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1.  Responsiveness of the National Eye Institute Visual Function Questionnaire to Changes in Visual Acuity 
Archives of ophthalmology  2003;121(4):531-539.
Background
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.
Objective
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1001/archopht.121.4.531
PMCID: PMC1434793  PMID: 12695250
2.  Health- and Vision-Related Quality of Life Among Patients With Ocular Histoplasmosis or Idiopathic Choroidal Neovascularization at Enrollment in a Randomized Trial of Submacular Surgery 
Archives of ophthalmology  2005;123(1):78-88.
Objectives
To (1) summarize vision-targeted and general health-related quality-of-life scores at baseline and quantify the effect of the ophthalmic problem, (2) evaluate the strength of relations between visual acuity and interview scores, and (3) compare scores for patients who also had choroidal neovascular lesions in the fellow eye (bilateral cases) with those of patients who had choroidal neovascularization in only the study eye (unilateral cases) at time of enrollment in a randomized trial of surgical removal of subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or of idiopathic origin.
Design
Eligible patients had subfoveal choroidal neovascularization (including some classic choroidal neovascularization) and a visual acuity of 20/50 to 20/800 (Snellen equivalent), inclusive, in the eye to be assigned randomly to surgery or observation. Interviews that incorporated the 39-item version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) and 2 other instruments were conducted by telephone by trained interviewers before patients enrolled and were assigned randomly to surgery or observation. Information from baseline clinical examinations and fluorescein angiograms interpreted centrally by masked readers was used to classify patients as unilateral or bilateral cases and to provide potential explanations for variability of interview responses using linear regression models.
Results
The median overall NEI-VFQ score was 75 (interquartile range, 60–84). The median scores on individual subscales ranged from 55 (general vision) to 100 (color vision). The visual acuity of the better-seeing eye accounted for much of the variability in scores on most NEI-VFQ subscales; a 3-line difference in visual acuity was associated with a 10-point or greater difference in scores on 5 subscales after adjustment for other characteristics of patients and eyes. Scores on most scales of all 3 instruments differed between unilateral cases (n=167) and bilateral cases (n=58). Even after adjustment for visual acuity and reading speed of the better-seeing eye, age, gender, and scores on the other instruments, scores on the NEI-VFQ near and distance activities subscales differed by almost 13 and 10 points, respectively, between unilateral and bilateral cases. Neither age nor gender was an important independent explanatory variable for NEI-VFQ scores.
Conclusions
Unilateral and bilateral cases had vision-targeted health-related quality-of-life scores worse than those published for a reference population without eye disease. Furthermore, despite younger age, better visual acuity, and better short-term visual prognosis, bilateral cases had NEI-VFQ scores at baseline similar to those published for 2 groups of patients with age-related macular degeneration. Unidentified factors, in addition to the visual acuity of the better-seeing eye, affected patients’ perceptions of visual function.
doi:10.1001/archopht.123.1.78
PMCID: PMC1256027  PMID: 15642816
3.  The Effect of Visual Impairment on Vision-Related Quality of Life in American Indian/Alaska Natives 
Ophthalmic epidemiology  2009;16(2):128-135.
Purpose
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
Methods
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.
Results
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.
Conclusion
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.
doi:10.1080/09286580902745428
PMCID: PMC3749833  PMID: 19353401
4.  Responsiveness of the National Eye Institute Visual Function Questionnaire to Progression to Advanced Age-Related Macular Degeneration, Vision Loss, and Lens Opacity 
Archives of ophthalmology  2005;123(9):1207-1214.
Objective
To describe the ability of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to detect meaningful change over time (responsiveness) to the primary Age-Related Eye Disease Study outcomes.
Methods
The 25-item NEI-VFQ plus appendix was administered at 2 visits at 1- to 4-year intervals to 4119 participants in the Age-Related Eye Disease Study. Events evaluated were progression to advanced age-related macular degeneration (AMD), visual acuity (VA) loss of at least 15 letters, and lens opacity progression. Responsiveness was measured by the t statistic, effect size (ES), responsiveness statistic, and area under the receiver operating characteristic curve. Variance components were used to estimate the contributions of events to variability of the NEI-VFQ score.
