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The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients

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Background: Evidence about the impact of routine feedback of patient-reported outcomes is contradictory, and there is limited information regarding its use in the routine management of cataract patients. Methods: The VF-14 Index was used to assess the visual function of 833 consecutive cataract patients, attending 19 ophthalmologists from public and private hospitals and primary care practices in Spain, in 1999–2000. In this before/after trial, the intervention included (1) an educational session, and (2) the provision of the VF-14 scores of all subsequent patients to the ophthalmologist. Mixed effects linear and logistic models were constructed to assess the effect on the process (correlation between patients’ and physicians’ assessments of visual function, appropriateness of surgery recommendation) and the outcome of care (satisfaction). Results: The adjusted regression coefficient for the VF-14 score significantly increased after the intervention as a predictor of the ophthalmologist’s assessment of visual function (β coefficient: control 0.10 vs. intervention 0.35, p < 0.05). The intervention did not increase the probability of an appropriate medical decision (OR=0.90; 95% CI: 0.42; 2,69) and it did not change patient satisfaction with care. Conclusions: Routine provision of education and feedback on the patient’s VF-14 Index score significantly increases agreement between patients’ and physicians’ assessments of functional capacity. The lack of a beneficial effect on management or outcome suggests the need for a more intense intervention to change medical practice.

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confidence interval


health related quality of life


odds ratio


ophthalmologist’s assessment of the patient’s visual function


standard deviation


Visual Function Index VF-14


  1. Vision 2020. The global initiative. Fact Sheet 213. WHO. 2000

  2. A Reidy DC Minassian G. Vafidis et al. (1998) ArticleTitlePrevalence of serious eye disease and visual impairment in a North London population: Population based, cross sectional study Br Med J. 316 1643–1646

    Google Scholar 

  3. C Klaver R Wolfs JR. Vingerling et al. (1998) ArticleTitleAge-specific prevalence and causes of blindness and visual impairment in an older population. The Rotterdam Study Arch Ophtalmol. 116 653–658

    Google Scholar 

  4. J Rodriguez R Sanchez B. Muñoz et al. (2002) ArticleTitleCauses of blindness and visual impairment in a population-based sample of US: Hispanics Ophthalmology. 109 737–743 Occurrence Handle11927431

    PubMed  Google Scholar 

  5. MR VanNewkirk L Weih CA. McCarty et al. (2002) ArticleTitleCauses of incident visual impairment: The Blue Mountains eye study Arch Ophtalmol. 120 613–619

    Google Scholar 

  6. M Woodcock S Shah RJ. Smith (2004) ArticleTitleRecent advances in customising cataract surgery Br Med J. 328 92–6

    Google Scholar 

  7. DA Laidlaw RA Harrad CD. Hopper et al. (1998) ArticleTitleRandomised trial of effectiveness of second eye cataract surgery Lancet 352 IssueID9132 925–929 Occurrence Handle9752814

    PubMed  Google Scholar 

  8. M Espallargues J. Alonso (1998) ArticleTitleEffectiveness of cataract surgery in Barcelona, Spain site results of an international study J Clin Epidemiol. 51 IssueID10 843–852 Occurrence Handle9762877

    PubMed  Google Scholar 

  9. HR. Taylor (2000) ArticleTitleCataract: How much surgery do we have to do? Br J Ophthalmol 84 1–2 Occurrence Handle10611088

    PubMed  Google Scholar 

  10. Cataract Management Guideline Panel. Cataract in Adults. Management of functional impairment. Clinical Practice Guideline, Number 4. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR pub no 93–0542. 1993

  11. The Alberta Clinical Practice Guidelines Working Group. Guideline for Surgical & Non-Surgical Management of Cataract in the Otherwise Healthy Adult Eye. Edmonton, AB, Canada: The Alberta Clinical Practice Guidelines Program, 2002

  12. American Academy of Ophthalmology, Anterior Segment Panel. Cataract in the adult eye. San Francisco, CA: American Academy of Ophthalmology (AAO), 2001; 62

  13. Scottish Intercollegiate Guidelines Network (SIGN). Day case cataract surgery. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2001, Aug., 20 p. (SIGN publication; no. 53)

  14. The Royal College of Ophthalmologists. Cataract Surgery Guidelines. [on-line] 2001. publications/guidelines/cataract_surgery.html

  15. EP Steinberg JM Tielsch O. Schein et al. (1994) ArticleTitleThe VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol. 112 630–638 Occurrence Handle8185520

    PubMed  Google Scholar 

  16. CM Mangione RS Phillips JM. Seddon et al. (1992) ArticleTitleDevelopment of the activities of daily vision scale. A measure of visual functional status. Med Care. 30 1111–1126 Occurrence Handle1453816

    PubMed  Google Scholar 

  17. M Espallargues JM Valderas J. Alonso (2000) ArticleTitleProvision of feedback on perceived health status to health care professionals A systematic review of its impact Med Care. 38 IssueID2 175–186 Occurrence Handle10659691

