基于循证医学构建白内障患者报告结局条目池

目的研制基于循证医学方法的白内障患者报告结局（PROs）条目池,为合理评估白内障PROs奠定了基础,并为其他类似研究提供参考。方法循证医学研究。遵循国际PROs测量工具研制流程构建白内障PROs条目池。首先建立条目池理论框架,再通过计算机检索美国国立图书馆医学文献检索系统（PubMed）、荷兰医学文摘数据库（Embase）、中国知网（CNKI）、万方期刊论文数据库（WanFang Data）、维普中文科技期刊全文数据库（VIP）、中国生物医学文献数据库（CBM）等数据库,纳入所有白内障PROs测量工具,进一步按照条目初筛、跨文化调试、患者访谈、条目分类及再次筛选、专家评审、确立条目主干及选项、人群验证等步骤构建白内障PROs条目池。结果条目池理论框架由视觉症状、视觉相关活动受限和精神心理健康等3个维度构成。通过文献检索后纳入19个PROs量表,条目初筛后纳入249个条目,患者访谈后保留204个条目,条目分类及再次筛选后保留118个条目,专家评审后保留94个条目,人群验证后形成的白内障条目池最终版本包括94个条目,其中视觉症状维度28个条目、视觉相关活动受限维度41个条目、精神心理健康维度25个条目,所有条目选项个数均为4个。结论本研究基于PROs循证医学方法,规范地构建了包含视觉症状、视觉相关活动受限和精神心理健康这三大维度的白内障PROs条目池,具有语言通俗易懂、内容全面并能反应视功能损害等特点,改善了目前眼科领域PROs测量工具的缺陷,为白内障PROs条目池构建的规范化提供了参考。     

视觉训练对功能性视力下降患者的疗效

目的 分析功能性视力不良患者集合功能、调节功能特点,研究双眼视觉训练对功能性视力不良患者的疗效.方法 回顾性研究.收集2012年7月至2013年10月于天津市眼科医院视光中心视觉训练工作室就诊的功能性视力不良的患者20例,平均年龄(11.2±5.9)岁.所有患者均排除眼部疾病、弱视危险因素和全身性疾病.在屈光矫正的基础上进行双眼视功能检查.分析、诊断后进行视觉训练治疗以提高矫正视力.采用配对t检验、Spearman相关性分析等进行统计分析.结果 患者右眼屈光度为+2.25～-8.75 D,左眼屈光度+2.87～-8.63 D.根据双眼视功能检查结果发现20例患者中,有13例诊断为集合不足并伴调节功能异常,有4例诊断为调节过度,2例为基本型外隐斜,1例为散开不足.经过2个月的视觉训练治疗,所有患者远、近矫正视力均提高到1.0(Z=-3.948,P＜0.01;Z=-3.193,P＜0.01).视力恢复后集合功能指标近距离融像范围(PRV)破裂点增加(t=-5.173,P＜0.01);单眼调节灵敏度(MAF,Z=3.928,P＜0.01)、双眼调节灵敏度(BAF,Z=-3.835,P＜0.01)、正负相对调节(PRA,t=4.094,P＜0.01;NRA,t=-4.254,P＜0.01)等调节功能均恢复到正常,差异有统计学意义.进行相关分析发现,训练前矫正远视力(r=-0.584,P＜0.01;r=-0.658,P＜O.01)、训练前矫正近视力(r=-0.451,P＜0.01;r=-0.540,P＜0.01)均与远隐斜、近距离融像范围呈负相关.结论 功能性视力不良患者通常伴有集合功能、调节功能不良,进行有效的视觉训练治疗,可以提高视力.     

