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Patient-reported Outcomes for Assessment of Quality of Life in Refractive Error: A Systematic Review

Kandel, Himal, MSc, PHEC1; Khadka, Jyoti, PhD1*; Goggin, Michael, MS2; Pesudovs, Konrad, PhD, FAAO1

doi: 10.1097/OPX.0000000000001143

SIGNIFICANCE This review has identified the best existing patient-reported outcome (PRO) instruments in refractive error. The article highlights the limitations of the existing instruments and discusses the way forward.

PURPOSE A systematic review was conducted to identify the types of PROs used in refractive error, to determine the quality of the existing PRO instruments in terms of their psychometric properties, and to determine the limitations in the content of the existing PRO instruments.

METHODS Articles describing a PRO instrument measuring 1 or more domains of quality of life in people with refractive error were identified by electronic searches on the MEDLINE, PubMed, Scopus, Web of Science, and Cochrane databases. The information on content development, psychometric properties, validity, reliability, and responsiveness of those PRO instruments was extracted from the selected articles. The analysis was done based on a comprehensive set of assessment criteria.

RESULTS One hundred forty-eight articles describing 47 PRO instruments in refractive error were included in the review. Most of the articles (99 [66.9%]) used refractive error–specific PRO instruments. The PRO instruments comprised 19 refractive, 12 vision but nonrefractive, and 16 generic PRO instruments. Only 17 PRO instruments were validated in refractive error populations; six of them were developed using Rasch analysis. None of the PRO instruments has items across all domains of quality of life. The Quality of Life Impact of Refractive Correction, the Quality of Vision, and the Contact Lens Impact on Quality of Life have comparatively better quality with some limitations, compared with the other PRO instruments.

CONCLUSIONS This review describes the PRO instruments and informs the choice of an appropriate measure in refractive error. We identified need of a comprehensive and scientifically robust refractive error–specific PRO instrument. Item banking and computer-adaptive testing system can be the way to provide such an instrument.

1NHMRC Centre for Clinical Eye Research, Flinders University of South Australia, Adelaide, South Australia, Australia

2University of Adelaide/South Australian Institute of Ophthalmology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia *

Supplemental Digital Content: Appendix 1, the search syntaxes for MEDLINE, PubMed, Scopus, Web of Science and Cochrane databases, is available at

Appendix 2, the criteria for grading PROs based on the guidelines proposed by Khadka et al,13 is available at

Appendix 3, the description of the patient reported outcome instruments used in refractive error, is available at

Submitted: January 3, 2017

Accepted: July 15, 2017

Funding/Support: This study was funded by the NHMRC (1031838) and the Australian Government Research Training Program scholarship.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: HK, JK, KP; Data curation: HK, JK, KP; Funding acquisition: HK, KP; Methodology: HK; Supervision: JK, MG, KP; Validation, Writing – original draft: HK; Writing – review & editing: HK, JK, MG, KP; The authors thank Ms. Sue Hammond for assisting in conducting the systematic review search.

Supplemental Digital Content: Direct URL links are provided within the text.

© 2017 American Academy of Optometry