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。     

Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma

Purpose:

To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33).

Patients and Methods:

The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months.

Results:

Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40–77 years) and controls (mean age: 54.9 ± 6.7 years, 42–73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01).

Conclusions:

Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.     

Development and validation of a patient based measure of outcome in ocular melanoma

BACKGROUND: Patients with uveal melanoma can be treated by a number of modalities. As none of the different treatments offer a survival advantage, a key factor in choosing among treatments is their differential impact on patients' quality of life. A short, patient based questionnaire was developed and validated for evaluating outcomes following treatment for uveal melanoma. METHODS: The 21 item measure of outcome in ocular disease (MOOD) assesses the patient's view of outcome in terms of visual function and the impact of treatment. The reliability and validity of the three MOOD scores (total, vision, impact) were evaluated in 176 patients who had been treated for uveal melanoma (75 brachytherapy, 78 proton beam radiotherapy, 23 enucleation). Of these, 165 patients also completed the SF-36. RESULTS: All three MOOD scales met standard criteria for acceptability, reliability, and validity. The proportion of missing data was low, and responses to all items were well distributed across response categories. Internal consistency, assessed by Cronbach's alpha coefficients, exceeded the standard criterion of 0. 70 for all three summary scores. Item total correlations ranged from 0.22 to 0.77 (mean item total correlation 0.58), indicating good homogeneity. Test-retest correlations for all three summary scores exceeded 0.85. Scaling assumptions, assessed by item convergent and discriminant validity correlations, were met for the vision and impact scores. The MOOD showed good content validity, as assessed by review by ophthalmologists and patients. Construct validity was demonstrated by high intercorrelations between the vision and impact scores and the total scale; higher scores for patients who reported being very satisfied compared with those who were not very satisfied and for those who reported persistent red eye compared with those who did not have this complication (known group differences/hypothesis testing); moderate correlations between the MOOD and the SF-36 and visual acuity (convergent validity); and low correlations between the MOOD and age and sex (discriminant validity). CONCLUSIONS: The MOOD is a practical and scientifically sound patient based measure which can be used in research and audit to evaluate outcomes following treatment for uveal melanoma. It takes 5 minutes to complete and meets standard psychometric criteria for reliability and validity.     

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。     

Functional and Visual Acuity Outcomes of Cataract surgery in Timor-Leste (East Timor)

Purpose: To report functional outcomes following cataract surgery in Timor-Leste.

Methods: Pre- and post-intervention study measuring visual function improvement following cataract surgery. Presenting visual acuity (VA) was measured and visual function documented using the Indian vision function questionnaire (IND-VFQ).

Results: All 174 persons undergoing cataract surgery from November 2009 to January 2011 in Timor-Leste were included. Mean age was 65.4 years; 113 (64.9%) were male, 143 (82.1%) were from a rural background and 151 (86.8%) were illiterate. Pre-operatively, 77 of 174 patients (44.3%, 95% confidence interval, CI, 37.0–51.7%) were blind (VA ≤3/60), 77 (44.3%, 95% CI 37.0–51.7%) were visually impaired (VA <6/18–>3/60), while 20 (11.5%, 95% CI 7.4–16.9%) had presenting acuity ≥6/18 in the better eye. Following surgery, significant improvement in visual function was demonstrated by an effect size of 2.8, 3.7 and 3.9 in the domains of general functioning, psychosocial impact and visual symptoms, respectively. Four weeks following surgery, 85 patients (48.9%, 95% CI 41.5–66.3%) had a presenting VA ≥6/18, 74 (42.5%, 95% CI 35.3–45.9%) were visually impaired and 15 (8.6%, 95% CI 5.0–13.6%) were blind. IND-VFQ improvement occurred even in patients remaining visually impaired or blind following surgery.

Conclusion: In this setting, cataract surgery led to a significant improvement in visual function but the VA results did not meet World Health Organization quality criteria. IND-VFQ results, although complementary to clinical VA outcomes did not, in isolation, reflect the need to improve program quality.     