双眼多焦点人工晶状体眼的远期立体视觉研究

目的比较双眼植入多焦点人工晶状体(MIOL)和单焦点人工晶状体(SIOL)植入术后远期的立体视觉,评价MIOL植入眼远期的立体视觉,进一步完善MIOL植入眼远期视功能的研究。方法观察2000年至2004年在我院接受白内障超声乳化吸除联合人工晶状体植入的患者共29例,其中双眼MIOL16例,双眼SIOL13例,术后随访时间>7m,分别检查术后非矫正近、远视力,矫正近、远视力,屈光,非矫正视力下远、近立体视锐度,矫正视力下远、近立体视锐度,问卷调查术后满意度、视觉症状。结果81.25%的MIOL眼非矫正近视力≥0.5,优于SIOL眼的15.38%(χ2=25.16,P<0.001,差异具有极显著性);非矫正远视力、矫正远视力及矫正近视力MIOL眼与SIOL眼差异无显著性(P>0.05);非矫正近视力下近立体视锐度,68.75%双眼植入MIOL者≤60s,而双眼植入SIOL者则无≤60s,两组间差异极具显著性(χ2=25.294,P<0.001);矫正近视力下近立体视锐度,93.75%的双眼植入MIOI者≤60s,相比双眼植入SIOL者的46.15%差异极具显著性(χ2=9.650,P=0.008,P<0.01);非矫正远视力下及矫正远视力下远立体视锐度,双眼植入MIOL组与双眼植入SIOL组间差异均无显著性;植入MIOL者术后满意度高于植入SIOL者(t=3.512,P=0.001,P<0.01)。结论术后远期,双眼MIOL植入者近立体视觉优于双眼SIOL植入者,植入MIOL患者满意度高于植入SIOL患者。     

双眼阶梯渐进衍射型多焦点人工晶状体植入术的视觉质量观察

目的 比较双眼行超声乳化白内障吸除联合植入ReSTOR阶梯渐进衍射型多焦点人工晶状体(MIOL)和单焦点人工晶状体(SIOL)的术后视觉质量.方法 回顾性比较性系列病例研究.回顾性分析25例(50只眼)双眼行超声乳化白内障吸除联合ReSTOR MIOL植入(多焦点组)和28例(56只眼)双眼行超声乳化白内障吸除术联合Natural SIOL植入(单焦点组)的年龄相关性白内障患者的临床资料.观察术后3个月时裸眼远、近视力,最佳矫正远、近视力,远矫正状态下近视力、对比敏感度和眩光敏感度,视觉干扰以及脱镜率.两组间计量资料采用t检验;两组间计数资料采用X2检验.结果 术后3个月,多焦点组94%(47/50)和单焦点组96%(54/56)患眼术后裸眼远视力≥0.6(X2=0.347,P＞0.05);多焦点组88%(44/50)和单焦点组13%(7/56)患眼裸眼近视力等于或好于J3(X2=60.315,P＜0.01);多焦点组90%(45/50)和单焦点组11%(6/56)患眼远矫正状态下裸眼近视力等于或好于J3(X2=66.515,P＜0.01);两组各空间频段的对比敏感度和眩光敏感度差异均无统计学意义(P＞0.05);多焦点组12%(3/25)和单焦点组7%(2/28)患者术后出现轻度以上的眩光感(X2=0.365,P＞0.05);多焦点组8%(2/25)和单焦点组4%(1/28)患者术后出现轻度以上的光晕(X2=0.485,P＞0.05);两组均有96%(24/25、27/28)的患者术后视远完全脱镜(X2=0.007,P＞0.05);多焦点组80%(20/25)和单焦点组11%(3/28)患者术后视近完全脱镜(X2=25.811,P＜0.01).结论 ReSTOR阶梯渐进衍射型MIOL能同时提供良好的远、近视力,减少了患者术后对眼镜的依赖,具有较好的视觉质量.     

