortening the response scale, the optimum length being three responses. There was poor targeting of item difficulty to patient ability, because many patients with cataract were sufficiently able that they had no difficulty with many activities. Items were eliminated if the task was too easy or did not fit with the overall concept of visual disability determined by the Rasch model. A reduced ADVS version was established that had adequate precision, equivalent criterion validity, and improved targeting of item difficulty to patient ability, but this version was still not ideal. Despite careful traditional validation, the ADVS data contained inadequacies exposed by Rasch analysis. Through Rasch scaling, particularly with response scale reduction, the ADVS can be improved, but additional questions seem to be needed to suit the more able, including patients undergoing second eye cataract surgery. There remains a need to develop Rasch-scaled measures of visual disability for use in ophthalmic outcomes research.

Impact of cataract surgery on self-reported visual difficulties: Comparison with a no-surgery reference group

Purpose To examine the impact of cataract surgery on older adults’ self-reported visual difficulties and compare them with those of patients with cataract who declined surgery over the same period. Setting Twelve area practices. Methods This was a consecutive chart review over a 6-month period. Primary inclusion criteria were 55 years or older, cataract in 1 or both eyes with 20/40 visual acuity or worse (best corrected, distance), and no previous cataract surgery in either eye. The Activities of Daily Vision Scale (ADVS) and visual acuity, contrast sensitivity, and disability glare tests were administered at baseline and at a 1-year follow-up visit. Results This study comprised 245 patients, 156 of whom elected to have cataract surgery and 89 of whom declined. Those electing surgery were more likely to be white, female, and have worse visual acuity and no ocular comorbidities. At baseline, ADVS subscale scores ranged from 53 to 76 in the surgery group and from 72 to 89 in the no-surgery group. In the surgery group, subscale scores improved by 15 to 21 points on average at the 1-year follow-up; scores were unchanged or worse in the no-surgery group over this period. This difference between the groups remained statistically significant after adjustment for group baseline differences in demographics, vision, and ADVS score. In the surgery group, visual acuity improvement in the first eye was an independent predictor of increases in the ADVS overall score and night driving and glare disability subscales; contrast sensitivity was an independent predictor of improvement in the night driving subscale. A reduction in disability glare in the second eye was independently linked to increases in the overall ADVS score and the night driving, near vision, and glare disability subscales. Conclusions Baseline findings suggest that cataract patients who have surgery have more difficulty in visual tasks than those who decline surgery. After surgery, patients reported less difficulty with visual tasks. In the no-surgery group, no change was reported. Improvements in visual acuity and contrast sensitivity and reductions in disability glare after surgery were independently linked to improvements in ADVS scores.

Early age-related maculopathy and self-reported visual difficulty in daily life

Purpose To determine whether early age-related maculopathy (ARM) is associated with visual difficulty in daily activities beyond the difficulty that would be expected based on normal retinal aging; to determine whether scotopic sensitivity and visual acuity are associated with visual difficulties in these older adults. Study design Comparative, cross-sectional questionnaire study. Subjects Ninety-two older adults with early ARM in at least one eye as defined by one or more large (>63 μm) drusen and/or focal hyperpigmentation but no choroidal neovascularization or geographic atrophy, acuity of 20/60 or better, and a reference group of 55 older adults in the same age range without these fundus features and acuity of 20/35 or better in each eye. Method Tests of visual acuity and scotopic sensitivity and a general health questionnaire were carried out. The Activities of Daily Vision Scale (ADVS) was administered to assess self-reported visual difficulties in everyday tasks and expressed on a scale of 0 (extreme difficulty) to 100 (no difficulty). Fundus photographs were taken and graded to characterize the presence and severity of ARM to determine eligibility. Results For purposes of analysis, the early ARM group was divided into those whose fellow eye (FE) was 20/60 or better and those whose FE was worse than 20/60. ADVS subscale scores were substantially lower in the early ARM group with FE worse than 20/60 (medians, 58–83) compared with the normal retinal health group (medians, 97–100). Even for those with early ARM with FE 20/60 or better, four of five subscale scores were lower (medians, 81–97), albeit slightly in some cases, than those of the reference group. For both ARM subgroups, the night driving subscale had the lowest scores of all subscales. Persons with early ARM with FE 20/60 or better were more likely to report difficulty on the night driving (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.6–11.4), near vision (OR, 5.0; 95% CI, 1.9–12.9), and glare disability (OR, 2.7; 95% CI, 1.1–6.3) subscales compared with those in normal retinal health, adjusting for age, gender, medical comorbidities, and lens density. For early ARM patients with FE worse than 20/60, there was widespread reporting of difficulty on all subscales (ORs ranging from 4.7–52.9). Poor scotopic sensitivity was highly associated with difficulty on the night driving subscale (OR, 6.6; 95% CI, 1.2–35.5) but not with any other subscale. Acuity worse than 20/25 in both eyes was significantly associated with difficulty on all ADVS subscales; when this acuity impairment was present in one eye only, associations were still significantly present on some subscales, although they were weaker. Conclusions Persons in the early phases of ARM, even when their fellow eye has relatively good acuity, are more likely to experience difficulty in night driving, near vision tasks, and glare disability compared with those in good retinal health. Scotopic dysfunction, a functional marker of early ARM, is linked to reported night driving problems. Even when acuity impairment occurs in one eye only, patients report difficulties with day driving and near and far vision tasks.