To examine the associations between vision-targeted health-related quality of life (VT-HRQ) and ocular surface parameters in patients with Sjögren's syndrome, a systemic autoimmune disease characterized by dry eye and dry mouth.
Forty-two patients fulfilling European / American diagnostic criteria for Sjögren's syndrome underwent Schirmer testing without anesthesia, ocular surface vital dye staining; and measurement of tear film breakup time (TBUT). Subjects were administered the Ocular Surface Disease Index (OSDI) and the 25-item National Eye Institute Vision Functioning Questionnaire (NEI-VFQ). Main outcome measures included ocular surface parameters, OSDI subscales describing ocular discomfort (OSDI-symptoms), vision-related function (OSDI-function), and environmental triggers, and NEI-VFQ subscales.
Participants (aged 31–81 y; 95% female) all had moderate to severe dry eye. Associations of OSDI subscales with the ocular parameters were modest (Spearman r (ρ) < 0.22) and not statistically significant. Associations of NEI-VFQ subscales with the ocular parameters reached borderline significance for the near vision subscale with TBUT (ρ = 0.32, p = .05) and for the distance vision subscale with van Bijsterveld score (ρ = 0.33, p = .04). The strongest associations of the two questionnaires were for: ocular pain and mental function with OSDI-symptoms (ρ = 0.60 and 0.45, respectively); and general vision, ocular pain, mental function, role function, and driving with OSDI-function (ρ = 0.60, 0.50, 0.61, 0.64, 0.57, and 0.67, respectively).
Associations between conventional objective measures of dry eye and VT-HRQ were modest. The generic NEI-VFQ was similar to the disease-specific OSDI in its ability to measure the impact of Sjögren's syndrome-related dry eye on VT-HRQ.
To describe the vision-targeted, health-related quality of life, measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ), in patients with age-related macular degeneration, cataract, or reduced visual acuity; to determine the relationship between the NEI-VFQ subscale scores and clinical measures of visual function; and to assess the internal consistency and reliability of the NEI-VFQ subscales.
The 39-item NEI-VFQ was administered at the 5-year clinic visit to 4077 Age-Related Eye Disease Study participants.
The subscales of the NEI-VFQ had moderate to high internal consistency (Cronbach’s α = 0.58–0.91). The NEI-VFQ scores for participants with advanced age-related macular degeneration in 1 or both eyes, severe nuclear opacity, reduced visual acuity, or cataract surgery generally were lower than scores for disease-free participants (P<.001).
These findings support the use of the NEI-VFQ as a measure of vision-targeted, health-related quality of life among patients with age-related macular degeneration, cataract, or reduced visual acuity.
To test the reliability and validity of questionnaires shortened from the National Eye Institute 25-item Vision Function Questionnaire (NEI VFQ-9 and NEI VFQ-8).
A cross-sectional multi-center cohort study.
Reliability was assessed by Cronbach alpha coefficients. Validity was evaluated by studying the association of vision-targeted quality-of-life composite scores with objective visual function measurements. Study population: A total of 5,482 women between the ages of 65 and 100 years participated in the Year-10 clinic visit in the Study of Osteoporotic Fractures (SOF). A total of 3,631 women with complete data were included in the visual acuity (VA) and visual field (VF) analysis of the NEI VFQ-9, which is defined for those who care to drive. and 5,311 in the analysis of the NEI VFQ-8. To assess differences in prevalent eye diseases, which were ascertained for a random sample of SOF participants, 853 and 1,237 women were included in the NEI VFQ-9 and the NEI VFQ-8 analyses, respectively.
Cronbach alpha coefficient for the NEI VFQ-9 scale was 0.83 and that of the NEI VFQ-8 was 0.84. Using both questionnaires, women with VA worse than 20/40 had lower composite scores compared to those with VA 20/40 or better (p<0.001). Participants with mild, moderate, and severe binocular VF loss had lower composite scores compared to those with no binocular VF loss (p<0.001).Compared to women without chronic eye diseases in both eyes, women with at least one chronic eye disease in at least one eye had lower composite scores.
Both questionnaires showed high reliability across items and validity with respect to clinical markers of eye disease Future research should compare the properties of these shortened surveys to those of the NEI VFQ-25.
To describe vision-targeted health-related quality of life (HR-QOL), measured with the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) in a cohort of patients with macular telangiectasia (MacTel) type 2 and to evaluate the relationship between visual acuity and NEI-VFQ-25 scores.