不同形态年龄相关性白内障视觉质量的临床评价

目的 通过眼内散射光及对比敏感度(CS)检查,探讨不同形态年龄相关性白内障对视觉质量的影响.方法 病例对照研究.选取2010年2月至12月就诊于中国医科大学眼科医院的最佳矫正远视力(BCVA)≥0.5的年龄相关性白内障患者76例(76只眼),分为4组,其中皮质性白内障组33例(33只眼),核性白内障组20例(20只眼),后囊膜下白内障组23例(23只眼),健康对照组26例(26只眼).使用综合验光仪测量患者的BCVA,CSV-1000E CS仪检测患者的CS,C-Quant散射光计量仪测量患者的眼内散射光,VF-14调查问卷评价患者的主观视觉质量.结果 各组的年龄、BCVA、眼内散射光、3、6、12、18 c/d的CS分别为:皮质性白内障组:(66.1±6.7)岁,0.58 ±0.10,1.50±0.24,1.33±0.19,1.21±0.18,1.01±0.19,0.50±0.09;核性白内障组:(67.6±5.0)岁,0.62±0.11,1.46±0.11,1.38±0.19,1.28±0.19,1.09±0.18,0.54±0.09;后囊膜下白内障组:(60.6±7.1)岁,0.57±0.09,1.85±0.26,1.11±0.12,1.04 ±0.13,0.89±0.13,0.34±0.11;健康眼对照组:(63.9±7.3)岁,1.00±0.11,1.28 ±0.17,1.58±0.19,1.72±0.21,1.53±0.19,0.71 ±0.11 (F=9.983,F=103.925,F=31.760,F=28.871,F=65.889,F=66.453,F=61.540;P =0.000).经SNK-q检验,健康对照组的BCVA、眼内散射光、不同空间频率的CS与3种形态白内障眼比较差异均有统计学意义(P＜0.05);皮质性、核性及后囊膜下白内障的BCVA差异无统计学意义(P＞0.05);后囊膜下白内障患者的年龄、散射光及不同空间频率的CS与皮质性及核性白内障比较差异有统计学意义(P＜0.05);皮质性与核性白内障年龄、散射光及不同频率的CS差异均无统计学意义(P＞0.05).3种形态白内障的视功能指数( VF-14)量表差异有统计学意义(F=10.211,P=0.000).校正年龄影响后,皮质性、核性、后囊膜下白内障的BCVA与散射光均不相关(r= -0.227,r= -0.279,r=-0.373;P＞0.05);BCVA与3、6、12、18 c/d的CS相关性为:与皮质性白内障成线性正相关(r =0.569,r=0.517,r=0.500,r=0.449;P＜0.01);与核性白内障成线性正相关(r=0.657,r=0.542,r=0.513,r=0.492;P＜0.05);与后囊膜下白内障均不相关(P＞0.05).VF-14量表与皮质性及核性白内障的BCVA、散射光及3、6、12、18 c/d的CS相关(r=0.670,r=-0.740,r=0.811,r=0.826,r=0.809,r=0.720,P＜0.01;r=0.731,r= -0.721,r=0.816,r=0.769,r=0.738,r=0.728,P≤0.01)与后囊膜下白内障的CS及散射光相关(r= -0.910,r=0.879,r=0.896,r=0.874,r=0.844;P＜0.001),BCVA不相关(r=0.370,P=0.090).结论 视力检查可能会低估皮质性、核性、后囊膜下混浊等形态差异对视觉质量的影响,后囊膜下白内障对视觉质量的影响最大.眼内散射光及CS可以灵敏、定量评估白内障患者真实的视觉质量.     

不同类型年龄相关性白内障眼内散射光的检测及其临床意义

背景 视力检查是传统的评价视觉质量的标准,但近年来的研究发现,仅用视力指标评价白内障患者术后的视觉质量是不全面的,因此对比敏感度、眼内散射光等相关指标被越来越多地用于白内障患者视觉质量评估的临床应用中. 目的 应用C-quant散射光仪测量不同类型白内障眼内散射光值,探讨白内障形态与人眼视功能损害之间的关系.方法 采用非随机病例对照研究设计.纳入单纯年龄相关性白内障患者40例80眼,根据LOCSⅢ评分标准分为核性白内障22眼、皮质性白内障19眼、混合性白内障23眼、后囊下白内障16眼,应用C-quant测量眼内散射光值,比较不同类型白内障眼内散射光值的差异,并分析不同组内年龄、最佳矫正视力(BCVA)与眼内散射光值的相关性.收集年龄匹配的正常人作为正常对照组. 结果 白内障组共有62眼顺利完成C-quant眼散射光值的检查,完成率为77.5％,正常对照组检查完成率为100％.完成检查的白内障眼平均散射光值为(2.06±0.88) log,正常对照组为(1.25±0.87) log,差异有统计学意义(t=3.251,P＜0.01).核性白内障患者眼内平均散射光值为(1.96±0.42) log,皮质性白内障为(1.91±0.16) log,混合性白内障为(2.05±0.19)log,后囊下白内障为(2.48±0.66) log,差异有统计学意义(F=2.156,P=0.019),其中后囊下白内障产生眼内散射光最高,其次为混合性.核性白内障组眼内散射光值随着年龄的增加而增大,回归方程为Y=0.0010X+1.025(r=0.455,P＜0.05),混合性和后囊下白内障眼内散射光值与BCVA相关性均不明显(r=-0.240、-0.235,P＞0.05),而核性白内障和皮质性白内障组眼内散射光值与BCVA均呈负相关(r=-0.590、-0.697,P＜0.01). 结论 白内障患者术前可以使用C-quant散射光检测仪评估核性和皮质性白内障患者的视觉功能情况,因为后囊下白内障对患者视觉质量产生更大的影响,眩光等症状出现早,应及早进行手术治疗.     

