Vision-related Quality Of Life Questionnaire Research Articles

Systematic review of vision-related quality of life questionnaires for older institutionalised seniors with dementia.

In view of our interest in helping older institutionalised adults with co-existing visual and cognitive deficits, our objective was to review vision-related quality of life (VRQoL) questionnaires developed for people with dementia. A systematic literature search was performed in seven relevant databases, limited to peer-reviewed journals published in English, French, Spanish, Italian or German languages, between 1982 and 2012. The retained VRQoL questionnaires were described. Only relevant articles that fully meet our target population and interest criteria were eligible for psychometric properties rating. The literature search identified 461 potentially relevant articles, from which 69 were isolated and reviewed. Eight articles presented questionnaires that were administered to older institutionalised individuals with dementia. Three VRQoL questionnaires were identified, from which only one was designed and validated for those with mild to moderate dementia and none for individuals with more advanced dementia. There is a pressing need to build and validate a questionnaire for assessing VRQoL in older institutionalised individuals with dementia, to provide a research tool capable of evaluating how changes in vision impact their QoL.

Rapid Assessment of Refractive Error, Presbyopia, and Visual Impairment and Associated Quality of Life in Nampula, Mozambique

Introduction Uncorrected refractive error is the leading cause of visual impairment worldwide and leads to an impaired quality of life. This study was designed to determine the prevalence of uncorrected refractive error and presbyopia, to assess spectacle coverage, and to evaluate visual health-related quality of life among persons aged 15–50 years old in Nampula, Mozambique. Methods Participants were assessed using a validated rapid assessment of refractive error protocol, comprised of a demographic questionnaire, a standardized ophthalmic assessment to determine refractive status and spectacle coverage, and a modified vision-related quality of life questionnaire to assess the impact of uncorrected refractive error on participants’ visual health status. Results Among the 3,453 respondents, visual impairment prevalence was 3.5% (95%, CI 2.7%–4.2%), with 65.8% of those visually impaired being 35 years of age and older. Uncorrected refractive error prevalence was 2.6% (95%, CI 2.1–3.2%), and was the primary cause of visual impairment among 64.5% of cases. The spectacle coverage for uncorrected refractive error was 0%. Presbyopia prevalence was higher, at 25.8% (95%, CI 12.0–30.5%), with only 2.2% spectacle coverage. Respondents with visual impairment demonstrated statistically significantly lower quality of life scores compared to those without visual problems ( p < 0.01). Implications for practitioners The uncorrected refractive error problem and a distinct lack of spectacle coverage for refractive error and presbyopia indicate an urgent need for the development and delivery of a comprehensive refractive error service in the Nampula region of Mozambique.

Vision-related quality of life in posterior capsule opacification patients after Nd∶YAG laser capsulotomy

Background Posterior capsular opacification (PCO) is a main complication after phacoemulsification and intraocular lens(IOL) implantation,and its primary treatment is capsulotomy.However,the study on quality of life after Nd∶YAG laser posterior capsulotomy is lack.Objective This study was to evaluate visual acuity-and vision-related quality of life in the patients who received Nd ∶ YAG laser posterior capsulotomy.Methods Two hundred PCO patients (250 eyes) undergoing Nd∶YAG laser posterior capsulotomy were included in this prospective study from September 2012 to December 2012 in Affiliated Eye Hospital of Wenzhou Medical College.The visual acuities of the patients were graded into without and with mild visual damage (grade 1),moderate visual damage (grade 2),serious visual damage (grade 3) and blindness (grade 4).Nd ∶ YAG laser capsulotomy was performed on all the patients by the same surgeon.The main observation indexes of this study included visual acuities and scores of National Eye Institute-Visual Function Questionnaire-25 (NEI-VFQ-25).The monocular and binocular acuities as well as the NEI-VFQ-25 questionnaire scores were compared before and 3 weeks after operation.Each item in the questionnaire table was divided into 0-4 scores,and the accumulated points were used as assessing result.Results The binocular vision (LogMAR) and NEI-VFQ-25 questionnaire scores were 0.47±0.44 and 59.1± 13.0 in preoperation,0.30±0.30 and 72.1 ± 15.9 in postoperation,respectively,showing significant enhancements in vision and questionnaire scores after operation (t =11.38,22.01,both at P＜0.05).The scores of each item from NEI-VFQ-25 table,such as general health status,overall vision,eye pain,near activities,distant activities,social functional,mental health,social role difficulties,independency,driving,color vision,perimetry,were improved 3 weeks after operation compared to before operation (all at P＜0.05).The overall scores of NEI-VFQ-25 questionnaire were significantly elevated between before and after operation in various visual damage groups (t =21.20,8.39,3.18,all at P＜0.05).Conclusions Visual acuity associated with vision-related quality of life questionnaires is an objective evaluating index for the patients following Nd∶YAG laser capsulotomy. Key words: Lens capsule, crystalline/surgery; Laser therapy; Lasers, solid-state/therapeutic use; Prospective study; Questionnaire; Quality of life; Vision; Posterior capsule opacification

