成人斜视生存质量评估量表在中国人群的应用

目的制作一个评价中国成人斜视患者生存质量状况的评估量表,探讨其应用在中国成人斜视患者时的信度和效度。方法 前瞻性病例对照研究。将英文版的成人斜视生存质量量表（AS-20）翻译为中文,征集就诊的成人斜视患者102例和视功能正常的对照者102例。对这2组患者使用中文版的成人斜视生存质量评估量表进行问卷调查。分析量表的内在一致性、重测信度、内容效度、结构效度和判别效度,同时分析影响患者CAS-20得分的相关因素。计算克朗巴赫α系数和因子分析评估量表信度和效度,Spearman′s 序列相关性分析评估条目集合效度和分辨效度。结果 CAS-20分为社会心理维度（条目1-10）和视功能维度（条目11-20）。经102例成人斜视患者和102视功能正常的对照者检验,总量表、社会心理维度和视功能维度的克朗巴赫系数分别为0.846、0.819、0.883,分半信度为0.846、0.801、0.898,重测信度为0.811、0.862、0.723。因子分析提取出6个公因子,能归纳为社会心理维度和视功能维度2个维度,斜视患者的得分显著低于正常对照组得分,伴有复视的斜视患者得分比没有复视的患者得分更低。量表得分与患者年龄、性别、视力水平及眼位偏斜方向无明显相关性。结论 中文版AS-20具有良好的信度和效度,能敏感反映中国成人患者与斜视相关的生存质量的变化。     

中文视功能相关生存质量量表-25的初步应用评价

目的研制中文视功能相关的生存质量量表-25,计算其信度和效度并应用于眼病患者中,评价量表反映眼病对患者生存质量的影响的应用效果。方法调查研究。选取美国国家眼科研究所开发的视功能相关的生存质量量表（NEI-VFQ-25）,经过翻译、回译和文化调适后,形成中文量表。分别测量113例眼病患者（病例组）和38例健康体检者（对照组）视功能相关的生存质量,分析量表条目的无应答率、克朗巴赫α系数以及内容效度、结构效度、区分效度,比较病例组与对照组各维度得分之间的差异,并评估性别、年龄、文化程度及视力与量表各维度得分的相关性。采用多变量方差分析法、因子分析法以及Pearson相关分析进行数据分析。结果原量表中“开车”一项,在中文版视功能相关的生存质量量表-25中均调整为“驾车”。量表整体及各维度（除维度“眼痛”外）的克朗巴赫α系数均大于0.6,病例组和对照组的区分效度有显著的统计学意义,内容效度中各条目与其等级之间的相关系数均大于0.4,结构效度示该量表各维度及各条目均只在某一因子上有较大载荷。病例组中各眼病患者与对照组之间以及病例组中男女患者之间的量表得分差异均具有显著的统计学意义,且量表的得分与性别无明确相关性,与较好眼矫正视力及双眼矫正视力相关性高,与年龄呈负相关,且文化程度愈高者,量表得分愈高。结论中文视功能相关的生存质量量表-25的信度、效度均较高,能较全面地反映眼病患者的视力对其视功能相关的生存质量的影响。该量表得分与年龄呈负相关,并受文化水平影响,文化水平高者,量表得分亦较高。     

视功能指数量表(VF-14)的修订及评价

目的:对视功能指数量表(VF-14)进行修订并对中文修订本进行信效度评价,为探索国内适宜的视功能评价工具提供依据。方法:选取眼科专家及年龄相关性白内障患者为研究对象,收集量表的修订资料形成修订本;选取年龄相关性白内障患者作为研究对象,收集其一般情况及量表资料。采用t检验、相关分析等统计方法对量表的信度效度进行分析。结果:VF-14量表中文修订本的信度:(1)重测信度:量表各条目和总分的ICC范围值在0.814～0.976;(2)内部一致性:量表的Cronbachα系数为0.916;(3)评定者间信度:量表各条目和总分的ICC范围值在0.854～0.996;(4)分半信度:量表的分半信度系数为0.817。VF-14量表中文修订本的效度:量表的条目包括了所要测量视功能的各个方面;采用术前及术后视功能生存质量量表(VRQOL)得分与VF-14中文修订本得分做相关分析,相关系数分别为0.67和0.46;采用50例患者术前术后VF-14中文修订本得分进行t检验得t=17.18,P<0.05;采用患者主观视功能改善程度与量表分值变化做相关分析,显示量表的相关系数在0.35～0.62之间。结论:视功能指数量表(VF-14)中文修订本的信度效度较好。     

