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Gittel L, Li JQ, Dell J, Wintergerst MWM, Heinz C, Finger RP, Terheyden JH. Piloting Rasch model scoring of the National Eye Institute Visual Function Questionnaire in uveitis. J Ophthalmic Inflamm Infect 2024; 14:16. [PMID: 38625428 PMCID: PMC11021379 DOI: 10.1186/s12348-024-00398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/07/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION The National Eye Institute Visual Function Questionnaire (NEI VFQ) is a common patient-reported outcome measure (PROM) in uveitis trials. Its psychometric properties using state-of-the-art scoring based on Rasch models, a latent trait model that improves accuracy of PROMs assessment, has not yet been investigated. METHODS The study participants were recruited online from uveitis patient organizations, where individuals self-reported their uveitis diagnosis and visual acuity level. These participants then completed the NEI VFQ-25. The visual function (VF) and socioemotional (SE) subscales were psychometrically analysed in terms of item fit, targeting, internal consistency, dimensionality, and differential item functioning (DIF), using Rasch models. Criterion validity was examined based on associations between NEI VFQ person measures and recent visual acuity (VA) levels. RESULTS Ninety-nine participants recruited online from uveitis patient organizations (68 women, 31 men; mean age 50 ± 15 years; 46.5% self-reported receiving systematic therapy for uveitis, 0.6% NEI VFQ-25 missing data) were included. The mean difficulty of items was lower than the average person ability. None of the items demonstrated misfit to an extent that would induce noise into the measurement. The consistency metrics person reliability and person separation index of the subscales were 0.85 and 2.34 (NEI VFQ-VF), 0.86 and 2.52 (NEI VFQ-SE), respectively. There was no evidence of multidimensionality and none of the items showed DIF by gender. The differences between item and person measures were 1.44 (NEI VFQ-VF) and 1.03 (NEI VFQ-SE). NEI VFQ-25 person measures were significantly lower in participants with visual impairment (all p values ≤ 0.007). CONCLUSION Rasch model-based scoring of the re-engineered NEI VFQ-25 demonstrates acceptable internal consistency, item fit and construct validity for assessing two key domains of quality of life in individuals self-reporting uveitis. The PROM was targeted at a higher level of difficulty than present in our heterogeneous sample.
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Affiliation(s)
- Lisa Gittel
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, NRW, 53127, Germany
| | - Jeany Q Li
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, NRW, 53127, Germany
| | | | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, NRW, 53127, Germany
- Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, NRW, 53127, Germany.
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Azzopardi M, Chong YJ, Sreekantam S, Barry RJ, Poonit N, Rauz S, Murray PI. Real-World Experience in the Use of Immunosuppression for the Management of Inflammatory Eye Disease. Ocul Immunol Inflamm 2024:1-10. [PMID: 38349962 DOI: 10.1080/09273948.2024.2311743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Patients with sight-threatening inflammatory eye disease (IED) are maintained on systemic immunosuppression whilst in long-term clinical remission. There are no clear guidelines on the duration of remission before implementing treatment withdrawal. We present a real-world analysis on the use of immunosuppression in IED in long-term remission and consider strategies for withdrawal. METHODS Adult IED patients on systemic immunosuppression were categorised into four disease groups: Corneal Transplant Survival Strategies (CTSS), Ocular Surface Disease (OSD), Non-infectious Uveitis (NIU) and Scleritis. Patients with Behçet's disease were excluded. Data on systemic immunosuppressants and biologics used; duration of treatment; reasons for drug discontinuation; disease activity/remission status; duration of clinical remission with an emphasis on patients who had been in remission for a minimum of 24 months were captured. RESULTS Out of a total of 303 IED patients, 128 were on systemic immunosuppression with a clinical remission of their ocular disease for ≥24 months. The median duration of remission was 4-5 years with the longest duration of remission 22 years, and some patients on immunosuppression for up to 23 years. Sixty patients stopped at least one immunosuppressive agent without prior discussion with a health-care practitioner. CONCLUSION Progressive conditions, such as cicatrising conjunctivitis may require lifelong immunosuppression, but patients with NIU and Scleritis and those on CTSS, immunosuppression withdrawal should be considered if they remain in remission for 2 years. Any patient stopping a medication should be contacted immediately for counselling. These data will better inform patients, encourage adherence and aide formal guideline development.