Quality of life in patients with visual impairment in Ibadan: a clinical study in primary care.

BackgroundVisual function is important for optimal orientation in functional and social life, and has an effect on physical and emotional well-being. Visual impairment, therefore, leads to restrictions in all aspects of daily living and is related to quality of life. The aim of this study was to provide information on the causes of visual impairment in patients presenting to their family physician, the spectrum of impairment, and its impact on quality of life for these patients.MethodsThis descriptive cross-sectional study of 375 adult patients with ocular symptoms was performed in the general outpatient department of the University College Hospital, Ibadan, from July to September, 2009. After checking their presenting visual acuity, the patients were interviewed using the Vision-Related Quality of Life questionnaire to determine the impact of visual impairment on their quality of life. Ophthalmic examinations were performed to determine the causes of visual impairment. The results were analyzed using proportions and percentages.ResultsThe main causes of visual impairment were cataracts (58.7%), refractive error (19.4%), and glaucoma (2.9%). Visual impairment was found to be associated with advancing age, low education, and unemployment (P<0.001). Most patients (85.1%) were found to have good quality of life overall. Quality of life was found to be poor in the domains of visual function (64.2%) and social interaction (50.9%). Quality of life was found to be related to the degree of visual impairment, ie, blind patients reported poor quality of life (41.4%) when compared with those having low vision (8.6%) or near normal vision (2.4%, P<0.001).ConclusionThis study identified poor quality of life in patients with a higher degree of visual impairment. Family physicians need to identify these visually impaired patients early and make timely referrals.

Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability

Objective: The objective of this article is to evaluate in multiple sclerosis (MS) patients the prevalence of persistent complaints of visual disturbances and the mechanisms and resulting functional disability of persistent visual complaints (PVCs). Methods: Firstly, the prevalence of PVCs was calculated in 303 MS patients. MS-related data of patients with or without PVCs were compared. Secondly, 70 patients with PVCs performed an extensive neuro-ophthalmologic assessment and a vision-related quality of life questionnaire, the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25). Results: PVCs were reported in 105 MS patients (34.6%). Patients with PVCs had more frequently primary progressive MS (30.5% vs 13.6%) and more neuro-ophthalmologic relapses (1.97 vs 1.36) than patients without PVCs. In the mechanisms/disability study, an afferent visual and an ocular-motor pathways dysfunction were respectively diagnosed in 41 and 59 patients, mostly related to bilateral optic neuropathy and bilateral internuclear ophthalmoplegia. The NEI-VFQ 25 score was poor and significantly correlated with the number of impaired neuro-ophthalmologic tests. Conclusion: Our study emphasizes the high prevalence of PVC in MS patients. Regarding the nature of neuro-ophthalmologic deficit, our results suggest that persistent optic neuropathy, as part of the progressive evolution of the disease, is not rare. We also demonstrate that isolated ocular motor dysfunctions induce visual disability in daily life.

