Development of a near activity visual questionnaire to assess accommodating intraocular lenses

https://doi.org/10.1016/j.clae.2007.01.004Get rights and content

Abstract

Purpose

To develop a questionnaire that subjectively assesses near visual function in patients with ‘accommodating’ intraocular lenses (IOLs).

Methods

A literature search of existing vision-related quality-of-life instruments identified all questions relating to near visual tasks. Questions were combined if repeated in multiple instruments. Further relevant questions were added and item interpretation confirmed through multidisciplinary consultation and focus groups. A preliminary 19-item questionnaire was presented to 22 subjects at their 4-week visit post first eye phacoemulsification with ‘accommodative’ IOL implantation, and again 6 and 12 weeks post-operatively. Rasch Analysis, Frequency of Endorsement, and tests of normality (skew and kurtosis) were used to reduce the instrument. Cronbach's alpha and test–retest reliability (intraclass correlation coefficient, ICC) were determined for the final questionnaire. Construct validity was obtained by Pearson's product moment correlation (PPMC) of questionnaire scores to reading acuity (RA) and to Critical Print Size (CPS) reading speed. Criterion validity was obtained by receiver operating characteristic (ROC) curve analysis and dimensionality of the questionnaire was assessed by factor analysis.

Results

Rasch Analysis eliminated nine items due to poor fit statistics. The final items have good separation (2.55), internal consistency (Cronbach's α = 0.97) and test–retest reliability (ICC = 0.66). PPMC of questionnaire scores with RA was 0.33, and with CPS reading speed was 0.08. Area under the ROC curve was 0.88 and Factor Analysis revealed one principal factor.

Conclusion

The pilot data indicates the questionnaire to be internally consistent, reliable and a valid instrument that could be useful for assessing near visual function in patients with ‘accommodating’ IOLS. The questionnaire will now be expanded to include other types of presbyopic correction.

Section snippets

Methods

A full and extensive review of existing VR-QOL questionnaires was carried out to identify all questions (items) relating to near vision tasks. Review papers focussing predominantly on questionnaires that assess visual impairment and rehabilitation were used as a starting point [23], [24] but other questionnaires that assess outcomes of cataract/CLE surgery, (with multifocal and accommodating IOL implantation), visual satisfaction and visual ability were also included. Activities were not

Analysis

The questionnaire responses were analysed by Rasch Analysis, which is a form of Item Response Theory (IRT). Details of Rasch Analysis and item response theory (IRT) are discussed elsewhere [27], [28], [29], [30], [31], [32], including its benefits over classical test theory (CTT) [33], [34], but the primary objective is to identify and eliminate redundant items, which is important to minimise respondent burden and implementation time. Previously validated instruments including the QIRC

Results

Rasch analysis was first used to assess the function of each category of the response scales. Table 2a shows that there was an unused response option on the scale for items 1–15 inclusive, as well as another response option that failed to meet the fit statistics. Table 2b shows that the scale for items 16–18 had a response option that failed to meet the fit statistics. As a result, the scales were reduced by first eliminating the response option ‘Stopped due to other reasons’ for items 1–15

Discussion

The purpose of this pilot study was to determine the feasibility of a new VR-QOL instrument to subjectively assess near visual function with ‘accommodating’ IOLs. Questionnaires are an increasingly important and a popular means of assessing outcomes of treatment in many health-related fields, as they provide rapid acquisition of QOL information in real-world settings [58] and are a more appropriate way of assessing outcomes and benefits as opposed to assessing the rate of mortality or morbidity

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    This paper was presented as a free paper at the 13th Annual Congress of the British Society for Refractive Surgery on 1–2 July 2006, Oxford UK, and at the XXIV Congress of the European Society of Cataract and Refractive Surgeons on 9–13 September 2006, London UK.

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