Optimizing measurement of vision-related quality of life: a computerized adaptive test for the impact of vision impairment questionnaire (IVI-CAT)

Structural validity of the impact of vision impairment questionnaire among patients with visual impairment in Thailand

Background

The Impact of Vision Impairment (IVI) questionnaire is used to assess vision-related quality of life (VRQOL) among patients with visual impairment. This study aims to evaluate the factor structure of the IVI in the context of Thai culture to assess psychometric properties.

Methods

This cross-sectional study was conducted between February and July 2022. Purposive sampling was used to include 502 patients with visual impairment who received treatment at a tertiary eye center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. The data were collected using the interviewer-administered questionnaire. The participants were randomly divided into two groups: one employed for exploratory factor analysis (EFA; n = 251) and the other for confirmatory factor analysis (CFA; n = 251).

Results

EFA yielded 28 items that supported a four-factor structure: behaviors related to mobility and independence (8 items), reading (3 items), self-dependence (7 items), and emotional impact of vision loss (10 items), with a total variance of 64.9 %. The model fit was good: χ2/df = 1.66, CFI = 0.949, TLI = 0.940, RMSEA = 0.052, and SRMR = 0.041. The AIC and BIC for the bifactor four-factor model (17,484.86 and 17,879.41, respectively) were lower than those for the bifactor three-factor model (17,566.44 and 17,961.29, respectively), indicating that the former showed the best fit.

Conclusions

Given its good reliability and validity, the IVI scale has been extensively used to explore the impact of visual impairment on the VRQOL of patients in the clinical setting, thus greatly benefitting researchers, healthcare providers, and ophthalmologists.

Measuring Quality of Life in Diabetic Retinal Disease: A Narrative Review of Available Patient-Reported Outcome Measures

Topic

Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of PROMs is needed to assess how they could relate to severity levels of a revised DRD grading system. This narrative review assessed the available generic-, vision-, and DRD-related PROMs used in DRD research and highlights areas for improvement.

Clinical Relevance

Diabetic retinal disease is a common complication of diabetes and can lead to sight-threatening complications with a devastating effect on HRQoL.

Methods

The Quality of Life working group is one of 6 working groups organized for the DRD Staging System Update Effort, a project of the Juvenile Diabetes Research Foundation Mary Tyler Moore Vision Initiative. PubMed, Cochrane Library, Embase, and Google Scholar databases were searched using core keywords to retrieve ophthalmology-related review articles, randomized clinical trials, and prospective, observational, and cross-sectional studies in the English language. A detailed review of 12 PROMs (4 QoL questionnaires and 8 utilities) that met a minimum level of evidence (LOE) was conducted. The relevance of each PROM to DRD disease stage and Biomarker Qualification guidelines (Biomarkers, EndpointS, and other Tools) categories was also defined.

Results

The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), Impact of vision impairment-computerized adaptive testing, and Diabetic Retinopathy and Macular Edema Computerized Adaptive Testing System had a LOE of II in detecting change due to late-stage DRD (diabetic macular edema), although several areas for improvement (e.g., psychometrics and generalizability) were identified. Other PROMs, particularly the utilities, had a LOE of III due to cross-sectional evidence in late-stage clinical DRD. Although the NEI VFQ-25 has been the most widely used PROM in late-stage DRD, more work is required to improve its multidimensional structure and other psychometric limitations. No PROM was deemed relevant for subclinical or early/mid-DRD.

Conclusion

This narrative review found that the most commonly used PROM is NEI VFQ-25, but none meets the ideal psychometric, responsiveness, and clinical setting digital administration requirements that could be included in an updated DRD staging system for diagnosis and monitoring of DRD progression.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The development of a glaucoma-specific health-related quality of life item bank supporting a novel computerized adaptive testing system in Asia

Background

A glaucoma-specific health-related quality of life (HRQoL) item bank (IB) and computerized adaptive testing (CAT) system relevant to Asian populations is not currently available. We aimed to develop content for an IB focusing on HRQoL domains important to Asian people with glaucoma; and to compare the content coverage of our new instrument with established glaucoma-specific instruments.

Methods

In this qualitative study of glaucoma patients recruited from the Singapore National Eye Centre (November 2018-November 2019), items/domains were generated from: (1) glaucoma-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with glaucoma patients (n = 27); and (4) feedback from glaucoma experts. Data were analyzed using the constant comparative method. Items were systematically refined to a concise set, and pre-tested using cognitive interviews with 27 additional glaucoma patients.

Results

Of the 54 patients (mean ± standard deviation [SD] age 66.9 ± 9.8; 53.7% male), 67 (62.0%), 30 (27.8%), and 11 (10.2%) eyes had primary open angle glaucoma, angle closure glaucoma, and no glaucoma respectively. Eighteen (33.3%), 11 (20.4%), 8 (14.8%), 12 (22.2%), and 5 (9.3%) patients had no, mild, moderate, severe, or advanced/end-stage glaucoma (better eye), respectively. Initially, 311 items within nine HRQoL domains were identified: Visual Symptoms, Ocular Comfort Symptoms, Activity Limitation, Driving, Lighting, Mobility, Psychosocial, Glaucoma management, and Work; however, Driving and Visual Symptoms were subsequently removed during the refinement process. During cognitive interviews, 12, 23 and 10 items were added, dropped and modified, respectively.