Development of a questionnaire to assess vision problems under low luminance in age-related maculopathy

PURPOSE: To develop a questionnaire for assessing self-reported visual problems under low luminance and at night for use in studies on age-related maculopathy (ARM). METHODS: The questionnaire was developed in three steps: (1) Content for questionnaire items was identified through focus groups of older adults with ARM and those exhibiting normal retinal aging. The topic for discussion was "vision at night and under low lighting." Discussion was audiotaped, transcribed, and subjected to content analysis to identify problem categories expressed by patients. (2) This content was used to develop a preliminary questionnaire administered by telephone to persons with ARM or normal retinal aging. Principal-components analysis identified groups of items that formed the questionnaire's subscales that were evaluated for internal consistency, and an item-reduction strategy was implemented to generate a briefer questionnaire. (3) Psychometric properties of the shortened Low-Luminance Questionnaire (LLQ) were determined, including construct validity, criterion validity, and test-retest reliability. RESULTS: The 32-item LLQ has six subscales (driving, extreme lighting, mobility, emotional distress, general dim lighting, and peripheral vision), all with good internal consistency (Cronbach alpha > or = 0.82). Scores on LLQ subscales correlated moderately with nearly all National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 subscales and decreased in value (indicating more disability) for patients with increasing ARM disease severity. Whereas rod-mediated parameters of dark adaptation were significantly associated with LLQ subscale scores (r = 0.19-0.43, all P < 0.03), cone-mediated parameters were not. Test-retest reliability ranged from 0.74 to 0.88 for all subscales (P < 0.0001), except for peripheral vision (0.46; P = 0.0003), which also exhibited a ceiling effect in almost half of the respondents. CONCLUSIONS: The 32-item LLQ, derived from the content of focus group comments by persons with ARM, has good construct validity, subscale scores related to rod-mediated visual function, and good test-retest reliability for five of six subscales. The LLQ may ultimately be useful in patient-centered evaluation of the outcome of interventions to prevent ARM or to arrest progression of early disease.     

The development and assessment of a self-perceived quality of vision questionnaire to test pseudophakic patients

purpose?To develop and test a questionnaire to assess quality of vision in pseudophakic patients. methods?The problems with existing health measurement scales and the need for a new questionnaire are first discussed. Development of the new questionnaire from concept to completion is presented and all stages discussed. The questionnaire is then tested for internal consistency, reliability and validity. results?The Cronbach Alpha for internal consistency was 0.92. British Standards Institution repeatability coefficient was satisfactory at 6.6. Discriminant construct validity testing by extreme groups demonstrated excellent discrimination between patients with functionally significant posterior capsule opacification (PCO) and no significant PCO (Mann-Whitney U test, p = 0.001). conclusion?The questionnaire is validated as a robust, stable measure of pseudophakic visual symptoms with a high degree of clinical utility. It should be invaluable for the many studies that compare outcomes from different forms of modern cataract surgery with implantation of different intraocular lenses.     

