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The Measurement of Vision Disability


Optometry and Vision Science: August 2002 - Volume 79 - Issue 8 - p 516-552

The American Medical Association’s (AMA) visual efficiency scale, a vision disability metric based on visual impairment measurements, was adopted in 1925. That scale was based on a 30-year history of theoretical models in vision economics, a misinterpretation of Snellen notation for visual acuity, and an erroneous application of Weber’s psychophysical law. The AMA visual efficiency scale survived uncontested for 75 years. In 2001, the AMA adopted a new vision disability scale based on logarithmic transformations of visual acuity and visual field diameter. Like the earlier visual efficiency scale, the new scale is theoretical—it is not supported by any data that speak to the relationship between vision disability and visual impairments. Attempts to measure vision disability date to the early 1980s with the development of self-assessment visual function rating scale questionnaires. Nearly all of the questionnaires developed over the last 20 years use Likert scales, but use them incorrectly. The development of a vision disability metric based on Likert scaling parallels the historical development of other forms of measurement. A tutorial review of psychometrics—classical test theory, item response theory, and Rasch analysis—shows how vision disability measurement scales can be estimated from Likert-type visual function rating scales. We conclude that preliminary data relating measures of vision disability to measures of visual acuity and visual fields support the new AMA vision disability scale.

Lions Vision Research and Rehabilitation Center, Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland

Received September 6, 2001;

revision received April 26, 2002.

Robert W. Massof

Lions Vision Research and Rehabilitation Center

Wilmer Ophthalmological Institute

The Johns Hopkins University School of Medicine

550 N. Broadway, 6th Floor

Baltimore, Maryland 21205


© 2002 American Academy of Optometry