Conclusion

Following a rigorous process, we developed a 221-item, 7-domain Asian glaucoma-specific IB. Once operationalised using CAT, this new instrument will enable precise, rapid, and comprehensive assessment of the HRQoL impact of glaucoma and associated treatment efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00513-3.

Factors associated with glaucoma-specific quality of life in a US glaucoma clinic in a pilot implementation of an online computerised adaptive test (GlauCAT)

OBJECTIVES

Measure quality of life (QoL) outcomes using a novel computerised adaptive test in a clinical setting, and determine the social and demographic factors associated with specific QoL domains in patients with glaucoma.

DESIGN

Cross-sectional study between July 2020 and April 2021.

PARTICIPANTS

English-speaking adults presenting to glaucoma clinic. Patients with cognitive impairment on a six-item cognitive impairment screen or with intraocular surgery within 90 days prior to presentation were excluded.

RESULTS

Of 206 patients surveyed, mean age was 64.8 years (SD 15.2), 122 (56.7%) were female and 159 (74.7%) were white. On multivariable regression, visual acuity was associated with greater activity limitation (β=-2.8 points, 95% CI -3.8 to -1.8, p<0.001) and worse mobility (β=-2.1 points, 95% CI -3.2 to -0.9, p<0.001), while poorer visual field (VF) mean deviation was associated with lower scores on the emotional well-being domain (β=-2.4 points, 95% CI -4.6 to -0.3, p=0.03). Glaucoma suspects and those with early VF defects had higher QoL scores than those with severe glaucoma in the following domains: activity limitation (88.5±14.6 vs 74.3±21.9, respectively, p<0.001), mobility (91.0±12.5 vs 80.0±25.3, respectively, p=0.005) and concerns domains (82.2±13.9 vs 72.5 5±18.9, respectively, p=0.01).

CONCLUSIONS

In a busy glaucoma clinic where QoL was measured with online adaptive tests for glaucoma, we found that several demographic and clinical variables are associated with lower domain scores, suggesting that patients with predisposing demographic and clinical factors are at a higher risk of worse QoL.

Calibration of the Dutch EyeQ to Measure Vision Related Quality of Life in Patients With Exudative Retinal Diseases

Purpose

This study aims to develop an item-bank to measure vision-related quality of life (Vr-QoL) and subsequently calibrate this set of items.

Methods

Three Vr-QoL instruments were searched for suitable items to be added in the EyeQ. Patients who received antivascular endothelial growth factor treatment for various retinal diseases involving macular edema were included in the study and completed the 47-item EyeQ. Item response theory (IRT) was used to calibrate the EyeQ items, which was performed multiple times in subsets as a novel approach, containing 80% of the data. Differential item functioning (DIF) was evaluated for various variables.

Results

Responses of 704 patients were used in analysis. One item violated the local independence IRT-assumption and showed a high percentage of missing values, after which this item was deleted from the item-bank. The data of the five subsets fitted the graded response model adequately, and no DIF was detected for items between subsets, after which mean item parameters were calculated. Item fit statistics were found to be good. DIF was detected for gender, age, and administration mode by the patient (independently vs. with help), this involved three items, which all showed negligible impact on total scores.

Conclusions

Because of separate calibrations of the EyeQ in multiple subsets, a high robustness of item parameters is expected.

Translational Relevance

The calibrated EyeQ can now be used for the assessment of Vr-QoL in patients suffering from exudative retinal diseases and is promising for use as a computer adaptive test.

Challenges of College Students' Ideological and Political and Psychological Education in the Information Age

The purpose of the study is to analyze the current situation of ideological and political education and psychological education of college students, and explore the challenges faced by these two kinds of education in the information age. First, different research methods, such as literature research, questionnaire survey, and interdisciplinary research, are used to investigate and study the current situation of ideological and political education and psychological education of college students. Second, the survey data are analyzed to reveal the challenges they have encountered. The results show that there are many problems in ideological and political education, which need to be improved and strengthened. The Internet has a strong attraction for college students, but the purpose of getting online of many college students is not clear. Although it plays an important role in improving teaching quality by helping college students establish correct attitudes toward their study, values, life, and society, ideological and political education lack strong pertinence and effectiveness due to the professionalism of the teachers. And the negative impact of network information on ideological and political education of college students is also obvious. About 11.4% of the respondents believe that network information affects their physical and mental health. About 8.4% of the respondents believe that harmful information on the network is easy to induce students to behave wrongly. About 41% believe that computer games distract them from learning, which indicates that the negative impact of network information on college students cannot be underestimated, and it is imperative to strengthen the ideological and political education of college students. The research provides a useful reference for the ideological and political and psychological education in the information environment and helps to solve the problem in the ideological and political education and psychological education of college students.