中国版视功能指数量表的修订及其在白内障患者生活质量评估中的应用

背景 白内障是目前全球主要的致盲眼病,患者视功能状态的全面评价要结合临床检查结果和患者主观评价.视功能指数量表(VF-14)是针对发达国家白内障患者研发的评估工具. 目的 研制中国版视功能指数量表并评估其在白内障患者生活质量(QoL)测量中的应用价值,探讨白内障患者QoL的影响因素.方法 采用前瞻性横断面调查研究方法,对原版VF-14量表进行翻译、回译和文化调试,形成中国版VF-12量表(VF-12-CN).于2013年2-10月在温州医科大学附属眼视光医院对拟行白内障手术的年龄相关性白内障或糖尿病性白内障患者215例中发放VF-12-CN进行QoL问卷调查,分析量表的条目区分度、信效度以及白内障患者得分的影响因素.任意选取完成问卷的48例白内障患者,由2名经过统一培训的调查员独立进行评分,由专家小组成员采用4级评分法对量表各条目内容是否能反映所测患者的心理特质、是否达到测量的目的进行评价. 结果 从受试者中共收回有效调查答卷200份,应答率为93.02％.根据中国的文化和经济背景及生活习惯对原版VF-14量表中涉及填表、体育和娱乐活动的3个条目进行了修改,对于应答率过低的关于驾车的2个条目进行删除.形成的VF-12-CN量表的条目区分度好,Cronbach's α系数为0.863,Guttmann Split-Half系数为0.874,调查员间信度为0.958.VF-12-CN量表中所有内容效度指数均为1.0;经因子分析共提取2个公因子,累计方差贡献率为59.3％.量表总分与年龄、较好眼裸眼远视力、较差眼裸眼远视力均呈正相关(r=0.277、0.534、0.367,均P＜0.01);文盲与非文盲组的量表得分分别为12.5±8.6和15.7±7.4,差异有统计学意义(t=2.798,P＜0.01);此外,不同年龄、较好眼裸眼远视力、较差眼裸眼远视力和白内障眼数间量表得分的差异均有统计学意义(均P＜0.05).不同性别间及是否有眼部伴发病或全身伴发病组间患者总评分的比较,差异均无统计学意义(t=-0.426、0.304、-1.019,均P＞0.05).较好眼裸眼远视力、患者年龄及文化程度为白内障患者QoL的主要影响因素,回归方程为量表总分=25.045-10.927×较好眼裸眼远视力-3.342×文化程度+3.201×年龄(R=0.586,R2=0.334,F=34.247,P=0.000). 结论 VF-12-CN量表具有良好的测量特性,可用于中国人白内障患者QoL的评估.较好眼裸眼远视力是影响白内障患者QoL的主要因素.     

Quality of life in glaucoma and its relationship with visual function

PURPOSE: The aims of this study were (a) to explore patients self-reported visual disability resulting from glaucoma by means of a questionnaire developed for this purpose; (b) identify activities strongly associated with a measure of visual field loss, (c) to quantify different psychophysical aspects of visual function; (d) to assess the relationship between objective measures of visual function and patients' perception of their vision-related quality of life. PATIENTS AND METHODS :Three groups of glaucoma patients (n = 47) with mild (n = 18), moderate (n = 19), and severe visual field loss (n = 10) and a group of normal controls (n = 19) underwent a comprehensive clinical examination, completed a questionnaire and, on a separate visit, performed a number of psychophysical tests of visual function. MAIN OUTCOME MEASURES: Questionnaire responses (vision-related quality of life, general health and psychosocial variables), visual acuity, visual fields, Esterman binocular disability scores, contrast sensitivity, critical flicker frequency, color vision, dark adaptation, glare disability (brightness acuity), and stereoacuity scores were measured. RESULTS: Fifteen of the 50 questions were noted to have a strong significant relationship with a measure of visual field loss and were included in a new questionnaire scale, the Glaucoma Quality of Life - 15 (GQL-15). The scale validity showed a significant correlation with perimetric mean deviation (MD) values (r = -0.6; P < 0.0001), the reliability of the scale was high (Cronbach alpha = 0.95), and test-retest reliability of the questionnaire was strong (r = 0.87). An overall statistically significant decrease in performance-related quality of life was noted between normal subjects and all groups of glaucoma patients. A significant relationship was found between the scale questionnaire summary performance measure and a number of psychophysical tests: Pelli-Robson contrast sensitivity (r = -0.45, P < 0.001), glare disability (r = -0.41, P < 0.001), Esterman binocular visual field test (r = -0.39, P < 0.001), dark adaptation (r = 0.34, P = 0.007), and stereopsis (r = 0.26, P = 0.04). CONCLUSION: Perceived visual disability relating to certain tasks (particularly involving dark adaptation and disability glare, activities demanding functional peripheral vision such us tripping over and bumping into objects and outdoor mobility tasks) was significantly associated with the severity of binocular visual field loss. As a result, a new glaucoma-specific questionnaire scale with good performance characteristics is presented in this study. The difficulties encountered by patients in everyday life (as measured with the questionnaire) were also mirrored in their performance on a number of psychophysical tests, especially contrast sensitivity, glare disability, Esterman binocular visual field test, and dark adaptation.     