Results
Overall NEI-VFQ score was responsive to AMD progression (t = 14.0; P<.001; ES=0.81) and VA (t = 16.2; P<.001; ES=0.74). Mean changes ranged from 11 to 25 points for the subscales of general vision, near and distance activities, social functioning, mental health, role difficulties, dependency, and driving. The NEI-VFQ was unresponsive to lens opacity progression, although when the event occurred in the eye with the best vision at the first administration, the lens opacity ES was moderate for the color vision (ES = 0.62) and driving subscales (ES=0.66). Progression to advanced AMD and VA loss contributed significantly to the variation in the mean difference in overall VFQ score.
Conclusions
Changes in the NEI-VFQ overall and subscale scores of 10 points or more are associated with clinically significant changes in vision and AMD. This finding may assist the design of interventional studies of AMD and VA loss that include the NEI-VFQ as an outcome measure.
doi:10.1001/archopht.123.9.1207
PMCID: PMC1473207  PMID: 16157800
5.  The National Eye Institute Visual Function Questionnaire in the Macular Telangiectasia (MacTel) Project 
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1167/iovs.08-1749
PMCID: PMC3021355  PMID: 18586874
6.  Reliability and validity of abbreviated surveys derived from the National Eye Institute Visual Function Questionnaire: The Study of Osteoporotic Fractures 
American journal of ophthalmology  2010;149(2):330-340.
Purpose
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).
Design
A cross-sectional multi-center cohort study.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1016/j.ajo.2009.09.008
PMCID: PMC2862227  PMID: 20103058
7.  Longitudinal Changes in Visual Acuity and Health Related Quality of Life. The Los Angeles Latino Eye Study 
Ophthalmology  2010;117(10):1900-1907.e1.
Purpose
To examine the association between longitudinal changes in visual acuity (VA) and Health Related Quality of Life (HRQOL) in a population-based sample of adult Latinos.
Design
A population-based cohort study of eye disease in Latinos.
Participants
3,169 adult Latino participants who live in the city of La Puente, California.
Methods
Data for these analyses were collected for the Los Angeles Latino Eye Study (LALES). Distance visual acuity (VA) was measured during a detailed ophthalmologic examination using the standard Early Treatment Diabetic Retinopathy Study protocol at baseline and a 4 year follow-up examination. HRQOL was assessed by the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-Item Short-Form Health Survey version 1 (SF-12 v.1).
Main Outcome Measures
Mean differences in HRQOL composite and subscale scores between baseline and follow-up were calculated for 3,169 participants with complete clinical examination and HRQOL data at both time points. Mean differences and effect sizes (ES) for NEI-VFQ and SF-12 v.1 scores were calculated for 3 categories of VA change over the 4 year follow-up period (VA improved ≥ 2 lines, no change in VA or −2
Results
For participants with a 2 line loss in VA, we noted an approximate 5 point loss in the NEI-VFQ-25 composite score; with the largest score changes found for the driving difficulties, vision related mental health, and vision related dependency subscales (−12.7, −11.5, and −11.3 respectively). For participants with a 2 line improvement in VA we also noted an approximate 5 point gain in the NEI-VFQ-25 composite score. The largest change (ES = 0.80) was observed for the driving difficulties subscale. No measurable differences in HRQOL were observed for individuals without change in VA from baseline to follow-up.
Conclusions
Clinically important, longitudinal changes in visual acuity (2 line changes or greater) were associated with significant changes in self-reported visual function and well-being. Both the size and direction of visual acuity change influenced change in HRQOL scores.
doi:10.1016/j.ophtha.2010.01.059
PMCID: PMC2945425  PMID: 20570364
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.
PMCID: PMC1312116  PMID: 8981717
Background
The purpose of this study was to assess visual function and vision-related quality of life after intravitreal injection of ranibizumab (IVR) using a pro re nata regimen for the treatment of age-related macular degeneration.
Methods
A prospective study of 54 eyes in 54 patients scheduled to undergo IVR for the treatment of exudative age-related macular degeneration was performed. A self-administered, 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was completed before and 3 and 12 months after the initial IVR treatment. We evaluated logMAR visual acuity and NEI VFQ-25 scores preoperatively and postoperatively. Further, associations between the changes in NEI VFQ-25 scores and patient characteristics were investigated at 12 months.