This was an analysis of cross-sectional baseline data from a longitudinal natural history study. Patients with MacTel type 2 were enrolled in the Natural History Study of The Macular Telangiectasia Project (The MacTel Project). NEI-VFQ-25 were completed at enrollment. Linear correlation and regression analyses were used to relate baseline NEI-VFQ-25 overall and subscale scores to visual acuity.
Participants reported lower vision-related functioning measured by the NEI-VFQ-25 in most of the domains measured by the NEI VFQ compared with that of a normal reference group (P < 0.001 for all domains except color vision). Visual acuity was found to be associated with the NEI-VFQ-25 in many of the domains measuring degree of difficulty with common visual activities.
This is the first cross-sectional cohort study to assess vision targeted HR-QOL in patients with MacTel type 2. Patients with MacTel type 2 reported markedly reduced visual functioning compared to reports of a normal reference group. These findings provide support to the use of the NEI-VFQ-25 in patients with MacTel type 2 to measure the effect of disease and potential therapies on vision-targeted HR-QOL.
To assess vision-specific quality of life (QOL), based on abbreviated surveys derived from the National Eye Institute Visual Function Questionnaire (NEI-VFQ), in a cohort of US women who participated in the Study of Osteoporotic Fractures (SOF).
Prospective, observational cohort study
Age-related macular degeneration (AMD) status, based on a three level classification (no AMD, early AMD, late AMD), and vision-specific QOL, based on abbreviated NEI-VFQ surveys were calculated for 1,674 women enrolled in the SOF at 4 centers within the US, who had gradable fundus photographs at both the 10-year and 15-year follow-up visits. The associations among 5-year changes in NEI-VFQ composite scores, change in AMD status, and distance visual acuity were examined.
Compared to study participants without AMD at both visits, study participants with late AMD at both visits and those that progressed from early AMD to late AMD demonstrated the greatest declines in adjusted NEI-VFQ composite scores, up to a mean decrease of 16.2 out of a scale of 100. Visual acuity declines were also most prominent for patients with late AMD at both visits and for those that progressed from early AMD to late AMD. Change in visual acuity was found to correlate significantly with change in vision-specific QOL.
The abbreviated NEI-VFQ surveys provide reliable assessments of vision-specific QOL in AMD patients. The decline in vision-specific QOL associated with the progression of AMD is clinically meaningful.
The National Eye Institute Visual Function Questionnaire (NEI-VFQ) measures vision-targeted quality of life, but it is unclear whether it is sensitive to changes within individuals over time.
To determine the responsiveness of the NEI-VFQ to “within-individual” changes in visual acuity in patients who had subfoveal choroidal neovascularization in at least one eye secondary to age-related macular degeneration, ocular histoplasmosis syndrome, or idiopathic causes, and who participated in randomized trials of submacular surgery.
Trained telephone interviewers administered the NEI-VFQ as part of annual follow-up data collection for pilot trials and larger clinical trials of sub-macular surgery. Best-corrected visual acuity was measured by local vision examiners at 12 months after enrollment and, typically, by central “traveling” vision examiners at 24 months after enrollment. Changes in visual acuity and NEI-VFQ scores from 12 to 24 months were analyzed using linear regression methods.
Two-hundred eighteen patients had both interviews and visual acuity measurements at 12 and 24 months after enrollment. Changes in the overall NEI-VFQ score and in 9 of the subscales (near activities, dependency, driving, role difficulties, distance activities, mental health, general vision, peripheral vision, and social functioning) were related to changes in visual acuity of the better-seeing eye based on linear regression analysis (P<.05). In our analysis, a 3-line decrease in the visual acuity of the better-seeing eye was associated with 3.6-to 16.2-point decreases in the overall NEI-VFQ score and 9 subscale scores.
Most of the NEI-VFQ subscales were responsive to changes in the visual acuity of the better-seeing eye over a 12-month interval in this patient population. Thus, the NEI-VFQ can be used to measure change in vision-targeted quality of life over time to augment clinical measurements of visual acuity.
To determine if National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores decrease with worsening visual acuity (VA) in American Indian/Alaska Natives (AI/AN), as well as determine the other associated explanatory factors for vision-related quality of life
The study included 414 randomly selected AI/AN tribal members aged 40 years or older from the Pacific Northwest. We excluded candidates who were deceased, seriously ill, had dementia, or otherwise were unable to perform subjective testing such as visual field testing. The participants completed the NEI-VFQ-25, as well as a detailed eye examination. We defined visual impairment as presenting distance VA 20/40 or worse in the better-seeing eye. The main outcome measures were NEI-VFQ-25 composite and subscale scores. We compared median NEI-VFQ-25 composite and subscale scores in those with visual impairment to those without visual impairment.
