Skip to main content
Log in

Vision-Specific Instruments for the Assessment of Health-Related Quality of Life and Visual Functioning

A Literature Review

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Clinically objective measures such as visual acuity or visual field provide an assessment of a patient’s visual status. However such measures may not reflect the degree of visual impairment the patient experiences in his or her daily activities. Visual impairment has been shown to have negative effects on health-related quality of life (HR-QOL) and a significant impact on daily functioning, including social activities. As such, there is a growing recognition of the importance of patient-reported outcomes of visual functioning.

This review examines the development and psychometric properties of 22 vision-specific instruments assessing visual functioning and/or the impact of visual impairment on HR-QOL or daily activities. Issues relevant to assessing vision-specific subjective outcomes are reviewed, with specific application of the reviewed instruments.

Three instruments, the Activities of Daily Vision Scale, National Eye Institute Visual Function Questionnaire, and Visual Function Index have been well validated and widely used, but others also show promise. To fully capture the benefits of a new ophthalmology treatment (or new treatment for eye disease) a valid and reliable visual instrument, in which the psychometric performance has been demonstrated in the particular ocular condition being treated, should be utilised.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

References

  1. Rahmani B, Tielsch JM, Katz J, et al. The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey. Ophthalmology 1996; 103: 1721–6

    PubMed  CAS  Google Scholar 

  2. Cheng CY, Liu JH, Chen SJ, et al. Population-based study on prevalence and risk factors of age-related cataracts in Peitou, Taiwan. Chin Med J 2000; 63: 641–8

    CAS  Google Scholar 

  3. National Eye Institute [online]. Available from URL: http://www.nei.nih.gov/eyedata/pdf/VPUS.pdf [Accessed 2002 May 2]

  4. Sasaki H, Jonasson F, Kojima M, et al. The Reykjavik Eye Study: prevalence of lens opacification with reference to identical Japanese studies. Ophthalmologica 2000; 214: 412–20

    Article  PubMed  CAS  Google Scholar 

  5. World Health Organization [online]. Available from URL: http://www.who.int [Accessed 2001 Jun 1]

  6. McKay R, McCarty CA, Taylor HR. Diabetic retinopathy in Victoria, Australia: The Visual Impairment Project. Br J Ophthalmol 2000; 84: 865–70

    Article  PubMed  CAS  Google Scholar 

  7. Morgan CL, Currie CJ, Stott NC, et al. The prevalence of multiple diabetes-related complications. Diabet Med 2000; 17: 146–51

    Article  PubMed  CAS  Google Scholar 

  8. Ramachandran A, Snehalatha C, Sasikala R, et al. Vascular complications in young Asian Indian patients with Type I diabetes mellitus. Diabetes Res Clin Pract 2000; 48: 51–6

    Article  PubMed  CAS  Google Scholar 

  9. Mangione CM, Phillips RS, Lawrence MG, et al. Improved visual function and attenuation of declines in health-related quality of life after cataract extraction. Arch Ophthalmol 1994; 112: 1419–25

    Article  PubMed  CAS  Google Scholar 

  10. West SK, Munoz B, Rubin GS, et al. Function and visual impairment in a population-based study of older adults. Invest Ophthalmol Vis Sci 1997; 38: 72–82

    PubMed  CAS  Google Scholar 

  11. Lee PP, Spritzer K, Hays RD. The impact of blurred vision on functioning and well-being. Ophthalmology 1997; 104: 390–6

    PubMed  CAS  Google Scholar 

  12. Genensky SM. Acuity measurements: do they indicate how well a partially sighted person functions or could function? Am J Optom Physiol Opt 1976; 53: 809–12

    Article  PubMed  CAS  Google Scholar 

  13. Cullinan TR. The epidemiology of visual disability: studies of visually disabled people in the community. Research report 28. Canterbury, England: Health Services Research Unit, University of Kent, 1977

    Google Scholar 

  14. Elliott DB, Patla AE, Furniss M, et al. Improvements in clinical and functional vision and quality of life after second eye cataract surgery. Optom Vis Sci 2000; 77: 13–24

    Article  PubMed  CAS  Google Scholar 

  15. Chang-Godinich A, Ou RJ, Koch DD. Functional improvement after phacoemulsification cataract surgery. J Cataract Refract Surg 1999; 25: 1226–31

    Article  PubMed  CAS  Google Scholar 

  16. Crabtree HL, Hildreth AJ, O’Connell JE, et al. Measuring visual symptoms in British cataract patients: the cataract symptom scale. Br J Ophthalmol 1999; 83: 519–23

    Article  PubMed  CAS  Google Scholar 

  17. Lundstrom M, Roos P, Jensen S, et al. Catquest questionnaire for use in cataract surgery care: description, validity, and reliability. J Cataract Refract Surg 1997; 23: 1226–36

    PubMed  CAS  Google Scholar 

  18. Lundstrom M, Stenevi U, Thorburn W, et al. Catquest questionnaire for use in cataract surgery care: assessment of surgical outcomes. J Cataract Refract Surg 1998; 24: 968–74

    PubMed  CAS  Google Scholar 

  19. Lundstrom M, Brege KG, Floren I, et al. Impaired visual function after cataract surgery assessed using the catquest questionnaire. J Cataract Refract Surg 2000; 26: 101–8

    Article  PubMed  CAS  Google Scholar 

  20. Lundstrom M, Stenevi U, Thorburn W. Cataract surgery in the very elderly. J Cataract Refract Surg 2000; 26: 408–14

    Article  PubMed  CAS  Google Scholar 

  21. Hart PM, Chakravarthy U, Stevenson MR, et al. A vision specific functional index for use in patients with age related macular degeneration. Br J Ophthalmol 1999; 83: 1115–20