Vision-Related Quality of Life in Patients with Pituitary Adenoma

To evaluate the vision-related quality of life (VR-QOL) in patients with pituitary adenoma. Prospective, consecutive, comparative case series. A VR-QOL questionnaire was distributed to 154 patients with pituitary adenoma and 81 normal controls. These were presurgical patients. VR-QOL was measured using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25). The influence of various factors on VFQ-25 score was assessed, including age, logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), critical flicker fusion frequency, Humphrey static perimetry scores, and the duration of ocular symptoms. The VFQ-25 composite score was significantly lower in patients with pituitary adenoma than in the normal controls (P < .001), with significant differences in all subscales except for color vision. The VFQ-25 composite score in patients with pituitary adenoma was significantly correlated with logMAR BCVA, mean deviation (MD) and corrected pattern standard deviation (CPSD) of Humphrey perimetry, critical flicker fusion frequency, and the duration of ocular symptoms. Stepwise multiple regression analysis revealed that MD score in the better-seeing eye (r = 0.69; P < .001) and the duration of ocular symptoms associated with pituitary adenoma (r = -0.36; P < .001) were significantly related to the VFQ-25 composite score. The VR-QOL is significantly deteriorated in patients with pituitary adenoma. The degree of visual field defect in the better-seeing eye and duration of ocular symptoms were found to be significantly related to the decline of VR-QOL in these patients.

Why Measurement Matters for Measuring Patient Vision Outcomes

Optometrists, by definition, care deeply about measurement. This brief review article considers the essential features of measurement that make many optometric instruments so useful and how patient-centered survey instruments such as vision-related quality of life questionnaires, can be analyzed using contemporary psychometric methods, so that they also conform to these essential features of measurement. These features include unidimensionality, hierarchical order, and equal interval scaling. Optometrists demand these features because they need to make meaningful comparisons both between patients and over time. Questionnaires about visual function or health-related quality of life, typically involve a series of rating scale type items that are added up to produce a total raw score. Yet total raw scores, which are ordinal, do not exhibit the essential properties of measurement. The Rasch Model, developed by Georg Rasch in 1956, converts ordinal-level raw score data into interval measures that demonstrate the essential features of measurement. Under the Rasch model any obtained score (response) is conceptualized as the difference between the amount of a trait reflected in an item, i.e., how "hard" the item is, and the ability of the person responding to the item. The Rasch model estimates the log odds probability (logit) for any response by any person. Logits are equal interval, representing equal amounts of the construct being measured across the entire range of the construct. Logits define the hierarchical order of items, how hard or easy items are, and the Rasch model specifies that this order of items must be invariant for all persons, that is, must be unidimensional. There are numerous software packages available for applying the Rasch model, all provide methods for evaluating how well data demonstrate unidimensionality, hierarchical order, and equal interval scaling. These can be used in the development, assessment or revision of questionnaires to optimize measurement.

Outcomes of low‐vision services using optometric and multidisciplinary approaches: a non‐randomized comparison

Consecutive patients (n = 215) who were referred to optometric (55%) or multidisciplinary (45%) low-vision services and above 50 years of age were recruited from four hospitals in the Netherlands. They completed two vision-related quality of life questionnaires, the Vision Quality of Life Core Measure (VCM1) and the Low Vision Quality of Life Questionnaire (LVQOL), before their first visit with low-vision services and 1 year later. At follow-up, patients referred to multidisciplinary low-vision services had lower scores on the mobility subscale of the LVQOL than patients referred to optometric low-vision services [5.3 points; 95% confidence interval (CI): 0.2-10.5]. Paired sample t-tests for the two groups of patients taken together show improvement for the VCM1 (3.1 points; 95% CI: 0.6-5.6) and deterioration for the basic aspects of vision (3.5 points; 95% CI: 1.1-5.9) and the mobility (6.6 points; 95% CI: 3.7-9.5) subscales of the LVQOL. In conclusion, people referred to optometric services showed less deterioration in mobility than those referred to multidisciplinary services. No differences were observed for any of the other subscales of the LVQOL and the VCM1. Future research in this field should include randomized controlled designs comparing low-vision services with no treatment or placebo.