Visual impairment occurred in 53 (12.8%, CI: 9.6–16.0) participants. The NEI-VFQ-25 median composite score was significantly lower in those with visual impairment as compared to those without visual impairment (77.5 vs. 90.1, p=.001). A univariate analysis showed VA to be significantly (p ≤ .05) associated with all subscales except ocular pain. When controlling for age, gender, income level, education, percent AIAN heritage, and marital status, a multivariate proportional odds model analysis showed VA to be the best predictor of NEI-VFQ 25 composite scores.
Visual impairment is common in Northwest AI/AN. The NEI-VFQ-25 was sensitive to differences in VA, suggesting it is a valid measure of vision-related quality of life in AI/AN.
To assess vision-related quality-of-life subscales with objective measurements of visual function in patients affected with retinitis pigmentosa of Bothnia type (BD).
Forty-nine patients answered the NEI-VFQ-25 questionnaire. High- and low-contrast distance acuity (VA), near VA, and visual fields (VF) were measured. Weighted VA (WVA) and low-contrast (10%) VA (WLCVA), binocular VF areas, and central scotoma were calculated. Adjusted mean subscale scores were calculated and associations analyzed.
Subscale scores for general, far, and near vision, social functioning, and color vision were lowest while general health, ocular pain, and mental health were highest in the BD phenotype. The correlations were substantial and similar for WVA, WLCVA, and near vision. The degree of measured VF impairment had few associations with the different adjusted subscale scores.
The NEI VFQ-25 subscales were well associated with clinical vision measures depending on VA. The progression of VF defects typical for the BD phenotype does not seem to affect the self-perceived quality of life, which might indicate adaptability to this type of progressive VF loss. The BD phenotype has a significant impact on multiple domains of daily life, but there are no signs of accelerating depression related to the increasing visual impairment.
visual function; low vision; maculopathy; RP; Bothnia dystrophy; visual cycle; RLBP1
Local tolerance of topical glaucoma treatment is important to achieve a good compliance. The aim of this study was to evaluate the consequences of local anti-glaucoma drug side effects on the vision-related quality of life (QoL).
A mail survey was sent to 20,000 homes of a panel representative of the French population asking whether one member of the family was suffering from ocular hypertension (OHT) or glaucoma. (POAG) A computer-assisted telephone interviewing system was used to confirm self-reported glaucoma, to describe the disease and its treatment, and medical item consumption. Vision-related QoL was assessed with the NEI-VFQ-25 (National Eye Institute Visual – Function Questionnaire) and local tolerance with the COMTOL (Comparison of Ophthalmic Medications for TOLerability).
13,352 homes (66.7%) answered the mail. 581 people declared they were suffering from glaucoma or OHT. Prevalence was 1.8%, increasing with age. 204 patients were selected at random Their NEI-VFQ-25 global score showed an overall good QoL. Two domain scores showed some deterioration: general health and driving. 62.4% of the patients cited at least one local side effect. 25.4% had burning, 20.8% blurred vision and 20.2% tearing. Poor vision related QoL was associated with the presence of local side effects leading to poor perceived treatment satisfaction. Dissatisfied patients visited their ophthalmologist more frequently.
Based on a representative French sample, poor vision related QoL was associated with topical drug side effects that also impact patient satisfaction and compliance. Longitudinal data collection should be performed to confirm our findings.
Glaucoma; topical treatment; side effects; quality of life
Background: Patients with visual field defects after visual pathway lesion may experience reduced vision-related quality of life (vrQoL). It has not been clarified how vrQoL impairments contribute to vision-related mental distress.
Methods: One hundred and eight subjects with visual field defects caused by optic neuropathies (age M = 57.6; SD = 13.7 years) answered the National Eye Institute Visual-Functioning Questionnaire 39 (NEI-VFQ) for vrQoL and the SF-12 Short Form Health Survey for health-related quality of life. A 10 item composite of NEI-VFQ “visual functioning” and 5 items of “mental-health symptoms due to vision problems” were subjected to Rasch analysis. The test battery comprised static and High Resolution Perimetry (HRP). Regression and path analysis were used to investigate associations between QoL, mental distress, and perimetry results.