儿童先天性白内障术后视感知觉训练对双眼视功能康复疗效评估

目的评价视感知觉训练对儿童先天性白内障术后双眼视功能康复的疗效。方法回顾性研究2014年至2019年在我院行白内障手术,并接受双眼视功能康复训练的36例(56眼)先天性白内障患儿,平均年龄3.81±1.53岁。25例(38眼)为人工晶体眼并配戴矫正框架眼镜,11例(18眼)未植入人工晶体并配戴硬性角膜接触镜进行屈光矫正。结果视觉康复训练后,52.50%(21/40)的双侧白内障患者BCVA≤0.3,87.50%(14/16)的单侧白内障患者BCVA≤0.3,差异具有统计学意义(P<0.05)。70.00%(21/30)进行视感知觉训练的双侧白内障患儿视力有提高,50.00%(5/10)进行传统弱视训练的双侧白内障患儿视力有提高,差异均具有统计学意义(P<0.05)。但40%(12/30)进行视感知觉训练的双侧白内障患儿视力明显改善,10%(1/10)进行传统弱视训练的双侧白内障患儿视力明显改善,差异具有统计学意义(P=0.05)。结论儿童先天性白内障术后感知觉训练对双眼白内障术后弱视治疗效果明确。     

多焦点人工晶状体植入术后视觉质量和阅读能力的研究

目的:研究多焦点人工晶状体(IOL)植入术后白内障患者的视觉质量及阅读能力。方法:前瞻性临床研究。选择2018年6月至2019年10月于重庆医科大学附属第一医院眼科就诊并行双眼白内障手术的患者共75例(150眼),依据患者选择的IOL进行分组,双眼植入Tecnis ZCB00 IOL 25例(50眼)作为单焦组,双眼植入Tecnis ZMB00 IOL 25例(50眼)作为双焦组,双眼植入AT Lisa tri.839MP IOL 25例(50眼)作为三焦组,对比3组患者术后3个月时的祼眼远视力(UDVA)、祼眼中视力(UIVA)、祼眼近视力(UNVA) (LogMAR)及阅读能力。使用NEI-RQL-42量表中文版评价3组患者术后视觉质量的差异。数据采用卡方检验、方差分析、Kruskal-Wallis检验、Mann-Whitney U检验进行统计分析。 结果:共75例(150眼)患者纳入研究。3组间UDVA差异无统计学意义( H=3.187, P=0.203)。三焦组UIVA(0.2±0.1)优于双焦组(0.3±0.2) ( Z=-2.041, P=0.041)和单焦组(0.3±0.3) ( Z=-2.142, P=0.032)。三焦组UNVA(0.3±0.2)和双焦组UNVA(0.3±0.2)优于单焦组(0.4±0.2) ( t=2.332, P=0.017;t=3.014, P=0.036)。3组阅读视力( F=0.421, P=0.658)、阅读速度( F=1.754, P=0.182)、阅读错误率( H=6.347, P=0.052)差异均无统计学意义。三焦组近视力维度得分(92±14)和双焦组近视力维度得分(100±11)均高于单焦组(50±42) ( U=-3.139, P=0.005;U=-3.726, P=0.001);三焦组中视力维度得分(100±12)高于双焦组(75±25)和单焦组(25±75) ( U=-2.758, P=0.017;U=-3.145, P=0.002)。三焦组脱镜率维度得分(100±25)和双焦组脱镜率维度得分(100±40)高于单焦组(30±100) ( U=-3.004, P=0.008;U=-3.766, P=0.001)。 结论:多焦点IOL植入患者可获得与单焦点IOL植入患者配戴老花镜时相同的近距离视觉质量;AT Lisa tri.839MP IOL与Tecnis ZMB00 IOL可提供相同的远近视力及近距离阅读能力,但前者中距离视觉质量更佳。     