Evaluation of Cross-sectional and Longitudinal Construct Validity of Two Vision-related Quality of Life Questionnaires: The LVQOL and VCM1

The Low Vision Quality of Life (LVQOL) questionnaire and the Vision-related Quality of Life Core Measure (VCM1) are two of the many vision-related quality of life (QOL) questionnaires that have been developed in recent years. Although psychometric properties of the LVQOL and VCM1 compare well with other vision-related QOL questionnaires, construct and longitudinal validity have not been assessed (adequately). The purpose of this study was to examine the cross-sectional and longitudinal construct validity of these questionnaires by testing specific pre-specified hypotheses about the relations of these questionnaires with other measures. The percentage of hypotheses regarding the cross-sectional construct validity that were refuted for the LVQOL was 22% for the basic aspects of vision subscale, 50% for the mobility subscale, 39% for the adjustment subscale and 17% for the reading and fine work subscale. For the VCM1 this percentage was 57%. For the longitudinal construct validity the percentage of hypotheses that were refuted ranged from 33 to 75% for the LVQOL subscales and was 50% for the VCM1. In conclusion, cross-sectional construct validity was satisfactory for the LVQOL subscales, but seemed poor for the VCM1. In addition, the longitudinal validity of these scales was poor to moderate.

The Refractive Status and Vision Profile (RSVP): Translation Into Persian, Reliability and Validity

Purpose: To translate and test the reliability and validity of a Persian translation of the Refractive Status and Vision Profile (RSVP), a vision-related quality of life questionnaire, in Iran. Methods: Forward & backward translation, committee review and pilot testing were performed to develop a final Iranian version of the RSVP. Seventy-three consecutive patients with refractive error before or after refractive surgery at the LASIK ward of Farabi Eye Hospital completed the questionnaire. A convenience sample of 14 patients completed the questionnaire twice within one week. Reliability was measured by internal consistency (Cronbach's α) and the intraclass correlation coefficient for test-retest reliability. Validity was evaluated by correlation between the different RSVP subscales, known groups comparison analysis, and correlation between the subscales versus global items and traditional clinical measures. Results: Internal consistency was high (Cronbach's α : 0.71–0.92; except for the subscale expectations, α : 0.6). Test-retest reliability of subscales and the overall RSVP scale, as estimated by the intraclass correlation coefficient, was high except for optical problems and glare. Comparisons between pre- and post-operative groups of patients showed significantly higher (worse) scores for concern, physical/social functioning, and the overall score in the pre-operative group. Almost all subscales showed desirable inter-scale correlations. Conclusion: The Iranian version of the RSVP is a reliable and valid measure of vision-related quality of life in patients with refractive error.

Changes to the subscales of two vision-related quality of life questionnaires are proposed

Background and Objective Psychometrically sound questionnaires for the assessment of vision-related quality of life (QOL) are scarce. Therefore, the objective was to further validate two vision-related QOL questionnaires in a Dutch population of visually impaired elderly. Methods A total of 329 visually impaired older persons referred to low vision services completed the low vision QOL (LVQOL) and Vision-Related Quality of Life Core Measure (VCM1) questionnaires at baseline, after 1–4 weeks (retest), and after 5 months. Confirmatory factor analyses were performed on baseline data. The smallest detectable change (SDC) was assessed, based on the standard error of measurement (SEM). Change scores between the baseline and 5 months follow-up data were related to a general transition question to assess the minimal important change (MIC). Furthermore, the MIC was related to the SDC, to examine whether the MICs were detectable beyond measurement error. Results The original factor structures could not be confirmed. After omitting items and remodeling, adequate fits were obtained. SDCs comprised at least one quarter of the scale for all scales and subscales on the individual level and exceeded the MICs on every occasion. Conclusion We propose MICs of 5–10 points for the scales and subscales of the LVQOL and VCM1. The questionnaires are not useful in the follow-up of individual patients.