    PubMed  Google Scholar 

  18. J Greenhalgh K. Meadows (1999) ArticleTitleThe effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: A literature review J Eval Clin Pract. 5 IssueID4 401–416 Occurrence Handle10579704

    PubMed  Google Scholar 

  19. SM Gilbody AO House T. Sheldon (2002) ArticleTitleRoutine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome – a systematic review Psychol Med. 32 IssueID8 1345–1356 Occurrence Handle12455933

    PubMed  Google Scholar 

  20. E. Lydick (2000) ArticleTitleApproaches to the interpretation of quality of life scales Med Care. 38 IssueIDSuppl 9 II180–II183 Occurrence Handle10982105

    PubMed  Google Scholar 

  21. JM Valderas J Alonso L. Prieto et al. (1999) ArticleTitleContent-based interpretation aids for health-related quality of life measures in clinical practice. An example for the visual function index VF-14 Qual Life Res 2004 IssueID13 35–44

    Google Scholar 

  22. TD Cook DT. Campbell (1979) Quasiexperimentation: Design and Analysis Issues for Field Settings Houghton Mifflin Co Boston, MA.

    Google Scholar 

  23. SD Cassard DL Patrick AM. Damiano et al. (1995) ArticleTitleReproducibility and responsiveness of the VF-14. Arch Ophthalmol. 113 1508–1513 Occurrence Handle7487617

    PubMed  Google Scholar 

  24. J Alonso M Espallargues T. Folmer-Andersen et al. (1997) ArticleTitleInternational applicability of the VF-14. An index of visual function in patients with cataracts. Ophthalmology 104 IssueID5 799–807 Occurrence Handle9160026

    PubMed  Google Scholar 

  25. Prieto L, Comas M, Vilagut G (1999) Turbo Pascal Measurement Program Rasch Measurement Transactions 12: 4, p. 672

    Google Scholar 

  26. AR Davies JE. Ware (1991) GHAA’s Consumer Satisfaction Survey and User’s Manual EditionNumber2 Group Health Association America Inc. Washington, DC

    Google Scholar 

  27. PP Lee CJ Kamberg LH. Hilborne et al. (1993) Cataract Surgery: A literature review and ratings of appropriateness and cruciality RAND Santa Monica, CA

    Google Scholar 

  28. JNK Rao AJ. Scott (1984) ArticleTitleOn chi-squared tests for multiway contingency tables with cell proportions estimated from survey data Ann Stat. 12 46–60

    Google Scholar 

  29. Eltinge JL, Sribney WM. Estimates of linear combinations and hypothesis tests for survey data. Stata Technical Bulletin 1996; 31: 31–42. Reprinted in Stata Technical Bulletin Reprints, Vol. 6, 246–259

  30. JC Pinheiro DM. Bates (2000) Mixed effects models in S and S_PLUS., Statistics and Computing Series Springer-Verlag New York.

    Google Scholar 

  31. DG Kleinbaum LL Kupper KE. Muller (1988) Applied Regression Analysis and Other Multivariable Methods Duxbury Press Belmont, CA.

    Google Scholar 

  32. L Prieto R Lamarca A. Casado (1998) ArticleTitleAssessment of the reliability of clinical findings: The intraclass correlation coefficient Med Clin (Barc). 110 IssueID4 142–145

    Google Scholar 

  33. JC Nunnally IH. Bernstein (1994) Psychometric Theory. EditionNumber3 McGraw-Hill New York

    Google Scholar 

  34. R Development Core Team (2003). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3–900051-00-3,

  35. StataCorp. (2003) Stata Statistical Software: Release 8.0 StataCorp LP College Station, TX

    Google Scholar 

  36. Swinskow TDV. Statistics at Square One. London: British Medical Association, 1996

  37. AD Oxman MA Thomson DA Davis RB. Haynes (1995) ArticleTitleNo magic bullets: A systematic review of 102 trials of interventions to improve professional practice Can Med Assoc J. 153 1423–1431

    Google Scholar 

  38. G Velikova L Booth AB. Smith et al. (2004) ArticleTitleMeasuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial J Clin Oncol. 22 IssueID4 714–724 Occurrence Handle14966096

    PubMed  Google Scholar 

  39. Temps mitjà de resolució i llistes d’espera per Regions Sanitàries. Generalitat de Catalunya. Departament de Salut. Servei Català de la Salut.

  40. Working Party of the Standing Committee of the Hospitals of the European Union (HOPE) on management of waiting lists. Measuring and comparing waiting lists: A study in␣four European countries. Third report. Brussels, April 18, 2004.; (accessed December 24th 2004)

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Correspondence to J. Alonso.

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The authors were done this work for the Systematic Use of Quality of Life Measures in the Clinical Practice Working Group

The Systematic Use of Quality of Life Measures in the Clinical Practice Working Group are: Alonso J, Castells X, Espallargues M, Guyatt G, Prieto L, Valderas JM.

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Valderas, J.M., Rue, M., Guyatt, G. et al. The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients. Qual Life Res 14, 1743–1753 (2005).

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