两种类型人工晶状体植入术后远期患者视觉质量的研究

目的比较多焦点人工晶状体(multifocalintraocu-larlens,MIOL)和单焦点人工晶状体(monofocalintraocularlens,SIOL)植入术后患者远期视觉质量的改善情况,以进一步完善MIOL植入眼远期视功能的研究。方法观察2000~2004年在我院接受白内障超声乳化吸出联合人工晶状体植入术患者共69例98眼,其中双眼MIOL16例,双眼SIOL13例,单眼MIOL20例,单眼SIOL20例,术后随访时间>7月,分别检查术后非矫正近、远视力,矫正近、远视力,屈光,问卷调查术后满意度、视觉症状并对结果进行统计分析。结果90.38%(47/52)的MIOL眼非矫正近视力≥0.4,优于SIOL眼的21.74%(10/46)(χ2=53.174,P<0.01,差异具有极显著性);植入MIOL眼视近时屈光度明显小于植入SIOL眼(χ2=25.695,P=0.000<0.05,差异具显著性);非矫正远视力、矫正远视力及矫正近视力MIOL眼与SIOL眼差异无显著性(P>0·05);双眼植入MIOL组视近使用眼镜频率明显少于其他3组(t=9.774,P=0·000<0·01),双眼植入MIOL者术后满意度明显高于其他3组(t=3·637,P=0·001<0·01),双眼植入SIOL、单眼植入SIOL及单眼植入MIOL组之间使用眼镜频率及术后满意度之间无显著性差异。结论双眼植入MIOL后远期可获得较SIOL更好的视觉质量,但单眼植入MIOL则没有明显的优势。     

个性化多焦点人工晶状体植入术的初步临床研究

目的 探讨超声乳化白内障吸除联合双眼分别植入衍射型与折射型多焦点人工晶状体(MIOL)术后的视觉质量,评价CustomMatch个性化搭配模式的可行性.方法 前瞻性研究.将年龄相笑性白内障患者分为MIOL组与单焦点人工晶状体(SIOL)组符10例,行超声乳化白内障吸除联合人工晶状体(IOL)植入术.MIOL组为主视眼植入ReZoom NXGl IOL,对侧眼植入Tecnis ZM900 IOL;SIOL组为同期双眼植入Sensar AR40e IOL.观察患者术后不同光照条件下的远、中、近距离视力、阅读视力和阅读速度、焦点深度以及问卷调查.采用析因设计的方差分析,两两比较采用ISD检验.结果 术后1个月观察发现,在100 cd/m~2和6 cd/m~2光照度下,MIOL组患者可获得满意的双眼裸眼远视力和最佳矫正远视力.100 cd/m~2时,MIOL组在40 cm、63 am和100 cm的裸眼视力均在0.63以上,显著高于SIOL组(P=0.000);6 cd/m~2时,MIOL组在100 cm时的双眼裸眼视力与SIOL组比较差异无统计学意义(P=0.360),在63 cm和40 cm时显著高于SIOL组(P=0.000).在明、暗光线下MIOL组患者的裸眼阅读视力和阅读速度显著高于SIOL组(P=0.000,0.000),与SIOL组矫正后的阅读能力比较,差异没有统计学意义.MIOL组的焦点深度可达5.5D,其在中、近距离工作和阅读时的脱镜率可达70%(7/10).结论 CustomMatch个性化搭配模式在一定范围内可给白内障术后患者提供良好的全程视力.     

