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Measurements of Vision Function and Quality of Life in Patients With Cataracts in Southern India: Report of Instrument Development

Measurements of Vision Function and Quality of Life in Patients With Cataracts in Southern India:... Abstract Objective: To develop and validate vision function (VF) and quality of life (QOL) instruments in patients with cataracts in the context of large volume surgery in a developing country. Materials and Methods: The instruments were developed using a consensus approach. One hundred patients who were undergoing cataract surgery at Aravind Eye Hospital, Madurai, India, were interviewed preoperatively and 3 and 12 months postoperatively. Standard clinical procedures were followed, including measurement of visual acuity. Between-interviewer reproducibility was measured by repeated administration of the preoperative questionnaire. Withininterviewer reproducibility was measured preoperatively in a separate study of 50 patients. Results: Preoperative scores from the VF and QOL instruments were significantly associated with visual acuity (r=0.4). Internal reliability (Cronbach α) was greater than.9. Both instruments showed large changes after surgery, with effect sizes of 3 or greater for most VF scales (range, 1.8-3.7) and 1 or greater for QOL scales (range, 1.0-2.2). Changes in visual acuity after surgery were correlated with changes in the VF (r=0.44) and QOL (r=0.41) scale scores. Betweeninterviewer reproducibility was acceptable (total VF scale, Spearman r=0.7; total QOL scale, r=0.74). The κ values were lower for within-interviewer reproducibility. Conclusions: The study provided strong evidence for the validity, reproducibility, and responsiveness of the instruments, and for the feasibility of using them in the setting of a large volume of cataract surgery in a developing country. References 1. Patrick DL, Erickson P. Assessing health related quality of life for clinical decision making . In: Walker SR, Rosser RM, eds. Quality of Life Assessment: Key Issues in the 1990s . Norwell, Mass: Kluwer Academic Publishers; 1993:11-63. 2. Fletcher A, Gore S, Jones D, Fitzpatrick R, Spiegelhalter D, Cox D. Quality of life measures in health care, II: design, analysis and interpretation . BMJ . 1992;305:1145-1148.Crossref 3. Bernth-Petersen P. The effectiveness of cataract surgery: a retrospective study . Acta Ophthalmol (Copenh) . 1981;58:50-56. 4. Applegate WB, Miller ST, Elam JT, et al. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients . JAMA . 1987;257:1064-1066.Crossref 5. Mangione CM, Phillips RS, Seddon JM, Lawrence MG, Cook EF, Goldman L. Development of the 'Activities of Daily Vision Scale.' Med Care . 1992;30:1111-1126.Crossref 6. Mangione CM, Phillips RS, Lawrence MG, Seddon JM, Orav J, Goldman L. Improved visual function and attenuation of declines in health-related quality of life after cataract extraction . Arch Ophthalmol . 1994;112:1419-1425.Crossref 7. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14: an index of functional impairment in patients with cataract . Arch Ophthalmol . 1994;112:630-638.Crossref 8. Scott IU, Schein OD, West S, Bandeen-Roche K, Enger C, Folstein MF. Functional status and quality of life measurement among ophthalmic patients . Arch Ophthalmol . 1994;112:329-335.Crossref 9. Brenner MH, Curbow B, Javitt JC, Legro MW, Sommer A. Vision change and quality of life in the elderly: response to cataract surgery and treatment of other chronic ocular conditions . Arch Ophthalmol . 1993;111:680-685.Crossref 10. Ellwein L, Fletcher A, Negrel D, Thulasiraj R. Quality of life assessment in blindness prevention interventions . Int Ophthalmol . 1995;18:263-268.Crossref 11. Sloane ME, Ball K, Owsley C, Bruni SR, Roenkar DL. The visual activities questionnaire: developing an instrument for assessing problems in everyday visual tasks . Tech Dig Noninvas Assess Vis Syst . 1992;1:26-29. 12. Ferris FL, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 13. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status . Med Care . 1989;27:S178-S189.Crossref 14. Javitt JC, Brenner MH, Curbow B, Legro MW, Street DA. Outcomes of cataract surgery: improvement in visual acuity and subjective visual function after surgery in the first, second and both eyes . Arch Ophthalmol . 1993;111:686-691.Crossref 15. Steinberg EP, Tielsch JM, Schein OD, et al. National study of cataract outcomes: variation in 4-month postoperative outcomes as reflected in multiple outcome measures . Ophthalmology . 1994;101:1131-1141.Crossref 16. Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments . J Chronic Dis . 1987;40:171-178.Crossref 17. Wiklund I, Karlberg J. Evaluation of quality of life in clinical trials . Control Clin Trials . 1991;12:204S-216S.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Measurements of Vision Function and Quality of Life in Patients With Cataracts in Southern India: Report of Instrument Development

