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Development of an Elderly Low Vision Quality of Life Questionnaire for less-developed areas of China

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Abstract

Purpose

To develop a quality of life questionnaire appropriate for elderly low-vision patients in less-developed areas of China.

Methods

The study was conducted at the Wenzhou Medical University Affiliated Eye Hospital. In the initial development of the questionnaire, we identified visual function concerns with individual interviews and designed a questionnaire and an empirical assessment of the questionnaire. Each individual visual function concern was then transformed into a question and put into a rating scale from 0 to 4. Then, questionnaire interviews were conducted on 188 low-vision patients and 63 normal control patients for item reduction and evaluation of psychometric properties.

Results

We first identified 24 concerns that older adults with serious vision loss thought most affected their daily lives. The initial item list of the Elderly Low Vision Quality of Life Questionnaire (ELVQoL) consisted of 28 items, including the 24 identified items and 4 additional concerns about general vision. Psychometric item reduction removed 9 items, and a 19-item questionnaire was generated. Assessment showed that the resulting questionnaire had acceptable internal consistency, reliability, and validity (Cronbach’s α > 0.9, mean item–total correlations >0.6, test–retest reliability >0.9, and concurrent validity range from 0.6 to 0.9). Low education level, need for a full range of working distances, and retinal diseases were all predictors of reduced visually related quality of life.

Conclusions

A patient-derived ELVQoL Questionnaire was developed specifically for elderly, uneducated, rural Chinese. All the psychometric properties met accepted levels for a disease-specific Qol Questionnaire.

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Abbreviations

AS-20:

Adult Strabismus Questionnaire

ADVS:

Activities of Daily Vision Scale

CLVQOL:

Chinese version of the Low Vision Quality of Life Questionnaire

ELVQoL:

Elderly Low Vision Quality of Life Questionnaire

FVQ-CYP:

Functional Vision Questionnaire for children and young people with visual impairment

IND-VFQ:

Indian Vision Function Questionnaire

LVQOL:

Low Vision Quality of Life Questionnaire

MGQ:

Myasthenia Gravis Questionnaire

NEI-VFQ25:

National Eye Institute Visual Function Questionnaire 25

VF-14:

Visual Functional Index 14

VCM1:

Vision-Related Quality of Life Core Measure

VDQ:

Visual Disability Questionnaire

VRQoL:

Vision-related quality of life

References

  1. Pascolini, D., & Mariotti, S. P. (2012). Global estimates of visual impairment: 2010. British Journal of Ophthalmology, 96(5), 614–618.

    Article  PubMed  Google Scholar 

  2. Shi, X. (2009). Income Gap between urban and rural residents and improvement of social security system in China. Productivity Research (11), 100–103.

  3. Colenbrander, A. (2010). Assessment of functional vision and its rehabilitation. Acta Ophthalmologica, 88(2), 163–173.

    Article  PubMed  Google Scholar 

  4. Binns, A. M., Bunce, C., Dickinson, C., Harper, R., Tudor-Edwards, R., Woodhouse, M., et al. (2012). How effective is low vision service provision? A systematic review. Survey of Ophthalmology, 57(1), 34–65.

    Article  PubMed  Google Scholar 

  5. Mangione, C. M., Lee, P. P., Gutierrez, P. R., Spritzer, K., Berry, S., & Hays, R. D. (2001). Development of the 25-item National Eye Institute Visual Function Questionnaire. Archives of Ophthalmology, 119(7), 1050–1058.

    Article  CAS  PubMed  Google Scholar 

  6. Steinberg, E. P., Tielsch, J. M., Schein, O. D., Javitt, J. C., Sharkey, P., Cassard, S. D., et al. (1994). The VF-14. An index of functional impairment in patients with cataract. Archives of Ophthalmology, 112(5), 630–638.

    Article  CAS  PubMed  Google Scholar 

  7. Mangione, C. M., Phillips, R. S., Seddon, J. M., Lawrence, M. G., Cook, E. F., Dailey, R., et al. (1992). Development of the ‘Activities of Daily Vision Scale’. A measure of visual functional status. Medical Care, 30(12), 1111–1126.

    Article  CAS  PubMed  Google Scholar 

  8. Massof, R. W., Ahmadian, L., Grover, L. L., Deremeik, J. T., Goldstein, J. E., Rainey, C., et al. (2007). The Activity Inventory: An adaptive visual function questionnaire. Optometry and Vision Science, 84(8), 763–774.

    Article  PubMed  Google Scholar 

  9. Murthy, G. V., Gupta, S. K., Thulasiraj, R. D., Viswanath, K., Donoghue, E. M., & Fletcher, A. E. (2005). The development of the Indian vision function questionnaire: Questionnaire content. British Journal of Ophthalmology, 89(4), 498–503.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Wolffsohn, J. S., & Cochrane, A. L. (2000). Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation. American Journal of Ophthalmology, 130(6), 793–802.