Results
Postoperative best-corrected visual acuity improved significantly when compared with the preoperative visual acuity throughout the 12-month period (P<0.05 at 3 and 12 months, respectively). On the other hand, IVR treatment significantly improved the postoperative NEI VFQ-25 mean composite score at both 3 and 12 months (P<0.05, respectively). Better visual acuity at 12 months was associated with a greater improvement in NEI VFQ-25 score at 12 months (P<0.05).
Conclusion
IVR was well tolerated and improved vision in these patients with age-related macular degeneration, as evaluated at one-year follow-up examinations. IVR also enabled good subjective perception, as indicated by higher composite NEI VFQ-25 scores. Maintaining good visual acuity may be an important factor for improving vision-related quality of life.
doi:10.2147/OPTH.S68293
PMCID: PMC4160327  PMID: 25228787
age-related macular degeneration; ranibizumab; intravitreal injection; vascular endothelial growth factor; vision-related quality of life
American journal of ophthalmology  2008;145(4):611-617.
Purpose
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.
Design
Prospective cohort study of 1166 participants followed for 7 years.
Methods
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.
Results
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.
Conclusions
Keratoconus is associated with significantly impaired V-QoL that continues to decline over time. For a substantial plurality these declines are significant.
doi:10.1016/j.ajo.2007.11.017
PMCID: PMC2753249  PMID: 18226798
keratoconus; quality of life; NEI Visual Function Questionnaire; NEI-VFQ CLEK Study
Ophthalmology  2012;119(9):1731-1736.
Objective
To assess the association between correction of myopia, hyperopia and astigmatism with self-reported near and distance visual function.
Design
Population based, cross-sectional study.
Participants
A random sample of 4272 Latinos over 40 years old from Arizona with both ophthalmic exam and questionnaire data, including answers to the NEI VFQ-25.
Methods
Cases of refractive error (RE) were defined as subjects who met at least one of the following criteria in both eyes: myopia, sphere ≤-0.5 diopters (D); hyperopia, sphere ≥1.0D; astigmatism, cylinder≥0.75D. Uncorrected refractive error (URE) was defined as having RE and achieving ≥2 line improvement in visual acuity in both eyes after refraction. The association between RE category and near and distance vision difficulty (as measured by the National Eye Institute Visual Functioning Questionnare-25 near and distance vision subscores) was modeled with ordinal logistic regression, adjusting for age, sex, diabetes, hypertension, income, education and acculturation.
Main Outcome Measures
Association between RE correction and near and distance vision difficulty by type of RE (myopia, hyperopia, and astigmatism).
Results
Of 4272 participants, 54% had RE. 48% of these had myopia, 41% hyperopia, and 11% astigmatism. 14% of myopes, 21% of hyperopes, and 22% of astigmatics had URE. Subjects with myopia, astigmatism, and hyperopia were significantly more likely to report more distance vision difficulty than subjects without RE, whether or not they had correction (Odds Ratios (OR) from 1.7-3.7; p<0.005 for all). Subjects with corrected myopia reported less near vision difficulty than subjects without RE (OR 0.8, Confidence Interval (CI) 0.7-0.9). Subjects with uncorrected hyperopia and uncorrected astigmatism reported more near vision difficulty than those without RE (OR 1.6, CI 1.2-2.2 and OR 1.7, CI 1.0-3.0, respectively). Self reported distance and near visual function scores were sensitive to non-vision variables; namely, age, sex, diabetes, high blood pressure, acculturation score, income, and education.
Conclusions
in our population, correction of any type of RE is not entirely sufficient to restore distance visual function to the level of those without RE. More research is necessary to determine the reasons for this shortcoming.
doi:10.1016/j.ophtha.2012.03.003
PMCID: PMC3433575  PMID: 22683060
Journal of glaucoma  2009;18(5):403-411.
Purpose
To compare two vision-specific functional status measures to each other and to clinical parameters in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
Methods
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.
Results
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.
Conclusions
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.
doi:10.1097/IJG.0b013e3181879e63
PMCID: PMC3060041  PMID: 19525733
Glaucoma; quality of life; visual field; visual acuity
Purpose
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).
Methods
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.
Results
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.
Conclusions
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.
doi:10.3341/kjo.2009.23.3.164
PMCID: PMC2739964  PMID: 19794942
AMA guidelines; Functional acuity score; Functional field score; Functional vision score (FVS); NEI-VFQ 25; Retinitis pigmentosa
Journal of Ophthalmology  2014;2014:694542.
