A Head-to-Head Comparison of 16 Cataract Surgery Outcome Questionnaires

doi:10.1016/j.ophtha.2011.06.008

Ophthalmology

Volume 118, Issue 12, December 2011, Pages 2374-2381

https://doi.org/10.1016/j.ophtha.2011.06.008 Get rights and content

Purpose

To investigate the responsiveness of 16 questionnaires used in cataract surgery outcomes.

Design

Prospective, observational study.

Participants

Patients at the Ophthalmology Eye Clinic, Flinders Medical Centre, Adelaide, Australia, and 1 matched eye clinic in Sweden.

Methods

Sixteen Rasch-scaled cataract surgery questionnaires were completed before and 6 months after surgery. These were: the Cataract Symptom Scale, 6 versions of the National Eye Institute Visual Function Questionnaire, the Quality of Life and Vision Function Questionnaire, the Cataract TyPE Specification, the Visual Activities Questionnaire, the Visual Disability Assessment (VDA), the Visual Function and Quality of Life questionnaire, the Visual Function Index, Catquest-9SF, the Visual Symptoms and Quality of Life questionnaire, and the Cataract Outcomes Questionnaire. Responsiveness was calculated with the effect size (ES) statistic (change in questionnaire score divided by pooled standard deviation of the preoperative and postoperative scores).

Main Outcome Measures

Questionnaire responsiveness to cataract surgery (ability to detect clinically important change).

Results

All 16 questionnaires and their subscales were responsive to cataract surgery, with visual functioning scales being more responsive than socioemotional scales and some subscales being less responsive. The largest ES was for the Catquest-9SF (1.45; 95% confidence interval [CI], 1.22–1.67), which was the only instrument with a mean and 95% CI of more than 1.0 (very large ES). Three measures had very large ESs and 95% CIs of more than 0.80 (large ES): the VDA (activity limitations and subscale) and the Cataract Outcomes Questionnaire, although their 95% CIs overlapped with a number of other instruments.

Conclusions

The Catquest-9SF is short and highly responsive to cataract surgery, and so is ideal for measuring visual functioning outcomes. Other instruments may be preferred to measure different constructs.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients

Consecutive patients on the public waiting list to receive cataract surgery were mailed packs of questionnaires. Each mailed pack was organized with regard the questionnaires included, with each patient being sent a maximum of 5 questionnaires, with no more than 120 total questions, to manage respondent burden. Questionnaire order within the packs was rotated to even out any impact of fatigue on response quality. Therefore, each questionnaire was completed effectively by a different group of

Results

Demographic data were collected for all 16 questionnaires completed before and after surgery, with their associated statistical comparison shown in Table 1. The highest number of completed preoperative and postoperative questionnaires was for the VDA, with 134 patients, and the lowest was for the revised 8-item Visual Function Index, with 53 patients.

Table 2 shows the responsiveness of each questionnaire as measured by ES. There was an improvement in all the mean questionnaire scores from

Discussion

The main aim of this study was to determine which Rasch-scaled questionnaires for investigating cataract surgery outcomes are the most responsive. Responsiveness was assessed using the ES, which is a statistic that indicates a questionnaire's ability to detect clinically important changes over time, such as before and after cataract surgery.⁴³ A cataract questionnaire with a high ES will be able to demonstrate an improvement easier compared with a questionnaire with a lower ES, and as such