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150769013
Publisher site
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Abstract

Abstract Objective: To develop and validate vision function (VF) and quality of life (QOL) instruments in patients with cataracts in the context of large volume surgery in a developing country. Materials and Methods: The instruments were developed using a consensus approach. One hundred patients who were undergoing cataract surgery at Aravind Eye Hospital, Madurai, India, were interviewed preoperatively and 3 and 12 months postoperatively. Standard clinical procedures were followed, including measurement of visual acuity. Between-interviewer reproducibility was measured by repeated administration of the preoperative questionnaire. Withininterviewer reproducibility was measured preoperatively in a separate study of 50 patients. Results: Preoperative scores from the VF and QOL instruments were significantly associated with visual acuity (r=0.4). Internal reliability (Cronbach α) was greater than.9. Both instruments showed large changes after surgery, with effect sizes of 3 or greater for most VF scales (range, 1.8-3.7) and 1 or greater for QOL scales (range, 1.0-2.2). Changes in visual acuity after surgery were correlated with changes in the VF (r=0.44) and QOL (r=0.41) scale scores. Betweeninterviewer reproducibility was acceptable (total VF scale, Spearman r=0.7; total QOL scale, r=0.74). The κ values were lower for within-interviewer reproducibility. Conclusions: The study provided strong evidence for the validity, reproducibility, and responsiveness of the instruments, and for the feasibility of using them in the setting of a large volume of cataract surgery in a developing country. References 1. Patrick DL, Erickson P. Assessing health related quality of life for clinical decision making . In: Walker SR, Rosser RM, eds. Quality of Life Assessment: Key Issues in the 1990s . Norwell, Mass: Kluwer Academic Publishers; 1993:11-63. 2. Fletcher A, Gore S, Jones D, Fitzpatrick R, Spiegelhalter D, Cox D. Quality of life measures in health care, II: design, analysis and interpretation . BMJ . 1992;305:1145-1148.Crossref 3. Bernth-Petersen P. The effectiveness of cataract surgery: a retrospective study . Acta Ophthalmol (Copenh) . 1981;58:50-56. 4. Applegate WB, Miller ST, Elam JT, et al. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients . JAMA . 1987;257:1064-1066.Crossref 5. Mangione CM, Phillips RS, Seddon JM, Lawrence MG, Cook EF, Goldman L. Development of the 'Activities of Daily Vision Scale.' Med Care . 1992;30:1111-1126.Crossref 6. Mangione CM, Phillips RS, Lawrence MG, Seddon JM, Orav J, Goldman L. Improved visual function and attenuation of declines in health-related quality of life after cataract extraction . Arch Ophthalmol . 1994;112:1419-1425.Crossref 7. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14: an index of functional impairment in patients with cataract . Arch Ophthalmol . 1994;112:630-638.Crossref 8. Scott IU, Schein OD, West S, Bandeen-Roche K, Enger C, Folstein MF. Functional status and quality of life measurement among ophthalmic patients . Arch Ophthalmol . 1994;112:329-335.Crossref 9. Brenner MH, Curbow B, Javitt JC, Legro MW, Sommer A. Vision change and quality of life in the elderly: response to cataract surgery and treatment of other chronic ocular conditions . Arch Ophthalmol . 1993;111:680-685.Crossref 10. Ellwein L, Fletcher A, Negrel D, Thulasiraj R. Quality of life assessment in blindness prevention interventions . Int Ophthalmol . 1995;18:263-268.Crossref 11. Sloane ME, Ball K, Owsley C, Bruni SR, Roenkar DL. The visual activities questionnaire: developing an instrument for assessing problems in everyday visual tasks . Tech Dig Noninvas Assess Vis Syst . 1992;1:26-29. 12. Ferris FL, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 13. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status . Med Care . 1989;27:S178-S189.Crossref 14. Javitt JC, Brenner MH, Curbow B, Legro MW, Street DA. Outcomes of cataract surgery: improvement in visual acuity and subjective visual function after surgery in the first, second and both eyes . Arch Ophthalmol . 1993;111:686-691.Crossref 15. Steinberg EP, Tielsch JM, Schein OD, et al. National study of cataract outcomes: variation in 4-month postoperative outcomes as reflected in multiple outcome measures . Ophthalmology . 1994;101:1131-1141.Crossref 16. Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments . J Chronic Dis . 1987;40:171-178.Crossref 17. Wiklund I, Karlberg J. Evaluation of quality of life in clinical trials . Control Clin Trials . 1991;12:204S-216S.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 1997

References