国人白内障视功能相关生存质量简表的研制及其测量特性评价

目的 研制国人白内障视功能相关生存质量简表Catquest-9SF并评价其在中国白内障人群中的适用性、项目区分度及信、效度,为中国白内障人群的视功能相关生存质量评价提供科学、简便的工具,并初步分析白内障术前患者生存质量的影响因素。方法 横断面调查研究。对原Catquest-9SF量表进行翻译、回译和跨文化调试,选取在温州医科大学附属眼视光医院确诊的白内障住院患者150例行量表调查,其中50例患者由2名调查者先后进行调查。对数据进行内部一致性、评定者间信度、内容效度和结构效度等分析,评价量表的适用性、项目区分度及信、效度,并分析得分的相关因素。结果 国人白内障视功能相关生存质量简表Catquest-9SF简短易行,项目区分度好;总表的Cronbach′s α系数为0.90;评定者间信度的Bland-Altman 95%一致性界限为-2.1~2.0,Pearson相关性分析表明评定者间信度高度相关（r=0.988,P＜0.01）;量表水平内容效度指数为0.98;结构效度的探索性因子分析提取出1个公因子,解释方差百分比为55.89%,累积方差贡献率为55.89%。量表得分和视力（r=0.43,P＜0.01）及年龄（r=-0.22,P<0.01）的相关性显著,不同性别的患者得分差异有统计学意义（t=-2.30,P<0.05）,不同文化程度和第一眼/第二眼手术的患者得分差异无统计学意义。结论 国人Catquest-9SF量表在中国南方地区适用性好,且具有良好的信、效度,是评价中国南方地区白内障人群视功能相关生存质量简单而有效的可行工具。     

老年性黄斑变性对生存质量的影响

目的 评价上海市老年性黄斑变性(AMD)患者与视功能相关生存质量（vision related health quality-of-life, VRQL）以及相关的影响因素。 方法 采用中文版低视力者生存质量量表（Chinese-version low vision quality of life questionnaire, CLVQL）测量AMD患者和非AMD对照者各105例的VRQL。 结果 AMD患者组量表的克郎巴赫α系数为0.97。AMD患者各方面生存质量得分均明显低于对照组。渗出型病变越多，AMD病程越长，量表得分越低。各维和总体量表得分与较佳眼、较差眼视力均相关。较佳眼远视力是影响AMD患者各方面VRQL的首要独立因素。 结论 AMD主要通过影响视力使患者的VRQL受到进行性的损害。采用CLVQL可以提供AMD患者全面的VRQL信息。（中华眼底病杂志，2004，20：303-306）     

中文版视觉训练视光师学会生存质量 量表的信度和效度研究

目的：研究中文版视觉训练视光师学会生存质量量表（COVD-QOL）的信度和效度。方法：横断面 调查研究。应用Brislin翻译模型对美国视觉训练视光师学会生存质量量表（19个条目）进行汉化，即 先将英文版量表翻译成中文版，再回译成英文版，专家组对个别条目进行调适，形成最终中文版。 2018年1月抽取118名20～23岁的厦门医学院大学生受试者进行中文版量表的调查测试，3周后其中 的80名参加了重复测试，采用项目分析、克朗巴赫系数和重测信度Pearson相关分析、内容效度和结 构效度进行数据分析。结果：项目分析显示，各个条目与量表总分均相关，相关系数在0.333～0.684 之间（P<0.01）；量表信度检测发现Cronbach's α系数为0.791；重测信度采用Pearson相关分析，重测 信度良好（r=0.750，P=0.002）；内容效度指数为0.985，探索性因子分析提取6个公因子，共解释了 62.3%的总方差，但6个公因子难以做专业解释，量表的结构效度欠佳。结论：中文版COVD-QOL具 有良好的信度、重测信度和内容效度，结构效度有待改进，可以应用于评估大学生双眼视异常患者 的生存质量。     