Assessment of function related to vision (AFREV)

OBJECTIVES: To evaluate the relationship of a performance-based measure of visual functioning to clinical and subjective measures in glaucoma patients. DESIGN: Cross-sectional survey of glaucoma patients. Participants: Forty-three patients with primary open-angle glaucoma. METHODS: Patients were evaluated using a novel performance-based measure, the Assessment of Function Related to Vision (AFREV), standard clinical tests of visual function, and the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ-25), a self-reported quality of life measure. Correlations of the AFREV scores with visual field scores, monocular and binocular visual acuity, contrast sensitivity scores, and NEI-VFQ scores were calculated. Rasch analysis was used to estimate the visual ability required by each task of AFREV for a particular response (item measures) and to estimate the visual ability of each patient (person measures). Main Outcome Measures: AFREV and NEI-VFQ total scores. RESULTS: The AFREV total scores were highly correlated with contrast sensitivity (r = 0.772), binocular visual acuity (r = -0.768), better-eye visual acuity (r = -0.737), worse-eye visual acuity (r = -0.675), and Estermann visual field efficiency scores (r = 0.606) as well as with NEI-VFQ scores (r = 0.70). The resulting index, constructed from 5 items of the AFREV, is unidimensional, thereby satisfying the primary assumption of the Rasch model. The Rasch person-item map demonstrates that the "putting stick into holes" and "reading small print" tests require the most visual ability. CONCLUSIONS: The AFREV performance-based measure, a new test of a spectrum of activities, correlates well with some standard measures of visual function and certain aspects of self-report assessments. AFREV appears to be a valid measure of performance ability that may provide information not obtainable from standard measures of visual function or subjective surveys.     

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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

温州市社区老年眼病筛查报告之一：视力损伤及年龄相关性白内障筛查与转诊情况

目的调查温州市区50岁及以上社区人群年龄相关性白内障患病及中重度视力损伤及后续转诊情况。方法调查研究。在2014年3月至2016年1月期间根据自愿原则,对温州市区124个社区共31 170例50岁及以上人群进行眼病筛查,包括生活视力、眼压、裂隙灯显微镜和眼底照相。对于视力下降至0.3或以下,存在明显白内障或其他眼病的受检者建议转诊。采用χ2检验或趋势χ2检验进行数据分析。结果31 170例受检者中,检出年龄相关性白内障10 023例,检出率为32.16%,随年龄增长,白内障的检出率增高（趋势χ2=4049.64,P＜0.01）。各年龄组中,女性人群白内障检出率均高于男性（50～59岁：χ2=8.70,P＜0.01;60～69岁：χ2=46.78,P＜0.01;70～79岁：χ2=52.21,P＜0.01;≥80岁：χ2=32.26,P＜0.01）。中度视力损伤（双眼中较差眼日常生活视力<0.3且≥0.1,较好眼视力≥0.1） 5 657例,检出率为18.15%;单眼盲和重度视力损伤（双眼中较差眼生活视力＜0.1,较好眼≥0.1） 2 161例,检出率为6.93%;双眼盲和重度视力损伤（双眼日常生活视力＜0.1） 604例,检出率为1.94%。随年龄增长,中度视力损伤（趋势χ2=217.14,P＜0.01）、单眼盲和重度视力损伤（趋势χ2=165.14,P＜0.01）以及双眼盲和重度视力损伤（趋势χ2=57.58,P＜0.01）的检出率明显增高。白内障患者中较好眼视力＜0.3者1 398例,占白内障总人数的13.95%,其中1 061例（75.90%）受检者接受转诊治疗卡表示愿意至医院就诊,最终有449例至眼视光医院检查并接受手术治疗,转诊率为32.12%。结论温州市区50岁及以上社区人群中视力损伤及白内障的检出率较高,社区人群仍缺乏视觉健康意识,应加强眼病相关知识的宣教工作。     