The development and assessment of a self-perceived quality of vision questionnaire to test pseudophakic patients

PURPOSE: To develop and test a questionnaire to assess quality of vision in pseudophakic patients. METHODS: The problems with existing health measurement scales and the need for a new questionnaire are first discussed. Development of the new questionnaire from concept to completion is presented and all stages discussed. The questionnaire is then tested for internal consistency, reliability and validity. RESULTS: The Cronbach Alpha for internal consistency was 0.92. British Standards Institution repeatability coefficient was satisfactory at 6.6. Discriminant construct validity testing by extreme groups demonstrated excellent discrimination between patients with functionally significant posterior capsule opacification (PCO) and no significant PCO (Mann-Whitney U test, p = 0.001). CONCLUSION: The questionnaire is validated as a robust, stable measure of pseudophakic visual symptoms with a high degree of clinical utility. It should be invaluable for the many studies that compare outcomes from different forms of modern cataract surgery with implantation of different intraocular lenses.     

Use of subjective and objective criteria to categorise visual disability

Context:

Visual disability is categorised using objective criteria. Subjective measures are not considered.

Aim:

To use subjective criteria along with objective ones to categorise visual disability.

Settings and Design:

Ophthalmology out-patient department; teaching hospital; observational study.

Material and Methods:

Consecutive persons aged >25 years, with vision <20/20 (in one or both eyes) due to chronic conditions, like cataract and refractive errors, were categorized into 11 groups of increasing disability; group-zero: normal range of vision, to group-X: no perception of light, bilaterally. Snellen''s vision; binocular contrast sensitivity (Pelli-Robson chart); automated binocular visual field (Humphrey; Esterman test); and vision-related quality of life (Indian Visual Function Questionnaire-33; IND-VFQ33) were recorded.

Statistical Analysis:

SPSS version-17; Kruskal-wallis test was used to compare contrast sensitivity and visual fields across groups, and Mann-Whitney U test for pair-wise comparison (Bonferroni adjustment; P < 0.01). One-way ANOVA compared quality of life data across groups; for pairwise significance, Dunnett T3 test was applied.

Results:

In 226 patients, contrast sensitivity and visual fields were comparable for differing disability grades except when disability was severe (P < 0.001), or moderately severe (P < 0.01). Individual scales of IND-VFQ33 were also mostly comparable; however, global scores showed a distinct pattern, being different for some disability grades but comparable for groups III (78.51 ± 6.86) and IV (82.64 ± 5.80), and groups IV and V (77.23 ± 3.22); these were merged to generate group 345; similarly, global scores were comparable for adjacent groups V and VI (72.53 ± 6.77), VI and VII (74.46 ± 4.32), and VII and VIII (69.12 ± 5.97); these were merged to generate group 5678; thereafter, contrast sensitivity and global and individual IND-VFQ33 scores could differentiate between different grades of disability in the five new groups.

Conclusions:

Subjective criteria made it possible to objectively reclassify visual disability. Visual disability grades could be redefined to accommodate all from zero-100%.     