神经眼科患者的视觉相关生存质量分析

背景 神经眼科疾病是眼科常见病,并且严重影响患者的生活质量.美国国立眼科研究所视觉功能问卷-39（NEI VFQ-39）可以用来评估视功能对生活质量的影响,但目前中国还缺少将其用于神经眼科疾病的研究. 目的 采用NEI VFQ-39评估神经眼科患者的视觉相关生存质量,为神经眼科患者的治疗及护理提供参考. 方法 选取2012年6月1日至9月30日于解放军总医院神经眼科就诊的97例患者,收集其所有的临床资料及中文版NEI VFQ-39调查量表.以发病眼数量、病种及最佳矫正视力（BCVA）等不同分组方式对NEI VFQ-39各项分数进行比较,同时对NEI VFQ-39分数与较好眼及较差眼的BCVA进行相关分析. 结果 受试患者平均年龄为（36.6±177;14.4）岁,且男女比例无明显差异.VFQ-39总分为57.36（46.50,73.38）,其中精神健康项得分最低,为45.00（35.00,60.00）.4个组疾病中,前部缺血性视神经病变（AION）组除眼痛、依赖程度及周边视力外,其他各项评分均较其余3个组评分低,但差异均无统计学意义（P＞0.05）.双眼发病患者各项得分均较单眼发病者低,除眼痛外,其余各项差异均有统计学意义（P＜0.05）.较好眼BCVA＞20/32的患者得分优于其他两组,与较好眼BCVA＜20/200组比较患者除整体健康及眼痛外,与20/200≤较好眼BCVA≤20/32组比较患者除眼痛、社会活动及色觉外,其余各项比较差异均有统计学意义（P＜0.05）.VFQ-39多数项目得分与较好眼或较差眼的BCVA呈正相关（P＜0.05）,且与较好眼BCVA的相关性较强.结论 神经眼科疾病严重影响患者的视功能及其生活质量,努力提高视功能有助于改善患者的生活质量.     

非斜视性双眼视异常学龄儿童生活质量量表研制

目的 初步研制非斜视性双眼视异常学龄儿童的生活质量量表,并评价其效度、信度和反应度。方法 调查研究。根据量表设计原则,经统计学评价,综合眼视光学和公共卫生学专家意见,设计非斜视性双眼视异常学龄儿童生活质量量表（加注拼音）。非斜视性双眼视异常判断标准：眼部不适、酸胀、视物模糊、视觉疲劳、复像或文字跳行重叠等症状明显,根据Morgan正常值,Sheard、Percival准则,综合分析是否为非斜视性双眼视异常并进行疗效评价。调查非斜视性双眼视异常小学生116例,首次调查2周后接受再次调查,其中经治疗训练有效的103例于停止治疗后第3个月随诊时接受第3次调查;选择双眼视功能正常小学生100例作为对照。应用变异系数、相关系数、因子分析、逐步回归分析、逐步判别分析、克朗巴赫系数、重测信度和分半信度来筛选量表的有效条目,评价量表的效度、信度和反应度。结果 该量表20个条目,包括双眼视功能、生活自理能力、活动交往以及精神心理等4个分项,具有良好的结构效度（经因子分析提取的4个公因子与本量表的4个分项一致,累计方差贡献率53.15%,各条目在其所属公因子上的因子载荷值均大于0.50）、内容效度（每个条目得分与所属分项得分的相关系数r均大于0.55;4个分项与总得分的相关系数r分别为0.87、0.48、0.49、0.54）和区分效度[双眼视功能正常与非斜视性双眼视异常小学生得分差异有统计学意义（t=1.97,P<0.01）及异常者经治疗训练前后得分差异有统计学意义（t=1.97,P<0.01）];重测信度r为0.98（P<0.01）,克朗巴赫α系数均达到0.70以上,分半信度Rh为0.78（P<0.01）;效应尺度统计量（ES）为0.53。结论 该量表符合生活质量量表效度、信度、反应度和容易分析的技术要求,可试用于临床研究。     