Purpose. The purpose of this study is to evaluate the vision related quality of life in patients with keratoconus by using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Methods. Thirty patients presented with keratoconus (keratoconus group) and 30 healthy patients (control group) were included in this study. Twenty patients were using rigid gas permeable and 10 patients were not using contact lenses in keratoconus group. High and low contrast visual acuity and mean K values of the patients were recorded. Each subject completed the 25-item NEI-VFQ-25. Results. All subscales of NEI-VFQ-25 were lower in the keratoconus patients. The difference was more evident in the subscales of general vision, ocular pain, near vision, vision-specific mental health, vision-specific role difficulties, and peripheral vision (P < 0.05). Overall composite score was 75.2 ± 17.2 in the keratoconus group and 93.2 ± 5.6 in the control group (P = 0.00). Contact lens wearers had higher best corrected visual acuity in comparison with noncontact lens wearers (P = 0.028). Patients with low visual acuity (logMAR > 0.4) in the better eye had lower distance vision, social functioning, mental health, and role difficulties. Meanwhile, patients with low visual acuity (logMAR > 0.4) in the worse eye had lower general health scores (P < 0.05). Conclusions. Vision related quality of life was worse in keratoconus patients. Success in the contact lens usage and maintaining higher visual acuity may improve vision related quality of life.
doi:10.1155/2014/694542
PMCID: PMC4020211  PMID: 24868455
American journal of ophthalmology  2010;150(5):683-691.
Purpose
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).
Design
Prospective, observational cohort study
Methods
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.
Results
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.
Conclusions
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.
doi:10.1016/j.ajo.2010.05.030
PMCID: PMC2967587  PMID: 20691423
Among uveitis patients, the vision-related function score correlated positively with visual acuity and correlated moderately positively with general quality-of-life measures.
Purpose.
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.
Methods.
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.
Results.
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).
Conclusions.
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.)
doi:10.1167/iovs.11-8259
PMCID: PMC3339901  PMID: 22247489
American journal of ophthalmology  2010;151(1):175-182.e2.
Purpose
To determine the change in vision-related quality of life scores after providing eyeglasses to American Indian/Alaska Natives with under-corrected refractive error.
Study Design
Prospective, comparative (non-randomized) interventional study
Methods
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).
Results
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.
Conclusion
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.
doi:10.1016/j.ajo.2010.06.043
PMCID: PMC3003763  PMID: 20951973
Ophthalmology  2010;118(2):353-358.
Purpose
To investigate changes of vision-related quality of life during a 10-year period in a type 1 diabetes population.
Design
Prospective cohort study
Participants
Individuals who had their diabetes diagnosed before 30 years of age were considered to have type 1 diabetes (N=1,210). Those who participated in both 14-year (1995–96) and 25-year (2005–07) follow-up examinations were included in the current analysis (N=471).
Methods
Vision-related quality of life was measured with the National Eye Institute Vision Function Questionnaire (NEI-VFQ-25).
Main Outcome Measures
Changes in vision-related quality of life scores.
Results
Loss of three lines in the Early Treatment Diabetic Retinopathy Study (ETDRS) chart was the most important factor related to negative changes in the NEI-VFQ-25 scores in our study after controlling for confounders. Most important changes were observed in subscales such as general vision (−6.46 points); mental health (−10.19 points); role difficulty (−6.06 points); and driving (−10.43 points). Unemployment and the development long-term complications such as nephropathy were also associated with negative changes in some NEI-VFQ-25 subscale scores. On the other hand, changes in diabetic retinopathy status were not related to changes in any subscale after 10 years.
Conclusions
Change in visual acuity was the most important factor associated with changes in vision-related quality of life scores in individuals with type 1 diabetes during a 10-year period. Our findings support the necessity of close follow-up of type 1 diabetes individuals in order to avoid development of long-term complications and vision loss to improve quality of life.
doi:10.1016/j.ophtha.2010.06.022
PMCID: PMC3017211  PMID: 20884058
Purpose:
To assess vision-related quality-of-life subscales with objective measurements of visual function in patients affected with retinitis pigmentosa of Bothnia type (BD).