Results: A higher level of “visual functioning” was associated with monocular impairment and a larger remaining visual field compared to binocular impairment. Subjective “visual functioning” but not visual field parameters predicted “mental-health symptoms due to vision problems” which was the only variable associated with the SF-12 mental component score. The SF-12 physical component score was less strongly associated with “mental-health symptoms due to vision problems.” Here, reaction time in HRP and mean threshold in perimetry were additional significant variables. Path analysis revealed a significant path from remaining visual field via visual functioning on mental health.
Conclusion: Subjective consequences of visual impairments in everyday life impact mental health rather than “objective” visual function loss as measured by perimetry. Since a higher extent of vrQoL was related to lower levels of mental distress, the maintenance of vrQoL could reduce and prevent mental distress due to vision problems. Patients with persisting visual field defects may benefit from neuropsychological rehabilitation and supportive therapies.
vision-related quality of life; visual field defects; mental health; psychological distress; National Eye Institute Visual-Functioning Questionnaire
To compare two vision-specific functional status measures to each other and to clinical parameters in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
CIGTS participants completed the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ) and were tested for visual field (VF) and visual acuity (VA). 426 subjects contributed VAQ and NEI-VFQ scores at 54 months. Pearson correlations were used to assess associations.
The VAQ subscales (range 0–100) that assessed light-dark adaptation (mean=66.1), glare disability (66.4), and acuity/spatial vision (67.7) indicated vision-related functions that CIGTS participants found most difficult. On the NEI-VFQ, subjects reported high levels of visual functioning, with mean ≥90 (out of 100) on the total score and in 9 of 12 subscales. General vision (mean=82.6) received the lowest subscale score. Two subscales common to both questionnaires were highly correlated: VA (r=0.68) and peripheral vision (r=0.77) (both p<.0001). Correlations between participants’ perceptions and clinical measures of visual function were in the expected direction, but weaker. Stronger associations were found between clinical measures and the NEI-VFQ than the VAQ. Better eye VF and worse eye VA had the highest number of significant correlations with subjects’ perceptions of their visual function. Increasing VF loss was associated with a significant decrease in the overall and peripheral vision subscale scores from both questionnaires, as well as several other subscales.
These findings will help researchers interested in assessing patients’ perceptions of their visual function make an informed selection when choosing between the VAQ and the NEI-VFQ.
Glaucoma; quality of life; visual field; visual acuity
BACKGROUND/PURPOSE: To determine the relation between visual impairment, visual functioning, and the global quality of life in patients with glaucoma. METHODS: Visual impairment, defined with the American Medical Association Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the Field Test Version of the National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ); and the global quality of life, assessed with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), were determined in 147 consecutive patients with glaucoma. RESULTS: None of the SF-36 domains demonstrated more than a weak correlation with visual impairment. The VF-14 scores were moderately correlated with visual impairment. Of the twelve NEI-VFQ scales, distance activities and vision specific dependency were moderately correlated with visual impairment. Of the twelve NEI-VFQ scales, distance activities and vision specific dependency were moderately correlated with visual field impairment; vision specific social functioning, near activities, vision specific role difficulties, general vision, vision specific mental health, color vision, and driving were modestly correlated; visual pain was weakly correlated; and two were not significantly correlated. Correcting for visual actuity weakened the strength of the correlation coefficients. CONCLUSIONS: The SF-36 is unlikely to be useful in determining visual impairment in patients with glaucoma. Based on the moderate correlation between visual field impairment and the VF-14 score, this questionnaire may be generalizable to patients with glaucoma. Several of the NEI-VFQ scales correlate with visual field impairment scores in patients with a wide range of glaucomatous damage.
Among uveitis patients, the vision-related function score correlated positively with visual acuity and correlated moderately positively with general quality-of-life measures.
To evaluate the associations between visual acuity and self-reported visual function; visual acuity and health-related quality of life (QoL) metrics; a summary measure of self-reported visual function and health-related QoL; and individual domains of self-reported visual function and health-related QoL in patients with uveitis.
Best-corrected visual acuity, vision-related functioning as assessed by the NEI VFQ-25, and health-related QoL as assessed by the SF-36 and EuroQoL EQ-5D questionnaires were obtained at enrollment in a clinical trial of uveitis treatments. Multivariate regression and Spearman correlations were used to evaluate associations between visual acuity, vision-related function, and health-related QoL.