视功能损害眼病患者生存质量量表的研究

目的研究一个适合测量我国视功能损害眼病患者的生存质量量表。方法通过指标筛选，最终选择２０个指标形成生存质量量表。应用该量表测量了５７例单纯视力损害的白内障患者和６０例有不同程度视力及视野损害的青光眼患者，并对该量表进行效度、信度和反应性的评价。结果该量表２０个指标，包括症状、视功能、身体机能、社会活动及精神心理等四个方面。（１）准则关联效度：ｒ＝０．６８６５，Ｐ＝０．０００。（２）重测信度：ｒ＝０．８９５９，Ｐ＝０．０００；克朗巴赫系数：α＝０．９３５８；方差比＝０．０５５１；分半信度：Ｒ＝０．９５５３。（３）反应度：ｔ检验＝５．９５（Ｐ＝０．０００），效应大小统计量为１．５３３。结论该量表具有满意的效度、信度和反应度。可试用于临床试验评价     

中文版IND-VFQ-33在白内障人群中的应用与评价

目的研制中文版印度视功能量表（IND-VFQ-CN-33）,评价其在中国白内障人群中的测量特性,并初步分析白内障患者术前生活质量的影响因素。方法横断面调查研究。对IND-VFQ-33量表进行标准的翻译、回译和跨文化调试后,选取在温州医科大学附属眼视光医院确诊的白内障住院患者293例进行调查,其中45例患者用于评估2名调查者信度。通过Cronbach′s α系数分析量表的内部一致性;Pearson相关分析评估评定者间信度;内容效度指数评估内容效度;探索性因子分析评估结构效度,评价量表的适用性、项目区分度及信度、效度。通过独立样本t检验分析不同性别、年龄、文化程度条件下生活质量的差异,并通过单因素方差分析不同双眼远视力情况下生活质量的差异。结果中文版IND-VFQ-CN-33项目区分度好。内部一致性和评定者间信度较高,总表的Cronbach′s α系数为0.93。量表水平内容效度指数为0.84;结构效度的探索性因子分析提取出8个公因子,累积方差贡献率为67.62%。男性患者的心理评估子表得分高（t=-3.27,P＜0.05）,文盲患者的视功能子表（t=-3.03,P＜0.05）和心理评估子表（t=-3.45,P＜0.05）得分高。单因素方差分析发现不同双眼远视力组间差异均有统计学意义（F=3.66~24.37,P＜0.05）。结论IND-VFQ-CN-33在中国白内障术前人群中适用性好,具有较优的测量特性,可用于中国白内障术前人群的生活质量评估研究。白内障男性患者的心理方面生活质量下降较女性更加显著,文盲患者的视功能和心理方面生活质量下降较非文盲患者更加显著。     

Influence of vitrectomy for diabetic retinopathy on health-related quality of life

PURPOSE: To evaluate the vision-related quality of life (QOL) in patients undergoing vitrectomy for diabetic retinopathy with the Japanese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). SUBJECTS AND METHODS: Subjects were 87 patients undergoing vitrectomy for diabetic retinopathy of vitreous hemorrhage, macular edema, or fibrovascular membrane, only for the subject eye, or for subjects undergoing vitrectomy for the fellow eye within 6 months or later. The VFQ-25 date was recorded one month before and 6 months after the vitrectomy. The VFQ-25 data were compared before and after the vitrectomy. The subjects were classified by the pathological condition: 41 eyes with vitreous hemorrhage, 28 eyes with macular edema, and 18 eyes with fibrovascular membrane. RESULTS: The average VFQ-25 scores of all the patients increased in almost all of the 12 subscales. Vitrectomy for vitreous hemorrhage was most effective in improving the VFQ-25 score, in improving 10 of the 12 subscales in the VFQ-25, and in increasing VFQ-25 scores to almost the same level as in phacoemulsification and foldable intraocular lens implantation for cataract patients in both eyes. CONCLUSION: NEI VFQ-25 quantitatively clarified that vitrectomy for diabetic retinopathy is effective in increasing the QOL of diabetic retinopathy patients.     