Catquest questionnaire: re-validation in an Australian cataract population

Background:  The Catquest questionnaire was developed using traditional methodology to enable cataract surgery outcomes assessment in European countries. Recently, it has been validated using Rasch analysis in a Swedish population resulting in the Catquest-9SF. The aim of the present study was to assess the performance of the Catquest and the Catquest-9SF questionnaires using Rasch analysis in Australian cataract patients.
Methods:  A total of 217 cataract patients awaiting surgery at Flinders Medical Centre, Adelaide, South Australia self-administered the Catquest questionnaire. This is a 19-item instrument containing frequency, difficulty, symptoms and global rating items. Rasch analysis was undertaken to assess the unidimensionality (whether all the items are measuring a single underlying construct using principal components analysis or PCA), person separation (ability of the questionnaire to distinguish between strata of patient ability) and targeting of item difficulty to person ability.
Results:  Similar to the previous validation study, the original Catquest questionnaire required revision because of misfit and multidimensionality necessitating removal of the frequency items. The revised version was similar to the Catquest-9SF although an extra driving item was a valid optional inclusion. The Catquest-9SF performed well in the Australian cohort satisfying all criteria for valid measurement including unidimensionality. However, targeting of item difficulty to person ability was marginally worse compared with the Swedish cataract population indicating the Australian cataract patients present for surgery at lower levels of visual disability.
Conclusions:  The Catquest-9SF is a reliable and valid measure of visual disability in the Australian cataract population.     

Psychometric properties of visual functioning index using Rasch analysis

Acta Ophthalmol. 2010: 88: 797–803

Abstract.

Purpose: The visual functioning index (VFI) was one of the first questionnaires developed using classical test theory to assess outcomes of cataract surgery. However, it was not Rasch‐validated. The objective of this study was to examine the psychometric properties of the VFI using Rasch analysis in patients with cataract. Methods: The 11‐item VFI was self‐administered to 243 patients (mean age 73.9 years) drawn from a cataract surgery waiting list. We examined the response category thresholds, item fit statistics, differential item functioning and unidimensionality for the VFI and its three subscales. Results: Category thresholds were ordered. The person separation and reliability were low, indicating the poor discriminatory ability of the VFI. No items misfit but there was suboptimal targeting of item difficulty to patient ability. On the whole the items in the VFI were too easy for the sample. Only one item showed moderate differential item functioning. Conclusion: The VFI does not meet the stringent requirements of the Rasch model. However adding more items to suit the more able patients with cataract as well as those awaiting second‐eye cataract surgery could optimize the VFI.     

The impact of visual impairment on functional vision of children in rural South India: the Kariapatti Pediatric Eye Evaluation Project

PURPOSE: To determine the impact of visual impairment on functional vision of children in a rural population of south India. METHODS: A visual function questionnaire (LVP-VFQ) was administered to 1194 children aged 7 to 15 years identified through a systematic random sampling technique from 144 hamlets of Kariapatti in rural south India as part of a larger population-based project. Visual acuity estimations and clinical examinations for morbidity were performed in these 1194 children. A Rasch analysis was performed to validate the use of the instrument in this population. Bootstrap estimates (95% confidence intervals) of the regression coefficients were used to compare visual function scores between children with normal sight and children with uncorrected monocular and binocular visual impairment. RESULTS: The mean age of children was 10.3 +/- 2.1 years. The reliability estimates were 0.82 for person ability and 0.88 for item difficulty parameters, according to the Rasch analysis. A separation index of 2.15 was obtained for person measures and 2.74 for item measures, and the mean square infit and outfit statistics were 1.03 (Z(STD) 0.1) and 0.99 (Z(STD) -0.1), respectively. Children with monocular visual impairment (bootstrap estimate [95%CI] -0.05 [-0.08 to -0.01]) and binocular visual impairment (bootstrap estimate [95%CI] -0.09 [-0.11 to -0.07]) were more likely to have functional visual deficits than were normally sighted peers. CONCLUSIONS: Monocular or binocular visual impairment impacts on the functional vision of children in this rural population. Further studies are needed to determine the impact of treatment of visual impairment on functional vision in children of this population.     