Among the 255 patients, median visual acuity in the better-seeing eyes was 20/25, the vision-related function score indicated impairment (median, 60), and health-related QoL scores were within the normal population range. Better visual acuity was predictive of higher visual function scores (P ≤ 0.001), a higher SF-36 physical component score, and a higher EQ-5D health utility score (P < 0.001). The vision-specific function score was predictive of all general health-related QoL (P < 0.001). The correlations between visual function score and general quality of life measures were moderate (ρ = 0.29–0.52).
The vision-related function score correlated positively with visual acuity and moderately positively with general QoL measures. Cost–utility analyses relying on changes in generic healthy utility measures will be more likely to detect changes when there are clinically meaningful changes in vision-related function, rather than when there are only changes in visual acuity. (ClinicalTrials.gov number, NCT00132691.)
To determine the change in vision-related quality of life scores after providing eyeglasses to American Indian/Alaska Natives with under-corrected refractive error.
Prospective, comparative (non-randomized) interventional study
We compared a group with under-corrected refractive error to a Control group who did not need a change in eyeglasses. Under-corrected refractive error was defined as distance visual acuity 20/40 or worse in the better-seeing eye that could be improved by at least 2 lines in Snellen visual acuity. Intervention was the provision of new glasses to the under-corrected refractive error group members, based on results of manifest refraction. The main outcome measures were the differences in the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) scores from baseline (T1) to the time after providing eyeglasses (T2).
The NEI-VFQ-25 median composite score at T1 was significantly lower in those with under-corrected refractive error when compared to the Control group (75 vs. 92, p=.001). The median composite score for the Under-corrected refractive error group improved to 96 (P<0.001) at T2 when compared to T1, while the Control group remained stable at 93 (p=0.417). The Under-corrected refractive error group showed significantly greater improvement than the Control group in 8 of 12 subscale scores and in the overall composite score (all p values ≤ 0.05). A multivariate linear regression analysis, which controlled for differences in age, percent self-identified American Indian/Alaskan Native and best-corrected visual acuity between the Under-corrected refractive error and Control group showed eyeglasses to be significantly associated with improvement in NEI-VFQ-25 composite score.
Visual impairment from under-corrected refractive error is common in American Indian/Alaskan Natives. Providing eyeglasses results in a large, significant increase in vision-related quality of life.
To assess the impact of diabetic retinopathy (DR) and its severity on health-related quality of life (HRQOL) in a population-based sample of Latinos with type 2 diabetes mellitus.
Cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES).
1,064 LALES participants with diabetes mellitus.
HRQOL was measured by the 25 item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). DR was assessed by masked standardized grading of stereoscopic photographs from 7 standard fields. Severity of DR in eyes was graded using a modified Airlie House classification. The severity scores from each eye were then concatenated to create a single per person grade ranging from 1(no DR in either eye) to 15 (bilateral PDR). Multiple linear regression analyses were performed to determine the independent relationship between severity of DR and HRQOL after adjusting for covariates.
Main Outcome Measures
NEI-VFQ-25 and SF-12 scores.
More severe DR was associated with worse HRQOL scores on all of the NEI VFQ-25 and SF-12 subscales (P<0.05). Individuals with DR from grade 2 (minimum NPDR) through grade 8 (unilateral moderate NPDR) show a modest decline in HRQOL. However, the decline become significantly steeper between steps 8 (unilateral moderate NPDR) and 9-15 (bilateral moderate NPDR to bilateral PDR). The domains with the most significant impact were for vision-related daily activities, dependency and mental health.
Greater severity of DR was associated with lower general and vision-specific HRQOL. Persons with bilateral moderate NPDR had the most substantial decrease in quality of life compared to those with less severe DR. The prevention of incident DR and more importantly its progression from unilateral to bilateral NPDR is likely to have a positive impact on a person’s HRQOL and should be considered an important goal in management of individuals with diabetes mellitus.
To compare the differences in vision and health-related quality of life (HRQOL) of individuals with ocular and non-ocular sarcoidosis; and to examine the impact of specific demographic and clinical factors on the noted differences.
A cross-sectional study using non-randomized prospective cohort was conducted at the National Eye Institute (protocol number: 06-EI-0239, NCT00379275) from August 31, 2006 until November 15, 2007. Each participant completed vision and HRQOL questionnaires, the Sarcoidosis Health Questionnaire (SHQ) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ), along with a demographic/environmental exposure survey. Clinical data were collected through an ophthalmic exam as part of the research protocol.