Quality of life evaluation of age-related macular degeneration

PURPOSE: To evaluate quality of life (QOL) characteristics and ophthalmic factors influencing QOL in age-related macular degeneration (AMD) patients. SUBJECTS AND METHODS: The subjects were 80 patients with AMD. An eye-disease specific QOL questionnaire, The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25), was administered. Results were compared with those of glaucoma or cataract patients and those of individuals without eye diseases. The VFQ-25 score was assessed according to visual acuity, absolute scotoma size, and disease type. Multiple regression analysis was used to evaluate ophthalmic factors influencing the QOL score. RESULTS: VFQ-25 scores were significantly lower in AMD patients than in all other groups. Scores of patients with visual acuity less than 0.1, with large absolute central scotoma, and bilateral exudative AMD were lower, for several items, than those of patients with visual acuity of 0.4 or more, those of patients without absolute scotoma, and those of bilateral atrophic AMD patients, respectively. Visual acuity and absolute central scotoma size influenced social functioning and mental health. The exudative form influenced mental health and critical print size influenced dependency. CONCLUSION: The VFQ-25-assessed QOL of AMD patients was lower than that of glaucoma or cataract patients. Visual acuity, absolute central scotoma and the existence of exudative AMD influenced the QOL in AMD patients.     

Adaptación cultural y validación al castellano del cuestionario National Eye Institute Visual Function Questionnaire 25

Introduction

Advances in medicine have contributed to a higher average life expectancy, as well as an increasing number of chronic diseases patients. This longevity means that the assessment of the quality of life, particularly that related to vision, has become very relevant.

Visual field defects and vision-specific health-related quality of life in African Americans and whites with glaucoma

PURPOSE: To examine the relationship of visual field impairment to vision-specific health-related quality of life and symptoms in a large cohort (N=345) of African Americans and Whites of non-Hispanic origin diagnosed with glaucoma. MATERIALS AND METHODS: Participants consisted of persons > or =55 years of age recruited from university-affiliated ophthalmology and optometry practices in Birmingham, AL who had been diagnosed with glaucoma. Medical records were abstracted to collect information on demographics, visual acuity, and visual fields. A telephone survey was conducted to obtain information on vision-specific health-related quality of life [National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25)], glaucoma symptoms [Glaucoma Symptom Scale (GSS)], and cognitive status (Short Portable Mental Status Questionnaire). Visual fields were used to compute a visual field defect score for each eye based on the Advanced Glaucoma Intervention Study (AGIS) scoring system. RESULTS: Mean NEI VFQ-25 subscale scores ranged from the 50s to 80s. Scores for African Americans and Whites did not differ except for the general health and ocular pain subscales for which African Americans had slightly higher scores. For both African Americans and Whites, as the AGIS score became worse in the better and/or worse eye, there was a decrease in VFQ subscale score for most VFQ subscales including general vision, distance vision, near vision, social functioning, color vision, and peripheral vision (P<0.05). AGIS scores were unrelated to the GSS subscales in African Americans; for Whites, the visual but not the nonvisual subscale was related to AGIS score. CONCLUSIONS: Scores on most subscales of the NEI VFQ-25 and the 2 subscales of the GSS are highly similar in African Americans and Whites of non-Hispanic origin who have been diagnosed with glaucoma. In addition, for both African Americans and Whites, the VFQ subscales for the most part demonstrated good construct validity with respect to the extent of visual field impairment. Results imply that the NEI VFQ-25 and the GSS are appropriate instruments for studying the personal burden of glaucoma in studies whose samples involve both African American and White adults.     