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To explore the utility of the Catquest 9SF visual function (VF) questionnaire along with visual acuity (VA) for determining appropriateness and priority for cataract surgery. To evaluate the feasibility of administering the Catquest-9SF in a clinical setting using web-based electronic data capture and interpretation.
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Subjects undergoing sequential cataract surgery in both eyes at 4 sites in Ontario.
We recorded best-corrected VA (BCVA) and VA with current correction (CCVA) in each eye and both eyes (OU) and Catquest-9SF responses on a tablet before and after cataract surgery. Linear regression models were employed to test for associations between VA and visual function (VF).
Preoperative BCVA and CCVA in the worse eye were significant predictors of change in VF (p = 0.006 and p = 0.008, respectively); subjects with worse VA had a greater improvement in VF after surgery. There was a significant association between improvement in VF and improvement in CCVA OU (p = 0.001). Fourteen of 151 subjects (9%) had no improvement or worse VF scores after surgery. Within this group, 10 of 14 subjects had a preoperative score ≤–3, which is suggestive of minimal visual disability. Within this subset, 4 of 14 subjects (2.6%) had a preoperative BCVA of 20/30 or better in their worse eye.
For patient groups with equal VA, the Catquest-9SF score can help determine priority for surgery. Web-based data capture and interpretation allow for efficient virtual assessments of VF. A BCVA in the worse eye of 20/30 or better combined with a Catquest-9SF score <–3 can be used as a guideline for lowest priority.
Examiner l'intérêt du questionnaire Catquest-9SF sur la fonction visuelle (FV) de même que la mesure de l'acuité visuelle (AV) pour ce qui est de déterminer la pertinence et le degré d'urgence d'une chirurgie de la cataracte, et évaluer la faisabilité d'administrer le questionnaire Catquest-9SF en milieu clinique en recourant à la saisie et à l'interprétation de données en ligne.
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Sujets devant subir une chirurgie de la cataracte séquentielle dans les 2 yeux au sein de 4 établissements en Ontario.
Nous avons noté, sur une tablette, la meilleure acuité visuelle corrigée (MAVC) et l'acuité visuelle de la correction actuelle (AVCA) dans chaque œil et dans les 2 yeux, de même que les réponses des patients au questionnaire Catquest-9SF avant et après la chirurgie de la cataracte. Des modèles de régression linéaire ont servi à vérifier les associations entre l'AV et la FV.
La MAVC et l'AVCA du pire œil étaient d'importants facteurs de prédiction d'une modification de la FV (p = 0,006 et p = 0,008, respectivement); les sujets dont l'AV était moins bonne ont bénéficié d'une plus grande amélioration de la FV après l'intervention. On a noté une association significative entre l'amélioration de la FV et l'amélioration de l'AVCA dans les 2 yeux (p = 0,001). Sur les 151 sujets, 14 (9 %) n'ont obtenu ni amélioration ni aggravation de leurs scores de FV après l'intervention. Au sein de ce groupe, le score préopératoire de 10 des 14 sujets était ≤ –3, ce qui donne à penser que l'incapacité visuelle était minime. Parmi les patients de ce sous-groupe, la MAVC préopératoire de 4 des 14 sujets (2,6 %) était de 20/30 ou mieux dans le pire œil.
Devant des groupes de patients dont l'AV est similaire, le score au questionnaire Catquest-9SF peut aider à déterminer l'ordre de priorité en ce qui a trait à la chirurgie. La saisie et l'interprétation des données en ligne permettent de réaliser des évaluations virtuelles efficaces de la FV. Une MAVC de 20/30 ou mieux dans le pire œil, conjointement à un score de < –3 au questionnaire Catquest-9SF, peuvent aider à identifier les cas moins prioritaires.
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To develop and validate an automated deep learning (DL)-based artificial intelligence (AI) platform for diagnosing and grading cataracts using slit-lamp and retroillumination lens photographs based on the Lens Opacities Classification System (LOCS) III.
Cross-sectional study in which a convolutional neural network was trained and tested using photographs of slit-lamp and retroillumination lens photographs.
One thousand three hundred thirty-five slit-lamp images and 637 retroillumination lens images from 596 patients.
Slit-lamp and retroillumination lens photographs were graded by 2 trained graders using LOCS III. Image datasets were labeled and divided into training, validation, and test datasets. We trained and validated AI platforms with 4 key strategies in the AI domain: (1) region detection network for redundant information inside data, (2) data augmentation and transfer learning for the small dataset size problem, (3) generalized cross-entropy loss for dataset bias, and (4) class balanced loss for class imbalance problems. The performance of the AI platform was reinforced with an ensemble of 3 AI algorithms: ResNet18, WideResNet50-2, and ResNext50.
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The AI platform showed robust diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.9992 [95% confidence interval (CI), 0.9986–0.9998] and 0.9994 [95% CI, 0.9989–0.9998]; accuracy, 98.82% [95% CI, 97.7%–99.9%] and 98.51% [95% CI, 97.4%–99.6%]) and LOCS III-based grading prediction performance (AUC, 0.9567 [95% CI, 0.9501–0.9633] and 0.9650 [95% CI, 0.9509–0.9792]; accuracy, 91.22% [95% CI, 89.4%–93.0%] and 90.26% [95% CI, 88.6%–91.9%]) for nuclear opalescence (NO) and nuclear color (NC) using slit-lamp photographs, respectively. For cortical opacity (CO) and posterior subcapsular opacity (PSC), the system achieved high diagnostic performance (AUC, 0.9680 [95% CI, 0.9579–0.9781] and 0.9465 [95% CI, 0.9348–0.9582]; accuracy, 96.21% [95% CI, 94.4%–98.0%] and 92.17% [95% CI, 88.6%–95.8%]) and good LOCS III-based grading prediction performance (AUC, 0.9044 [95% CI, 0.8958–0.9129] and 0.9174 [95% CI, 0.9055–0.9295]; accuracy, 91.33% [95% CI, 89.7%–93.0%] and 87.89% [95% CI, 85.6%–90.2%]) using retroillumination images.
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: Manuscript no. 2010-1684.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported in part by the National Health and Medical Research Council, Centre of Clinical Research Excellence, Canberra, Australia (grant no.: 264620). The sponsor or funding organization had no role in the design or conduct of this research.

View full text

Original articleA Head-to-Head Comparison of 16 Cataract Surgery Outcome Questionnaires

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Am J Ophthalmol

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Development and validation of clinical scores for visual outcomes after cataract surgery

Ophthalmology

Prevalence of cataract in an older population in India: the India Study of Age-Related Eye Disease

Ophthalmology

Validity of newly developed appropriateness criteria for cataract surgery

Ophthalmology

Classical test theory

Med Care

The measurement of vision disability

Optom Vis Sci

Probabilistic Models for Some Intelligence and Attainment Tests

The development of an instrument to measure quality of vision: the Quality of Vision (QoV) questionnaire

Invest Ophthalmol Vis Sci

Development of the 25-item Cardiff Visual Ability Questionnaire for Children (CVAQC)

Br J Ophthalmol

Cataract Symptom Scale: clarifying measurement

Br J Ophthalmol

Rasch analysis of the Quality of Life and Vision Function questionnaire

Optom Vis Sci

Visual disability assessment: valid measurement of activity limitation and mobility in cataract patients

Br J Ophthalmol

Rasch analysis of Visual Function and Quality of Life questionnaires

Optom Vis Sci

Original article
A Head-to-Head Comparison of 16 Cataract Surgery Outcome Questionnaires