The outcome of cataract surgery measured with the Catquest‐9SF

Purpose: The purpose of this study was to use the Catquest‐9SF to measure cataract surgery outcomes, and to use Rasch analysis to test the psychometric properties of this questionnaire, including its validity and responsiveness. Methods: Patients were recruited as consecutive cataract surgery patients during 1 month at six surgical units in Sweden (via the National Cataract Register). The patients completed the questionnaire before surgery and 3 months after. The Catquest‐9SF data were assessed for fit to the Rasch model using version 3.63.2 of the WINSTEPS software (Winsteps.com, Beaverton, OR, USA). Both preoperative and postoperative questionnaires were included in the analysis. The responsiveness to cataract surgery was calculated as the effect size. Results: Completed questionnaires before and after surgery were received from 846 patients. The Rasch analysis showed that the category thresholds were ordered. All items fit a single overall construct (infit range 0.79–1.40; outfit range 0.74–1.40). The ability to discriminate different strata of person ability was good, with a real patient separation of 2.58 and patient separation reliability of 0.87. The questionnaire showed unidimensionality and was largely free from differential item functioning. The item difficulty was reasonably well targeted to both preoperative and postoperative patient ability. The Catquest‐9SF Rasch score correlated significantly with visual acuity, and cataract surgery resulted in a significant improvement with an effect size of 1.8. Conclusion: The Catquest‐9SF shows excellent psychometric properties, as demonstrated by Rasch analysis. It is highly responsive to cataract surgery, and its brevity (nine items) makes it well suited for use in daily clinical practice.     

The Impact of Cataract Surgery questionnaire: re‐evaluation using Rasch analysis

Purpose: The Impact of Cataract Surgery (ICS) questionnaire was designed to assess cataract surgery outcomes. The aim of this study was to describe the psychometric properties of the ICS questionnaire using the Rasch model in a cataract population. Methods: Ninety‐one patients waiting to undergo cataract surgery in the first or second eye at the Flinders Medical Centre, Adelaide, South Australia self‐administered the four‐item ICS questionnaire. Rasch analysis was performed to assess behaviour of response categories, ability to differentiate between participants’ visual abilities (person separation; minimum acceptable 2.0), if items measure a single underlying construct [i.e. unidimensionality assessed by fit statistics and further by principal components analysis (PCA)] and matching of item difficulty to participant ability (targeting; ideal < 0.5 logits). Adequate person separation was defined as basic requirement for a measure, failing which further assessment such as PCA was not performed. Results: The four‐item ICS questionnaire did not meet the required measurement properties (person separation zero). Response categories did not behave as intended, requiring the collapsing of categories for one item (read ordinary newspaper‐size print). One item misfit (estimating distance) indicating that it was not measuring the same construct as other items. However, person separation failed to improve following the deletion of this item. Targeting was ?0.46 logits, indicating that the item difficulty was well suited to the visual abilities of the participants. Conclusion: In its present form, the ICS is unsuitable for visual disability assessment in patients awaiting cataract surgery. Other, better visual function questionnaires are available and preferred.     

Association between visual impairment and patient-reported visual disability at different stages of cataract surgery

PURPOSE: To evaluate the association between visual impairment (visual acuity, contrast sensitivity, stereopsis) and patient-reported visual disability at different stages of cataract surgery. METHODS: A cohort of 104 patients aged 60 years and over with bilateral cataract was assessed preoperatively, after first-eye surgery (monocular pseudophakia) and after second-eye surgery (binocular pseudophakia). Partial correlation coefficients (PCC) and linear regression models were calculated. RESULTS: In patients with bilateral cataracts, visual disability was associated with visual acuity (PCC = -0.30) and, to a lesser extent, with contrast sensitivity (PCC = 0.16) and stereopsis (PCC = -0.09). In monocular and binocular pseudophakia, visual disability was more strongly associated with stereopsis (PCC = -0.26 monocular and -0.51 binocular) and contrast sensitivity (PCC = 0.18 monocular and 0.34 binocular) than with visual acuity (PCC = -0.18 monocular and -0.18 binocular). Visual acuity, contrast sensitivity and stereopsis accounted for between 17% and 42% of variance in visual disability. CONCLUSIONS: The association of visual impairment with patient-reported visual disability differed at each stage of cataract surgery. Measuring other forms of visual impairment independently from visual acuity, such as contrast sensitivity or stereopsis, could be important in evaluating both needs and outcomes in cataract surgery. More comprehensive assessment of the impact of cataract on patients should include measurement of both visual impairment and visual disability.