The study enrolled 75 biopsy-proven and 20 clinically presumed sarcoidosis participants which were divided into two cohorts, ocular (N = 60) and non-ocular groups (N = 35). The ocular group had significantly lower (P < 0.01) total NEI-VFQ scores compared to the non-ocular group. Multiple linear regression analysis showed that participants with ocular sarcoidosis who had an annual household income of < $50,000 (P < 0.01) had significantly lower total SHQ scores while participants with ocular sarcoidosis whose visual acuity was 20/100 or worse had significantly lower total NEI-VFQ scores (P = 0.03).
Ocular involvement impacts both overall and vision-related quality of life among sarcoidosis patients. Lower economic status appears to have a significant impact on the quality of life of sarcoidosis patients. Assessment of visual function and general health status provide pertinent information for individuals with sarcoidosis and should be included in their care to assess burden of their disease on their quality of life.
Health-related quality of life; Vision-related quality of life; Ocular sarcoidosis; Pulmonary sarcoidosis; Burden of disease
The EPIRET3 retinal prosthesis was implanted in six volunteers legally blind from retinitis pigmentosa (RP) and removed after 4 weeks. Two years later, these subjects were re-examined to investigate ocular side effects and potential changes to quality of life.
Vision-related quality of life was recorded using the NEI-VFQ-25 questionnaire. Clinical data including interval history, visual acuity, and intraocular pressure were obtained. Anterior and posterior segments of the study eyes were examined and photographed; this included fluorescein angiography and optical coherence tomography (OCT).
Data from five patients could be analysed. Life-quality score was consistent with results obtained at baseline. No unexpected structural alteration could be found in the study eyes. A moderate epiretinal gliosis was present in areas where the epiretinal stimulator had been fixated using retinal tacks. Angiography revealed no leakage or neovascularisation; OCT showed no generalised increase of central retinal thickness.
Vision-related quality of life is low in patients suffering from end-stage RP. No further deterioration of life quality could however be detected within our monitoring period. Surgery was well tolerated by both patients and their eyes, without adverse events occurring during the follow-up period. Epiretinal gliosis is known to occur with retinal tacks, but seems of no major concern to the integrity of the study eyes. However, it may potentially interfere with functional aspects of active implants. Hence, alternative, possibly biochemical, fixation methods merit further research.
retinal prosthesis; retinal degeneration; quality of life
The Collaborative Longitudinal Evaluation of Keratoconus Study (CLEK) has previously shown that people with keratoconus report significantly impaired vision-related quality of life (V-QoL) as measured on the National Eye Institute Visual Function Questionnaire (NEI-VFQ), similar to people who have severe macular degeneration. In this report we evaluate changes that occurred in V-QoL over 7 years of follow-up.
Prospective cohort study of 1166 participants followed for 7 years.
We estimated change in quality of life by projecting the slope of a minimum of three reports on 11 scales of the NEI-VFQ. Correlation with clinical indicators was evaluated, and differences were assessed between those who had clinically significant changes in clinical factors and those who did not. Logistic regression was used to assess factors associated with a decline in 10 points or more in a scale score over 7 years.
All scales showed modest decline except Ocular Pain and Mental Health. Baseline factors were not associated with longitudinal change in NEI-VFQ scores. A 10-letter decline in high-contrast binocular visual acuity and a 3.00 D increase in corneal curvature were associated with significantly larger declines in V-QoL. In multivariate analysis, these factors also were found to be associated with a 10-point decline in NEI-VFQ scale scores.
Keratoconus is associated with significantly impaired V-QoL that continues to decline over time. For a substantial plurality these declines are significant.
keratoconus; quality of life; NEI Visual Function Questionnaire; NEI-VFQ CLEK Study
The use of self-report questionnaires to substitute for visual acuity measurement has been limited. We examined the association between visual impairment and self reported visual function in a population sample of older people in the UK.
Cross sectional study of people aged more than 75 years who initially participated in a trial of health screening. The association between 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores and visual impairment (defined as an acuity of less than 6/18 in the better eye) was examined using logistic regression.