Measuring the effectiveness of cataract surgery: the reliability and validity of a visual function outcomes instrument

AIMS: To assess test-retest reliability and validity of the "TyPE" patient self assessed visual function questionnaire, as part of a study in two hospitals measuring the effectiveness of cataract surgery. The American TyPE questionnaire had minor adaptations made for use in Britain. METHODS: Test-retest reliability was assessed on 63 out of 378 adult cataract surgery patients in the study, using Spearman correlation coefficients and kappa coefficients of agreement. "Construct" validity was evaluated by comparing the association between changes in visual function questionnaire scores after surgery, with patients' perception of change in visual function obtained by independent interview of 24 patients. RESULTS: The TyPE questionnaire items showed very good test-retest reliability. Average Spearman and kappa coefficients for 39 patients from hospital 1 were 0.93 and 0.84 respectively. Spearman and kappa coefficients of 0.9 and 0.81 were obtained for those nine patients in hospital 2 where both the test and retest questionnaires were filled in by the same people. However, for the 15 patients from hospital 2, where the questionnaire was filled in by different people in the retest, reliability was less good: the Spearman coefficients were still high, average 0.72, but the kappa coefficients were poor, 0.27. Good construct validity was exhibited, with a correlation of 0.79 between change in distance vision score from the questionnaires and the independent interview. CONCLUSIONS: The adapted TyPE questionnaire is both very reliable and has good construct validity. The kappa coefficient should be used wherever possible to evaluate reliability. The test-retest reliability and validity and practicability of other visual function questionnaires have not been assessed adequately, and further development should be carried out of all such questionnaires, so that they may be introduced into routine clinical care.     

The MacDQoL individualized measure of the impact of macular degeneration on quality of life: reliability and responsiveness

PURPOSE: To investigate the MacDQoL test-retest reliability and sensitivity to change in vision over a period of one year in a sample of patients with age-related macular degeneration (AMD). DESIGN: A prospective, observational study. METHOD: Patients with AMD from an ophthalmologist's list (n = 135) completed the MacDQoL questionnaire by telephone interview and underwent a vision assessment on two occasions, one year apart. RESULTS: Among participants whose vision was stable over one year (n = 87), MacDQoL scores at baseline and follow-up were highly correlated (r = 0.95; P < .0001). Twelve of the 22 scale items had intraclass correlations of >.80; only two were correlated <.7. There was no difference between baseline and follow-up scores (P = .85), indicating excellent test-retest reliability. Poorer quality of life (QoL) at follow-up, measured by the MacDQoL present QoL overview item, was associated with deterioration in both the better eye and binocular distance visual acuity [VA] (r = 0.29; P = .001, r = 0.21; P = .016, respectively; n = 135). There was a positive correlation between deterioration in the MacDQoL average weighted impact score and deterioration in both binocular near VA and reading speed (r = 0.20; P = .019, r = 0.18; P = .041, respectively; n = 135). CONCLUSION: The MacDQoL has excellent test-retest reliability. Its sensitivity to change in vision status was demonstrated in correlational analyses. The measure indicates that the negative impact of AMD on QoL increases with increasing severity of visual impairment.     

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh

PURPOSE: To determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India. METHODS: The World Health Organization (WHO) QOL (WHOQOL) instrument was adapted as a health-related quality of life (HRQOL) instrument for administration to adults participating in the Andhra Pradesh Eye Disease Study. Participants aged 40 years and older (n = 3702), 99.4% of the 3723 eligible, who underwent interview and detailed dilated ocular eye evaluation by trained professionals were included in this study. Psychometric properties of the HRQOL instrument were evaluated among visually impaired people. Relationships among overall QOL scores and presenting visual acuity in the better eye, specific eye diseases, and demographic variables were examined. RESULTS: Internal consistency was high for the entire questionnaire (alpha = 0.94). Each item of the QOL scale had an adequate item-total correlation (range, 0.25-0.77) greater than 0.2. After adjusting for demographic variables and ocular disease, Subjects with blindness had significantly lower QOL scores. Subjects with glaucoma or corneal disease independent of visual acuity had lower scores than subjects without those eye diseases. Subjects with cataract or retinal disease had significantly lower scores than those without cataract or retinal disease in the model without visual acuity but not when visual acuity was added to the model. CONCLUSIONS: Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.     