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Affiliation(s)
- Matthew Azzopardi
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yu Jeat Chong
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Sreekanth Sreekantam
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Robert J Barry
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natraj Poonit
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Philip I Murray
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Wan W, Chen Z, Xun Y, Yi K, Zhu Y, Pu Y, Su G, Zhou C, Wang Y, Yang P. Comprehensive evaluation of functional vision, quality of life, and cognitive ability in pediatric uveitis. BMC Ophthalmol 2023; 23:381. [PMID: 37723468 PMCID: PMC10507833 DOI: 10.1186/s12886-023-03117-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Pediatric uveitis may cause severe impairment of vision in children and affect their quality of life as well as cognitive ability. This study aims to evaluate the functional vision, visual-related and health-related quality of life, and cognitive ability in pediatric uveitis. METHODS Children with uveitis aged 5-16 years old completed six validated instruments to assess functional visual ability with Cardiff Visual Ability Questionnaire for Children (CVAQC), vision-related quality of life with Impact of Vision Impairment for Children (IVI-C), health-related quality of life with Pediatric Quality of Life Inventory (PedsQL), cognitive ability with Chinese Wechsler Intelligence Scale for Children (C-WISC), and depression and anxiety evaluation with Hospital Anxiety and Depression Scale (HAD). RESULTS The CVAQC, IVI-C, and PedsQL scores of pediatric uveitis were significantly lower than that of normal levels. Full-scale intelligence quotient (IQ) and performance IQ were significantly lower in pediatric uveitis patients with impaired vision in their best eye (visual acuity < 0.3) compared to those with a vision equal to or better than 0.3. Verbal IQ was significantly lower in male pediatric uveitis patients with impaired vision compared to those with a vision equal to or better than 0.3. Additionally, parents of pediatric uveitis patients with impaired vision generally had lower educational levels than parents of those with a vision equal to or better than 0.3. CONCLUSIONS Impaired vision caused by pediatric uveitis has a significant impact on children's functional visual ability and quality of life. The development of cognitive function in pediatric uveitis is also significantly hindered.
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Grants
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
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Affiliation(s)
- Wenjuan Wan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Zhijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Yan Xun
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Kun Yi
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Ying Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Yanlin Pu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China.
- The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, 400016, Chongqing, P.R. China.
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Ostrovsky M, Rosenblatt A, Hollander N, Habot-Wilner Z. Online support group for patients with inflammatory eye disease: Characterisation of members and assessment of benefits. Clin Exp Ophthalmol 2023; 51:704-713. [PMID: 37565254 DOI: 10.1111/ceo.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Support groups in ophthalmology may be of utmost importance for patients and caregivers. We aimed to characterise members of an online support group for patients and parents of children with inflammatory eye disease and assess the members' expectations and perceived benefits. METHODS A survey based on a voluntary, anonymous web questionnaire was distributed to the members of the 'Lirot' association online support group. The questionnaire included demographic, ocular and systemic information, functional and psychosocial data, support group use patterns, expectations and perceived benefits. Analysis was done for patients and parents. RESULTS Out of 67 respondents, 43 (64%) were patients, and 24 (36%) were parents. Fifty-eight (88%) were women. The mean age of respondents was 42.9 ± 1.34 years. Anterior uveitis was the most common, and most patients had good visual acuity (<0.3 logMAR). Parents reported higher anxiety levels (p = 0.044) and a more significant effect of their child's disease on their general function (p = 0.005). Most members sought several experts' opinions, psychological treatments and alternative medicine. All members used the WhatsApp group, while only approximately half used Facebook (p < 0.001). Members' expectations were fulfilled for social support, a sense of shared experience and being able to help others, but not for receiving information (p < 0.001). All members reported being willing to recommend the group to others. CONCLUSIONS Support group participation benefited group members. We suggest that ophthalmologists encourage their inflammatory eye disease patients to use online support groups, which may significantly improve their well-being.
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Affiliation(s)
| | - Amir Rosenblatt
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadine Hollander
- "Lirot", the Israeli Research Association for Eye Health and Blindness Prevention, Herzliya, Israel
| | - Zohar Habot-Wilner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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