全视网膜光凝术改善PDR患者的视觉相关生活质量及日常视觉功能

目的：评估全视网膜光凝术( PRP )对糖尿病视网膜病变( PDR)患者在视觉相关生活质量及日常视觉功能的影响。方法：研究纳入30例(男13例,女17例)接受全视网膜光凝术治疗糖尿病视网膜病变患者。国家眼科研究所发布的视觉功能量表( VFQ-25)用来评估全视网膜光凝术治疗前后视觉相关生活质量及日常视觉功能。患者在接受全视网膜光凝术治疗前和治疗后6 mo分别填写VFQ-25量表,比较视觉相关生活质量及日常视觉功能差异。运用配对t检验对治疗前后VFQ-25评分对比。结果：全视网膜光凝术治疗前平均VFQ-25综合评分为74.79±15.7,术后平均综合评分为74.08±19.1。术前与术后的平均VFQ-25综合评分无统计学意义( P=0.875)。结论：全视网膜光凝术( PRP)对糖尿病视网膜病变( PDR)患者在视觉相关生活质量及日常视觉功能无不利影响。     

Vision-specific health-related quality of life in age-related maculopathy patients presenting for low vision services

Few studies have examined the effectiveness of low vision rehabilitation for age-related maculopathy (ARM) patients and its impact on vision-specific health-related quality of life (HRQoL). However, before a multi-site clinical trial can be conducted, appropriate outcome measures need to be identified for ARM patients who seek out low vision rehabilitation, including a vision-specific HRQoL instrument. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was developed to assess vision-specific HRQoL for low vision patients, including those with ARM. This study examines the performance of the NEI VFQ-25 among ARM patients who seek out low vision services and examines its relationship with visual acuity and self-reported use of low vision aids. One hundred and twenty-seven patients were recruited from a University-affiliated low vision clinic. During two telephone interviews, subjects completed the NEI VFQ-25 and a short cognitive test and provided information on general health and use of low vision aids. Additional information on visual acuity and eye health were collected from the medical record. Our results indicate that ARM patients who seek out low vision services report significant impairment in their vision-specific HRQoL. Their NEI VFQ-25 scores were lower compared to other ARM and low vision rehabilitation samples previously studied. The VFQ subscales with the largest deficits were near and distance visual acuities and psychosocial issues (near vision, distance vision, role difficulties, dependency, social functioning, mental health). These subscale scores were lower for those with greater visual acuity impairment. The VFQ subscale scores most impacted by the disease had wide variability and were higher for those who used low vision aids, suggesting that the NEI VFQ-25 is suitable for measuring further decline and treatment-related improvements. Thus, it should be strongly considered for a multi-site clinical trial on the effectiveness of low vision rehabilitation.     

Self-reported visual dysfunction in multiple sclerosis: new data from the VFQ-25 and development of an MS-specific vision questionnaire

PURPOSE: To examine vision-specific health-related quality of life in a cohort of patients with multiple sclerosis (MS) using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25), and to identify content areas for a brief MS-specific vision questionnaire. DESIGN: Cross-sectional survey. METHODS: The VFQ-25 and a modified version of the Optic Neuritis Treatment Trial (ONTT) Patient Questionnaire were administered by in-person interview to 80 patients at the University of Pennsylvania MS Center. Binocular visual acuities were obtained following a standard protocol using retroilluminated Early Treatment Diabetic Retinopathy Study charts. RESULTS: Despite a median binocular visual acuity of 20/16 (20/12.5-20/250), VFQ-25 subscale scores in the MS cohort were significantly lower (worse) compared with those of a published reference group of eye disease-free patients (P =.0001-0.009, two-tailed t tests). Rank-correlations of VFQ-25 composite (overall) scores with visual acuity were modest, but significant (r(s) = 0.33, P =.003), supporting construct validity for VFQ-25 scores in MS populations. Seven additional aspects of self-reported visual dysfunction in MS were also identified. CONCLUSIONS: Patients with MS have a high degree of self-reported visual dysfunction that is not entirely captured by visual acuity. The VFQ-25 is an effective measure of self-reported visual loss in MS. A brief MS-specific vision questionnaire may provide additional useful information when administered concurrently with the VFQ-25 in future investigations of MS and other neuroophthalmologic disorders.