Visual acuity and NEI-VFQ scores were obtained from 1807 participants (aged 77 to 101 years, 36% male), from 20 general practices throughout the UK. After adjustment for age, gender, practice and NEI-VFQ sub-scale scores, those complaining of poor vision in general were 4.77 times (95% CI 3.03 to 7.53) more likely to be visually impaired compared to those who did not report difficulty. Self-reported limitations with social functioning and dependency on others due to poor vision were also associated with visual impairment (odds ratios, 2.52, 95% CI 1.55 to 4.11; 1.73, 95% CI 1.05 to 2.86 respectively). Those reporting difficulties with near vision and colour vision were more likely to be visually impaired (odds ratios, 2.32, 95% CI 1.30 to 4.15; 2.25, 95% CI 1.35 to 3.73 respectively). Other NEI-VFQ sub-scale scores were unrelated to measures of acuity. Similar but weaker odds ratios were found with reduced visual acuity (defined as less than 6/12 in the better eye). Although differences in NEI-VFQ scores were small, scores were strongly associated with visual acuity, binocular status, and difference in acuity between eyes.
NEI-VFQ questions regarding the quality of general vision, social functioning, visual dependency, near vision and colour vision are strongly and independently associated with an objective measure of visual impairment in an elderly population.
To assess the vision-related quality of life of corneal transplant recipients using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), and to identify the socio-demographic factors that associate with patients' self-assessment of perceived visual function.
Thirty patients who received corneal transplants were included in this prospective observational, cross-sectional study. Socio-demographic and clinical data, including age, sex, systemic health status, employment status, visual acuity, reason of corneal transplantation, laterality of corneal graft, and follow-up period were collected. NEI VFQ-25 was scored using Rasch analysis. Subgroup analyses were also performed.
Age, sex, visual acuity, and health status had no significant correlation or association with the Rasch-transformed score. Patients who received bilateral corneal grafts were significantly less able socioemotionally than those with unilateral graft. Patients who became unemployed or retired after transplantation were also significantly less able in both visual functioning and socioemotional status.
Corneal transplant recipients had a decreased vision-related quality of life as demonstrated by the NEI VFQ-25. Apart from anatomical success and visual acuity, ophthalmologists should also consider other aspects of visual outcome. In particular, those who received bilateral grafts require more attention. Employment programmes should be part of corneal transplantation rehabilitation planning.
corneal transplant; quality of life; visual function
The aim of this study was to evaluate different approaches to scoring the NEI VFQ-25 in patients with low vision including: scoring by the standard method, by Rasch analysis, and by use of an algorithm created by Massof to approximate Rasch person measure. Subscale validity and use of a seven-item short form instrument proposed by Ryan et al were also investigated.
NEI VFQ-25 data from 50 patients with low vision were analyzed using the standard method of summing Likert-type scores and calculating an overall average, Rasch analysis using Winsteps software, and the Massof algorithm in Excel. Correlations between scores were calculated. Rasch person separation reliability and other indicators were calculated to determine the validity of the subscales and of the seven-item instrument.
Scores calculated using all three methods were highly correlated, but evidence of floor and ceiling effects was found with the standard scoring method. None of the subscales investigated proved valid. The seven-item instrument showed acceptable person separation reliability and good targeting and item performance.
Though standard scores and Rasch scores are highly correlated, Rasch analysis has the advantages of eliminating floor and ceiling effects and producing interval-scaled data. The Massof algorithm for approximation of the Rasch person measure performed well in this group of low vision patients. The validity of the subscales VFQ-25 should be reconsidered.
low vision; NEI VFQ-25
Background and Aim:
To evaluate the psychometric properties of the national Eye Institute refractive error correction quality of life questionnaire (NEI-RQL-42) among Iranian patients with refractive errors.
Materials and Methods:
Two samples of patients (n1 = 296, n2 = 95) were consecutively selected from the eye clinic of the Boo-Ali Hospital, Qazvin. A forward-backward procedure was conducted to translate and cross-culturally adapt the Iranian version of the NEI-RQL-42. A homogeneity, stability, and reliability test was conducted for the first sample after a two-week interval. Convergent validity was computed using the correlation between the NEI-RQL-42 subscale scores, National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ-25), and the Short Form-36 (SF-36). Furthermore, Known-group analysis was performed, to determine the discriminant validity between the subgroups of patients with hyperopia, emmetropia, and myopia. Responsiveness to clinical change was tested by administering NEI-RQL-42 on the second sample that was scheduled for surgery.
Homogeneity was satisfactory with the Cronbach’s alpha coefficients ranging between 0.70 and 0.92. The 13 subscales of the NEI-RQL-42 showed a considerable stability in intra-class-correlation (ICC) ranging between 0.70 and 0.89. Positive correlation coefficients were found among all subscales of the NEI-RQL-42 and the other quality-of-life instruments (NEI-VFQ-25 and SF-36). The NEI-VFQ-25 displayed excellent discriminant validity to differentiate the subgroups of patients, and was found to be responsive to change after the surgical correction at three months.
