IN THIS ISSUE:
How Good Are Those Patient-Reported Outcome Studies?
Our authors provide a systematic review of all the available published ophthalmic patient-reported outcome (PRO) instruments (questionnaires) that demonstrated interval measurement properties to identify those instruments of the highest quality in optometry and ophthalmology. (p. 720)
Editor’s Choice open access
Quality of Life: the NEI-VFQ and Glaucoma Patients
The National Eye Institute Visual Function Questionnaire (NEI-VFQ) is one of the most commonly used vision-related quality-of-life (QOL) questionnaires. The authors feel that some modifications of the questionnaire might improve its use and make it more responsive to changes in vision-related QOL in glaucoma patients. (p. 745)
Models Analyzing Patient-Reported Outcomes to Improve Cataract Care
Follow-up data on almost 10,000 cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011 were used to answer three questions. (1) Is there a relationship between clinical parameters and patient-reported outcomes? (2) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (3) When and why do clinical and patient-reported outcomes diverge? (p. 754)
Do We Need All Three Scales in the Quality of Vision Questionnaire?
The three subscales of the Quality of Vision Questionnaire (Frequency, Severity, and Bothersome) measure different aspects of the latent trait quality of vision. Our authors show that users should continue to use all three subscales of the questionnaire to achieve a comprehensive assessment of subjective quality of vision. (p. 760)
Clinical Outputs for Self-Reports of Visual Functioning in Low Vision
More than 100 patients were administered the 39-item Self-Report Assessment of Functional Vision Performance (SRAFVP), a Visual Function Questionnaire (VFQ) used to measure performance of vision-dependent Activities of Daily Living. The authors note that, as with many VFQs, the SRAFVP showed good psychometrics and may prove to be useful in goal setting and treatment planning for low-vision rehabilitation. (p. 765)
Predicting Low-Vision Rehabilitation Outcomes Is Not a Clinician’s Strength!
The ability to predict low-vision rehabilitation (LVR) outcomes influences patient care and drives decisions in terms of device recommendations, rehabilitation training, and treatment goals. Our authors compare LVR clinicians’ predictions of the probability of success of LVR with patients’ self-reported outcomes after provision of usual outpatient LVR services. Surprisingly, they find that clinicians’ predictions do not agree with observed changes in functional ability from the patients’ perspective and are no better than chance. (p. 776)
How to Interpret Low-Vision Rehabilitation Outcome Measures
Low-vision rehabilitation makes everyday activities targeted by the intervention easier to perform. But questionnaires with patient-rated difficulty of easy prerehabilitation activities can distort outcomes. Our authors propose an approach designed to interpret patient-reported outcome measures for interventions that change the difficulty of selected items in a visual function questionnaire. (p. 788)
Limited Efficacy of the EQ-5D in Low-Vision Rehabilitation
Quality-of-life (QoL) outcome measures are changing reimbursement policies and methods of clinical research. There are a multitude of tools available to measure QoL outcomes, both vision specific and general health instruments. The EQ-5D is one of the most commonly used, but this study shows that it is not sensitive to the effects of low-vision rehabilitation and is not an appropriate outcome measure for clinical care or low-vision research. (p. 799)
Improved Activity Tool to Target Rehabilitation Goals
Our authors use psychometric analyses to create an improved and shorter version of the Dutch ICF Activity Inventory (D-AI). The D-AI helps investigate rehabilitation needs from the patient’s perspective using the ICF Activity and Participation domains. They report that optometrists can use the D-AI, currently implemented in all Dutch rehabilitation centers that serve visually impaired adults, to screen the more complex patients and their rehabilitation needs. (p. 806)
Assessing Vision Impairment in Children
The authors examined the psychometric properties of the 24-item Impact of Vision Impairment for Children (IVI_C), a vision-related quality-of-life questionnaire. Rasch analysis resulted in a 17-item Indian IVI_C that is shorter and has better psychometric properties than the original version. (p. 820)
Bullies and Low-Vision Children