Methods:
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.
Results:
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.
Conclusion:
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.
PMCID: PMC2850827  PMID: 20390035
visual function; low vision; maculopathy; RP; Bothnia dystrophy; visual cycle; RLBP1
Eye  2012;26(9):1249-1255.
Aims
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.
Methods
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.
Results
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.
Conclusion
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.
doi:10.1038/eye.2012.130
PMCID: PMC3443836  PMID: 22744389
corneal transplant; quality of life; visual function
Archives of ophthalmology  2003;121(2):211-217.
Objectives
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.
Design
The 39-item NEI-VFQ was administered at the 5-year clinic visit to 4077 Age-Related Eye Disease Study participants.
Results
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).
Conclusion
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.
PMCID: PMC1473210  PMID: 12583787
Background
To evaluate vision-related and health-related quality of life (VRQoL, HRQoL) in first stroke patients with homonymous visual field defects (VFD) with respect to the extent of the lesion. Since VFD occur in approximately 10% of stroke patients the main purpose of the study was to investigate the additional impact of VFD in stroke patients hypothesizing that VFD causes diminished VRQoL.
Methods
In 177 first stroke patients with persisting VFD 2.5 years after posterior-parietal lesions VRQoL was assessed by the National-Eye-Institute-Visual-Functioning-Questionnaire (NEI-VFQ) and HRQoL by the Medical-Outcome-Study Short-Form-36 Health-Survey (SF-36). Questionnaire results of VFD-patients were compared with age- and sex-matched healthy controls and with general non-selected stroke samples as published elsewhere. VFD-type and visual acuity were partially correlated with questionnaire results.
Results
Compared to healthy controls VFD-patients had lower NEI-VFQ scores except ocular pain (Z-range -11.34 to -3.35) and lower SF-36 scores except emotional role limitations (Z-range -7.21 to -3.34). VFD-patients were less impaired in SF-36 scores than general stroke patients one month post lesion (6/8 subscales) but had lower SF-36 scores compared to stroke patients six months post lesion (5/8 subscales). Visual acuity significantly correlated with NEI-VFQ scores (r-range 0.27 to 0.48) and VFD-type with SF-36 mental subscales (r-range -0.26 to -0.36).
Conclusions
VFD-patients showed substantial reductions of VRQoL and HRQoL compared to healthy normals, but better HRQoL compared to stroke patients one month post lesion. VFD-patients (although their lesion age was four times higher) had significantly lower HRQoL than a general stroke population at six months post-stroke. This indicates that the stroke-related subjective level of HRQoL impairment is significantly exacerbated by VFD. While VRQoL was primarily influenced by visual acuity, mental components of HRQoL were influenced by VFD-type with larger VFD being associated with more distress.
doi:10.1186/1477-7525-8-33
PMCID: PMC2859371  PMID: 20346125
Purpose
This study compared the general health related quality of life (HRQOL) and the vision specific HRQOL in patients following the surgical removal of one eye who had good vision in the remaining eye to a group of binocular patients with good vision in both eyes.
Methods
The Medical Outcomes Study Short Form 12 (SF-12) and the National Eye Institute Visual Function Questionnaire (NEI VFQ) health related quality of life (HRQOL) surveys were administered to 29 patients who had surgical removal of an eye who attended an ocular prosthetics clinic and to 25 binocular persons who accompanied a patient. All subjects in each group had best corrected visual acuity of 20/40 or better. Overall statistical significance was tested using Cramer's V followed by individual t-tests for independent groups for each of the scales on the two questionnaires to determine if the means between the two groups differed statistically.
Results
The patient group had a mean age of 50.98 years (range 19 to 76). The control group had a mean age of 49.46 years (range 18 to 76). The mean time after loss of vision was 28.03 years (range 1-71 years) and the mean time from surgical removal of the eye was 23.6 years (range 0.5 to 59.5). There was an overall significant difference between the two groups on the 15 derived subscales of the two forms (Cramer's V, p = 0.0025). Three general HRQOL subscales (SF-12- mental component summary (MCS), SF-12 physical component summary (PCS), NEI VFQ-General Health) showed no differences between the two groups (p = 0.48, p = 0.81, p = 0.78 respectively). Three of the twelve vision specific NEI VFQ subscales demonstrated statistically significant differences between the patient and control groups: peripheral vision (p = 0.0006), role difficulties (p = 0.015) and the composite score (p = 0.014). Additionally, two monocular patients had given up driving compared to no binocular subjects (p = 0.056).