The Iranian version of the NEI-RQL-42 is a valid and reliable instrument to assess refractive error correction quality-of-life in Iranian patients. Moreover this questionnaire can be used to evaluate the effectiveness of interventions in patients with refractive errors.
Methodology; NEI-RQL-42; quality of life; refractive error; validity
To determine the relationship between the American Medical Association's (AMA) functional vision score (FVS) and vision-specific quality of life in retinitis pigmentosa (RP) patients using the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ 25).
One hundred eight patients with RP participated in the study. We measured best-corrected visual acuity, conducted Goldmann perimetry, and collected the self-reported NEI-VFQ 25. The FVS was calculated using the functional field score (FFS) and the functional acuity score (FAS). The correlations of the VFQ composite scores to the FVS, FFS, and FAS were determined using correlation and regression analyses.
FVS was highly correlated to the BCVA (r=0.69, p<0.001), the FFS (r=0.86, p<0.001) and the FAS (r=0.73, p<0.001). Significant correlations of the VFQ composite score to the BCVA (r=0.60, p<0.001), FFS (r=0.44, p<0.001), FAS (r=0.60, p<0.001), FVS (r=0.58, p<0.001) were also found. However, the correlation strengths of BCVA, FVS, FAS, and FFS to NEI-FVQ were not different.
In RP patients, the vision-specific quality of life was correlated with the AMA guidelines' FVS, FFS, and FAS. Their correlation degrees to NEI-FVQ were not different. This result suggests that vision-specific quality of life can be explained by both visual acuity and visual field in RP patients.
AMA guidelines; Functional acuity score; Functional field score; Functional vision score (FVS); NEI-VFQ 25; Retinitis pigmentosa
To report the test-retest variability of the new Adult Strabismus 20 (AS-20) and the NEI VFQ-25 health-related quality of life (HRQOL) instruments in adults with strabismus.
Prospective case series
55 adult patients in a clinical practice with stable strabismus completed the AS-20 and the NEI VFQ-25 at two visits, without intervening treatment. Questionnaires were completed the second time either at a subsequent office visit, immediately pre-operatively, or by mail. Intraclass correlation coefficients were calculated. 95% limits of agreement and 95% confidence intervals (CI) around the 95% limits of agreement were also calculated.
There was excellent agreement of overall questionnaire scores for the AS-20 (ICC = 0.92) and NEI VFQ-25 (ICC = 0.94). 95% limits of agreement for overall scores were 14.3 points (CI 10.9 to 17.7) for the AS-20 and 11.1 points (CI 8.5 to 13.8) for the NEI VFQ-25. The lower test-retest variability of the VFQ-25 appeared to be partly due to ceiling effects with many scores at the normal end of the range.
The new AS-20 and the NEI VFQ-25 show excellent test-retest reliability in adults with strabismus. Change exceeding 95% limits of agreement (14 points on the AS-20 and 11 points on the VFQ-25) is indicative of real change in an individual patient. The AS-20 may be more useful than the VFQ-25 because it is less prone to ceiling effects in adults with strabismus.
The purpose of this study was to investigate the effect of residential blind rehabilitation on patients’ vision targeted health-related quality of life (HRQOL) and general physical and mental function.
The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ) plus appendix questions, the 12 item Short-Form Health Survey (SF-12), Hope Scale and Coopersmith self-esteem inventory were administered to 206 legally blind veterans prior to their entering a residential (in-patient) blind rehabilitation program and again to 185 and 176 of the original cohort at two and six months after completion of the rehabilitation program, respectively. Data on visual acuity, visual field extent, contrast sensitivity and scanning ability were also collected. The duration of the in-patient rehabilitation programs ranged from 11–109 days. Questionnaire scores were compared pre-rehabilitation and post-rehabilitation.
Following rehabilitation there was a significant improvement in nine of eleven NEI VFQ subscales and in a composite score at both 2- and 6-month post-rehab intervals. Mental health (SF-12) and self esteem also improved significantly although physical health ratings declined over the course of the study (approximately 10 months).
Residential blind rehabilitation appears to improve patients’ self-reported vision-targeted HRQOL, self-esteem, and mental health aspects of generic HRQOL.
Health related quality of life; NEI-VFQ; SF-12; Hope Scale; self-esteem; profound low vision; vision rehabilitation; blind rehabilitation; United States veterans