    Article  CAS  PubMed  Google Scholar 

  11. Frost, N. A., Sparrow, J. M., Durant, J. S., Donovan, J. L., Peters, T. J., & Brookes, S. T. (1998). Development of a questionnaire for measurement of vision-related quality of life. Ophthalmic Epidemiology, 5(4), 185–210.

    Article  CAS  PubMed  Google Scholar 

  12. Marella, M., Gothwal, V. K., Pesudovs, K., & Lamoureux, E. (2009). Validation of the visual disability questionnaire (VDQ) in India. Optometry and Vision Science, 86(7), E826–E835.

    Article  PubMed  Google Scholar 

  13. Mangione, C. M., Lee, P. P., Pitts, J., Gutierrez, P., Berry, S., & Hays, R. D. (1998). Psychometric properties of the National Eye Institute visual function questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol, 116(11), 1496–1504.

    CAS  PubMed  Google Scholar 

  14. Zou, H. D., Zhang, X., Xu, X., & Bai, L. (2005). Development and evaluation of psychometric tests of the Chinese-version of low vision quality of life questionnaire. Zhonghua Yan Ke Za Zhi, 41(3), 246–251.

    PubMed  Google Scholar 

  15. Hatt, S. R., Leske, D. A., Bradley, E. A., Cole, S. R., & Holmes, J. M. (2009). Development of a quality-of-life questionnaire for adults with strabismus. Ophthalmology, 116(1), 139 e135–144 e135.

    Article  Google Scholar 

  16. Patrick, D. L., & Deyo, R. A. (1989). Generic and disease-specific measures in assessing health status and quality of life. Medical Care, 27(3 Suppl), S217–S232.

    Article  CAS  PubMed  Google Scholar 

  17. Guyatt, G. H., Feeny, D. H., & Patrick, D. L. (1993). Measuring health-related quality of life. Annals of Internal Medicine, 118(8), 622–629.

    Article  CAS  PubMed  Google Scholar 

  18. Mangione, C. M., Berry, S., Spritzer, K., Janz, N. K., Klein, R., Owsley, C., et al. (1998). Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: Results from focus groups with visually impaired persons. Archives of Ophthalmology, 116(2), 227–233.

    Article  CAS  PubMed  Google Scholar 

  19. Tadic, V., Cooper, A., Cumberland, P., Lewando-Hundt, G., & Rahi, J. S. (2013). Development of the Functional Vision Questionnaire for Children and Young People with Visual Impairment: The FVQ_CYP. Ophthalmology, 120(12), 2725–2732.

    Article  PubMed  Google Scholar 

  20. Rahi, J. S., Tadic, V., Keeley, S., & Lewando-Hundt, G. (2011). Capturing children and young people’s perspectives to identify the content for a novel vision-related quality of life instrument. Ophthalmology, 118(5), 819–824.

    Article  PubMed  Google Scholar 

  21. Weih, L. M., Hassell, J. B., & Keeffe, J. (2002). Assessment of the impact of vision impairment. Investigative Ophthalmology & Visual Science, 43(4), 927–935.

    Google Scholar 

  22. Brazier, J. E., Harper, R., Jones, N. M., O’Cathain, A., Thomas, K. J., Usherwood, T., et al. (1992). Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ, 305(6846), 160–164.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Scott, I. U., Smiddy, W. E., Schiffman, J., Feuer, W. J., & Pappas, C. J. (1999). Quality of life of low-vision patients and the impact of low-vision services. American Journal of Ophthalmology, 128(1), 54–62.

    Article  CAS  PubMed  Google Scholar 

  24. Gothwal, V. K., Wright, T. A., Lamoureux, E. L., & Pesudovs, K. (2010). Activities of Daily Vision Scale: what do the subscales measure? Investigative Ophthalmology & Visual Science, 51(2), 694–700.

    Article  Google Scholar 

  25. Fang, J. (2000). Determination and application of quality of life. Bejing: Peking University Medical Press.

    Google Scholar 

  26. Sun, Z. (2002). Medical statistics (2nd ed.). Beijing: People’s Medical Publishing House.

    Google Scholar 

  27. Padua, L., Evoli, A., Aprile, I., Caliandro, P., Batocchi, A. P., Punzi, C., et al. (2002). Myasthenia gravis outcome measure: development and validation of a disease-specific self-administered questionnaire. Neurological sciences, 23(2), 59–68.

    Article  CAS  PubMed  Google Scholar 

  28. Henry, B., Aussage, P., Grosskopf, C., & Goehrs, J. M. (2003). Development of the Cystic Fibrosis Questionnaire (CFQ) for assessing quality of life in pediatric and adult patients. Quality of Life Research, 12(1), 63–76.