Conclusions
This population of monocular patients had general physical and mental HRQOL equivalent to the normal binocular group despite the surgical removal of one eye. However, the reduced vision specific HRQOL of monocular patients on the NEI VFQ indicates that there are substantial residual visual deficits even after prolonged monocular status.
doi:10.1097/IOP.0b013e318275b754
PMCID: PMC3541504  PMID: 23299809
Quality of Life; monocular blindness; enucleation; evisceration; evisceration; exenteration; disability; visual field loss
BMC Ophthalmology  2012;12:22.
Background
Dry eye syndrome (DES) is a common ocular disorder occurring in general population. The purpose of this study is to evaluate the impact of DES on vision-related quality of life (QoL) in a non-clinic-based general population.
Methods
This population-based cross-sectional study enrolled subjects older than 40 years, who took part in an epidemiological study on dry eye in Sanle Community, Shanghai. Apart from the collection of sociodemographics, dry eye symptoms, and other clinical data, a Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was administered to all subjects. Comparisons of the NEI VFQ-25 subscale item scores and composite score were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate regression analysis was performed to investigate the relationship between the clinical variables and the VFQ-25 composite score.
Results
A total of 229 participants were enrolled in the study, with an average age of (60.7 ±10.1) years old. Majority of these participants were female (59.8 %, 137/229). The total DES symptom scores (TDSS) in subjects either with definite DES or only with dry eye symptoms were significantly higher (F = 60.331, P < 0.001). The values of tear break-up time (TBUT) and Schirmer test were significantly lower in participants with DES and those with dry eye signs only (F = 55.158 and 40.778, P < 0.001). The composite score of the NEI VFQ-25 was significantly lower in subjects with DES (F = 4.901, P = 0.003). Moreover, the subscale scores of ocular pain and mental health were significantly lower in those with either DES or dry eye symptoms only (F = 10.962 and 7.362 respectively, both P < 0.001). The multiple regression analysis showed that the TDSS had a significant negative correlation with the VFQ-25 composite score as well as with the subscale score for ocular pain and mental health, even after the adjustment of all other factors (all P < 0.01).
Conclusions
The symptoms of dry eye are associated with an adverse impact on vision-related QoL in non-clinic-based general population, which is mainly represented as more ocular pain and discomfort, and impaired mental health as well. Apart from clinical examination, it is also important to refer to subjective symptoms and QoL scores when assessing the severity of DES.
doi:10.1186/1471-2415-12-22
PMCID: PMC3437197  PMID: 22799274
Dry eye syndrome; NEI VFQ-25; Visual quality of life
American journal of ophthalmology  2007;143(6):1013-1023.
Purpose
To examine the association between severity of visual field loss (VFL) and self-reported health-related quality of life (HRQOL) in a population-based sample.
Design
Population-based cross-sectional study.
Methods
Participants in the Los Angeles Latino Eye Study underwent a comprehensive ophthalmic examination including visual field testing using the Humphrey Automated Field Analyzer II (SITA Standard 24-2). Mean Deviation (MD) scores were used to determine severity of VFL both as a continuous variable and stratified by severity: no VFL (MD≥ − 2 decibels [dB]), mild VFL (6dB
Results
Of the 5,213 participants included in this study, 18% had unilateral mild, 1.5% unilateral moderate/severe, 19% bilateral mild, and 6.5% bilateral moderate/severe VFL. Worse NEI-VFQ-25 and SF-12 HRQOL scores were associated with VFL in a linear manner. 4–5 dB differences in VFL were associated with a 5-point difference in the NEI-VFQ composite and most subscale scores. Persons with VFL had the greatest difficulty with driving activities, dependency, mental health, distance vision and peripheral vision.
Conclusion
HRQOL is diminished even in persons with relatively mild VFL based on MD scores. Prevention and management of persons with VFL may be important in preventing or reducing poor HRQOL related to difficulties in driving, distance and peripheral vision activities and a sense of dependency.
doi:10.1016/j.ajo.2007.02.022
PMCID: PMC2731547  PMID: 17399676

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