In their study, our authors find that the revised Olweus Bully/Victim questionnaire, in its current form, is not a reliable and valid psychometric tool to effectively evaluate “being a bully/victim and bullying others” in schoolchildren with visual impairment. (p. 828)
Emotional Support Service for the Visually Impaired Is Evaluated
A peer group emotional support service is found to improve self-reported visual quality of life during a 6-month period in participants with initially poor visual quality of life. As with other studies of group-based interviews aimed at improving self-management skills, this study supports the finding that the interventions particularly influence perception of safety outside the home, feeling lonely, and feeling sad due to poor eyesight. (p. 836)
The Patient’s Preference: Utility Assessment
Utility instruments allow a measurement of health-related quality of life with a single number representing the value or preference that a person attaches to a particular health state (e.g., vision impairment). It typically is measured directly (time trade-off) but can be measured indirectly (e.g., Vision and Quality of Life Index [VisQoL]). The indirect approach uses a questionnaire, a process that is reasonably familiar to respondents (because they simulate surveys conducted in public places), it takes a relatively shorter time to complete, and is cognitively less demanding for the respondents. For our authors’ 350 vision-impaired study patients, the direct and indirect methods of utility evaluation agreed well. And given the high completion rates of the indirect method, the VisQoL, they argue that it may be a suitable alternative for utility assessment in their South Indian patient population. (p. 843)
Public and Patient Preferences for AMD Health States
Cost-utility analysis is increasingly important for assessing health technologies in a resource-constrained health care system. Health utilities for the calculation of quality-adjusted life-years (QALYs) may be based on public preferences for a particular health state or patient preferences for their own health state. The public offers an unbiased view, whereas patients may have greater knowledge of the condition. Our authors’ study shows that age-related macular degeneration (AMD) patients rate their health significantly more severely than does the public, but the reasons are unclear. (p. 855)
Benefit of Cataract Surgery
In a study of Asian patients, with health utility measured by the EQ-5D index score, the authors found new evidence for an association between both visual functioning measured by the VF-14 questionnaire and the impact of cataracts measured using the standard gamble method. The EQ-5D index score also reflected the benefit of cataract surgery. They conclude that the generic EQ-5D questionnaire may be useful to quantify the treatment benefit of cataract surgery in health resource decisions. (p. 861)
Can Children Describe How Amblyopia Treatment Affects Them?
The quality-of-life implications of amblyopia treatment are most often reported from the parental perspective. As part of a program to ultimately establish a child-reported quality-of-life instrument for amblyopia treatment, the author reports on the initial qualitative study phase. She notes that young children were able to identify their thoughts and opinions of their own health and describe the impact of amblyopia treatment on their daily lives. (p. 867)
What Do Patients Understand About Diabetic Retinopathy?
This qualitative study revealed gaps in patient knowledge and potentially damaging beliefs about the cause and treatment of diabetic retinopathy (DR) from the patient and provider perspective. Some patients expressed adequate understanding of factors contributing to DR, and others were less certain. Our authors believe that interventions to improve patients’ understanding about all major risk factors for DR as well as the realistic outcomes of laser treatment may benefit them. (p. 874)
Improving Glaucoma Medication Adherence
Glaucoma medication adherence is a significant issue. Given the higher prevalence of glaucoma in African Americans, the authors set out to understand the barriers and limitations to good glaucoma medication adherence in this population. The purpose? The authors wish to develop a culturally informed health education program to improve adherence. (p. 883)
Improving Contact Lens Wearers’ Compliance
The authors used quantitative and qualitative research to explore the lens wear and care habits of current soft contact lens wearers. An online questionnaire confirmed the most frequently reported aspects of noncompliance. Focus group discussions disclosed key themes related to noncompliance: instructions, normal routine, convenience, time, personal values, and finances. (p. 898)