    Article  PubMed  Google Scholar 

  29. Lloyd, A. J., Loftus, J., Turner, M., Lai, G., & Pleil, A. (2013). Psychometric validation of the Visual Function Questionnaire-25 in patients with diabetic macular edema. Health Qual Life Outcomes, 11, 10–19.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Gupta, S. K., Viswanath, K., Thulasiraj, R. D., Murthy, G. V., Lamping, D. L., Smith, S. C., et al. (2005). The development of the Indian vision function questionnaire: Field testing and psychometric evaluation. British Journal of Ophthalmology, 89(5), 621–627.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Sakane, Y., Yamaguchi, M., Yokoi, N., Uchino, M., Dogru, M., Oishi, T., et al. (2013). Development and Validation of the Dry Eye-Related Quality-of-Life Score Questionnaire. JAMA Ophthalmology, 131(10), 1331–1338.

    Article  PubMed  Google Scholar 

  32. Naik, R. K., Gries, K. S., Rentz, A. M., Kowalski, J. W., & Revicki, D. A. (2013). Psychometric evaluation of the National Eye Institute Visual Function Questionnaire and Visual Function Questionnaire Utility Index in patients with non-infectious intermediate and posterior uveitis. Quality of Life Research, 22(10), 2801–2808.

    Article  PubMed  Google Scholar 

  33. Paz, S. H., Slotkin, J., McKean-Cowdin, R., Lee, P., Owsley, C., Vitale, S., et al. (2013). Development of a vision-targeted health-related quality of life item measure. Quality of Life Research, 22(9), 2477–2487.

    Article  PubMed  Google Scholar 

  34. Trento, M., Passera, P., Trevisan, M., Schellino, F., Sitia, E., Albani, S., et al. (2013). Quality of life, impaired vision and social role in people with diabetes: A multicenter observational study. Acta Diabetologica, 50(6), 873–877.

    Article  PubMed  Google Scholar 

  35. Lamoureux, E. L., Fenwick, E., Moore, K., Klaic, M., Borschmann, K., & Hill, K. (2009). Impact of the severity of distance and near-vision impairment on depression and vision-specific quality of life in older people living in residential care. Investigative Ophthalmology & Visual Science, 50(9), 4103–4109.

    Article  Google Scholar 

  36. Cacho, I., Dickinson, C. M., Smith, H. J., & Harper, R. A. (2010). Clinical impairment measures and reading performance in a large age-related macular degeneration group. Optometry and Vision Science, 87(5), 344–349.

    PubMed  Google Scholar 

  37. Massof, R. W., & Fletcher, D. C. (2001). Evaluation of the NEI visual functioning questionnaire as an interval measure of visual ability in low vision. Vision Research, 41(3), 397–413.

    Article  CAS  PubMed  Google Scholar 

  38. Gothwal, V. K., Bagga, D. K., & Sumalini, R. (2012). Rasch analysis of the Indian vision function questionnaire. British Journal of Ophthalmology, 96(5), 619–623.

    Article  PubMed  Google Scholar 

  39. Hernandez Trillo, A., & Dickinson, C. M. (2012). The impact of visual and nonvisual factors on quality of life and adaptation in adults with visual impairment. Investigative Ophthalmology & Visual Science, 53(7), 4234–4241.

    Article  Google Scholar 

  40. Wilkie, R., Peat, G., Thomas, E., Hooper, H., & Croft, P. R. (2005). The Keele Assessment of Participation: a new instrument to measure participation restriction in population studies. Combined qualitative and quantitative examination of its psychometric properties. Quality of Life Research, 14(8), 1889–1899.

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was supported by the National Natural Science Foundation of China (Grant No 81170869). The funding organization had no role in the design or conduct of this research. No conflicting relationship exists for any authors. The authors would like to thank Dr. Frank Thorn and Dr. Alan Johnston for their comments and English editing. The authors also would like to thank colleagues from the Eye Hospital of Wenzhou Medical University who helped with patient recruitment.

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Authors and Affiliations

  1. School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, Zhejiang, China

    Xiaoman Li, Jie Chen, Gengui Xu, Yin Zhong, Longfei Jang, Li Lin & Fan Lu

  2. State Key Laboratory Cultivation Base and Key Laboratory of Vision Science, Ministry of Health P.R. China and Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China

    Xiaoman Li, Jie Chen, Gengui Xu, Yin Zhong, Longfei Jang, Li Lin & Fan Lu

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  1. Xiaoman Li
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Correspondence to Fan Lu.

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Li, X., Chen, J., Xu, G. et al. Development of an Elderly Low Vision Quality of Life Questionnaire for less-developed areas of China. Qual Life Res 24, 2403–2413 (2015). https://doi.org/10.1007/s11136-015-0970-2

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