双眼先天性白内障儿童生活质量量表的制订及评价

目的制订8～15岁双眼先天性白内障儿童生活质量量表,评价量表的效度、信度以及反应度。方法根据儿童生活质量的定义设计,涵盖与视功能损害有关的重要指标,编制23个条目的双眼先天性白内障儿童生活质量量表。应用该量表对8～15岁的18例正常视力儿童和76例双眼先天性白内障儿童进行了量表调查。应用离散程度法、相关系数法、因子分析法、区分度分析法、克朗巴赫系数法和重测信度法来筛选量表有效条目,并评价筛选后量表的效度、信度以及反应度。结果条目5、7和21经筛选后删除,形成20个条目的量表。每个条目和每个分项的内容效度相关系数均大于0．6（P〈0．05）。正常儿童和白内障儿童、白内障儿童术前和术后总得分间的差异均有统计学意义（P=0．000）。重测信度的相关系数为0．895（P=0．000）。本量表4个分项的克朗巴赫a信度系数值分别为0．822、0．922、0．797和0．794。效应尺度统计量为1．141。结论经筛选后的20个条目的量表符合生活质量量表效度、信度以及反应度的技术要求,可以应用于8～15岁的双眼先天性白内障儿童生活质量的临床研究。     

低视力者生活质量量表中文版的研制和信度与效度考评

目的探讨制定一个可量化测定视力下降人群视功能相关生活质量的量表,评价其信度和效度。方法翻译英文版““低视力者生活质量量表““(LVQOL)为中文版CLVQOL。采用单纯随机抽样,设置原始组和对照组。原始组间隔2周再次复查,成为重测组。分析量表的内在一致性、重测信度、内容效度、结构效度及判别效度,计算不同性别、年龄、学历及视力与CLVQOL量表得分的相关性。 结果经过系统的翻译、回译及文化调适步骤后所得的CLVQOL量表无论是在临床患者,还是在社区居民中克朗巴赫α系数和分半信度都在0.75～0.97之间,重测信度的组内相关系数在0.69～0.95之间。各条目集合效度的相关系数均在0。4以上,而条目判别效度绝大多数在0.4以下。因子分析共提出4个公共因子。原始组的CLVQOL各维和总体得分比对照组明显低。CLVQOL得分在不同性别、年龄和学历之间无差异,与视力的相关系数高。结论 CLVQOL符合中国的文化特点;其信度、效度均高,适用于临床和社区等各种人群,是能敏感地反映视力下降人群与视功能相关生活质量状况的量表。     

白内障患者报告结局条目库的研制

目的:基于Rasch模型研制白内障患者报告结局(PROs)条目库,为准确、全面和动态评估白内障PROs奠定基础.方法:横断面调查研究.根据纳入标准选取我院已确诊的白内障住院患者,采用本课题组前期基于循证医学方法构建的白内障PROs条目池对其进行问卷调查.通过Rasch分析各维度条目选项概率曲线(CPC)、测量精密性、条目拟合指标(infit/outfit MNSQ)、单维性、匹配度和条目功能差异(DIF)等测量特性指标,并反复迭代、提炼,直至得到测量特性优良的条目.采用Pearson相关分析评估各维度和视力的相关性.结果:共纳入296例白内障患者,其中男130例,女166例,年龄70(63,77)岁,受过小学及以上教育者178例(60.1%),术前双眼日常生活视力(LogMAR)为0.0~3.0,中位数为0.6.条目库共纳入3个维度,其中视觉相关活动受限维度23个条目,视觉症状维度14个条目,精神心理健康11个条目,所有条目选项数量均为4个.视觉相关活动受限维度中,选项类别阈值分别为-1.84、0.04、1.79,被试分离信度/被试分离系数(PSR/PSI)为0.93/3.59,主成分分析(PCA)第一成分未解释方差特征值为2.61,匹配度为-0.81,DIF值均小于1;该维度得分与好眼视力(r=0.619,P<0.01)和双眼视力(r=0.622,P<0.01)有相关性.视觉症状维度中,选项类别阈值分别为-1.83、-0.18、2.00,PSR/PSI为0.88/2.68,PCA第一成分未解释方差特征值为2.53,匹配度为-1.35,2个条目在眼部并发症方面的DIF值大于1,其余DIF值均小于1;该维度得分与好眼视力(r=0.482,P<0.01)和双眼视力(r=0.492,P<0.01)有相关性.精神心理健康维度中,选项类别阈值分别为-2.83、0.03、2.80,PSR/PSI为0.88/2.68,PCA第一成分未解释方差特征值为2.79,匹配度为-0.34,所有条目DIF值均小于1;该维度得分与好眼视力(r=0.425,P<0.01)和双眼视力(r=0.426,P<0.01)有相关性.上述所有条目infit和outfit值均介于0.50~1.50之间.结论:基于Rasch分析研制的白内障PROs条目库覆盖了视觉相关活动受限、视觉症状和精神心理健康3个方面,全面地反应了白内障PROs的内涵,且条目简明易懂,临床可操作性好,具有较好的测量特性.     

Perceived visual ability for functional vision performance among persons with low vision in the Indian state of Andhra Pradesh

PURPOSE: To determine the distribution of perceived visual ability for functional vision performance among persons with low vision in the Indian state of Andhra Pradesh. METHODS: As part of a population-based epidemiologic study, the Andhra Pradesh Eye Disease Study (APEDS), a 16-item visual function questionnaire was designed and applied to 7363 persons older than 15 years, to record the levels of difficulty perceived by the subjects. Of these, 123 persons were found to have low vision. Rasch analysis was used to convert the ordinal difficulty ratings of these 123 persons into interval measures of perceived visual ability for functional vision. RESULTS: Content validity of the questionnaire was demonstrated by good separation indices (3.17 and 5.44) and high reliability scores (0.91 and 0.97) for person and item parameters. Construct validity was shown with model fit statistics. Criterion validity of the questionnaire was shown by good discrimination among the general vision ratings. The functional situation that required the least visual ability was "reaching an object farther or closer than you thought"; the situation requiring the most visual ability was "recognizing small objects." Bivariate regression analysis determined that for every unit of logMAR visual acuity, perceived visual ability for functional vision decreased by 2.9 logit, which could explain 32% of the variability in the person measure. CONCLUSIONS: The described assessment, across a range of visual problems, is a valid way to measure perceived ability for functional vision in persons with low vision. Perceived visual ability varies with every unit of logarithm of the minimum angle of resolution (logMAR) visual acuity.     

Assessment of visual satisfaction and function after cataract surgery

PURPOSE: To examine the relationships between importance, satisfaction, visual acuity, and visual function in a sample of preoperative cataract patients and to derive and prospectively evaluate a shortened measure of visual function. SETTING: Day-stay cataract surgery unit at large private hospital and consulting rooms of metropolitan ophthalmologists. METHODS: Two independent samples of 111 and 121 patients were surveyed before and after surgery with regard to their visual satisfaction, trouble with vision, VF-14 visual function, overall satisfaction, and importance of factors affecting patient satisfaction. A 7-item scale of visual function derived from the first sample's results was prospectively tested against the second sample. Distance and reading acuities were recorded from the patients' charts. RESULTS: The 7-item measure of visual function strongly correlated with the VF-14 (r>0.9) and had predictive power equal to that of the VF-14 for satisfaction and trouble with vision. However, the 7 items differed somewhat from a version developed in Helsinki. Distance visual acuity was not significantly correlated with visual function, satisfaction, or trouble with vision, although reading acuity was significantly correlated with visual function and trouble with vision (r=0.31 and r=0.32, respectively). CONCLUSIONS: A shortened measure of visual function that had a predictive value equal to that of the VF-14 can more practically be used in everyday practice. Furthermore, the study showed that regional factors matter and highlights the necessity of basing measurement scales on factors important to the population in question to ensure scale validity.