    Article  PubMed  CAS  Google Scholar 

  22. McClure ME, Hart PM, Jackson AJ, et al. Macular degeneration: do conventional measurements of impaired visual function equate with visual disability? Br J Ophthalmol 2000; 84: 244–50

    Article  PubMed  CAS  Google Scholar 

  23. Terwee CB, Gerding MN, Dekker FW, et al. Development of a disease specific quality of life questionnaire for patients with Graves’ Ophthalmopathy: the GO-QOL. Br J Ophthalmol 1998; 82: 773–9

    Article  PubMed  CAS  Google Scholar 

  24. Prager TC, Chuang AZ, Glasser JH, et al. The Houston vision assessment test (HVAT): an assessment of validity. Ophthalmic Epidemiol 2000; 7: 87–102

    PubMed  CAS  Google Scholar 

  25. Keeffe JE, McCarty CA, Hassell JB, et al. Description and measurement of handicap caused by vision impairment. Aust N Z J Ophthalmol 1999; 28: 184–6

    Article  Google Scholar 

  26. Weih LM, Hassell JB, Keeffe JE. Assessment of the impact of vision impairment. Invest Ophthalmol Vis Sci. In press

  27. Fletcher AE, Ellwein LB, Salvaray S, et al. Measurements of vision function and quality of life in patients with cataracts in southern India: report of instrument development. Arch Ophthalmol 1997; 115: 767–74

    Article  PubMed  CAS  Google Scholar 

  28. Miedziak AI, Perski T, Andrews PP, et al. Stargardt’s Macular Dystrophy: a patient’s perspective. Optometry 2000; 71: 165–76

    PubMed  CAS  Google Scholar 

  29. Foss AJ, Hungerford J, Lamping DL, et al. Development and validation of a patient based measure of outcome in ocular melanoma. Br J Ophthalmol 2000; 84: 347–51

    Article  PubMed  CAS  Google Scholar 

  30. Mangione CM, Berry S, Spritzer K, et al. Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol 1998; 116: 227–33

    PubMed  CAS  Google Scholar 

  31. Mangione CM, Lee PP, Pitts J, et al. Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Arch Ophthalmol 1998; 116: 1496–504

    PubMed  CAS  Google Scholar 

  32. Mangione CM. NEI VFQ-25 scoring algorithum. Bethesda (MD): National Eye Institute, 1997

    Google Scholar 

  33. Mangione CM. NEI VFQ-25 scoring algorithm. Bethesda (MD): National Eye Institute, 2000

    Google Scholar 

  34. Gutierrez P, Wilson MR, Johnson C, et al. Influence of glaucomatous visual field loss on health-related quality of life. Arch Ophthalmol 1997; 115: 777–84

    Article  PubMed  CAS  Google Scholar 

  35. Parrish RK, Gedde SJ, Scott IU, et al. Visual function and quality of life among patients with glaucoma. Arch Ophthalmol 1997; 115: 1447–55

    Article  PubMed  Google Scholar 

  36. Cruickshanks KJ, Fryback DG, Nondahl DM, et al. Treatment choice and quality of life in patients with choroidal melanoma. Arch Ophthalmol 1999; 117: 461–7

    Article  PubMed  CAS  Google Scholar 

  37. Scott IU, Smiddy WE, Schiffman J, et al. Quality of life of low-vision patients and the impact of low-vision services. Am J Ophthalmol 1999; 128: 54–62

    Article  PubMed  CAS  Google Scholar 

  38. Cole SR, Beck RW, Moke PS, et al. The National Eye Institute Visual Function Questionnaire: experience of the ONTT. Invest Ophthalmol Vis Sci 2000; 41: 1017–21

    PubMed  CAS  Google Scholar 

  39. Vitale S, Schein OD, Meinert CL, et al. The refractive status and vision profile: a questionnaire to measure vision-related quality of life in persons with refractive error. Ophthalmology 2000; 107: 1529–39

    Article  PubMed  CAS  Google Scholar 

  40. Schein OD, Vitale S, Cassard SD, et al. Patient outcomes of refractive surgery: the refractive status and vision profile. J Cataract Refract Surg 2001; 27: 665–73

    Article  PubMed  CAS  Google Scholar 

  41. Scott IU, Schein OD, West S, et al. Functional status and quality of life measurement among ophthalmic patients. Arch Ophthalmol 1994; 112: 329–35

    Article  PubMed  CAS  Google Scholar 

  42. Desai P, Reidy A, Minassian DC, et al. Gains from cataract surgery: visual function and quality of life. Br J Ophthalmol 1996; 80: 868–73

    Article  PubMed  CAS  Google Scholar 

  43. Turano KA, Geruschat DR, Massof RW. Perceived visual ability for independent mobility in persons with retinitis pigmentosa. Ophthalmol Vis Sci 1999; 40: 865–77

    CAS  Google Scholar 

  44. van Dijk K, Lewallen S, Chirambo M, et al. Creation and testing of a practical visual function assesment for use in Africa: correlation with visual acuity, contrast sensitivity, and near vision in Malawian adults. Ophthalmology 1999; 83: 792–5

    Google Scholar 

  45. Mills RP. Correlation of quality of life with clinical symptoms and signs at the time of glaucoma diagnosis. Tr Am Ophth Soc 1998; XCVI: 753–812

    Google Scholar 

  46. Pesudovs K, Coster DJ. An instrument for assessment of subjective visual disability in cataract patients. Br J Ophthalmol 1998; 82: 617–24

    Article  PubMed  CAS  Google Scholar 

  47. Nelson P, Aspinall P, O’Brien C. Patients’ perception of visual impairment in glaucoma: a pilot study. Br J Ophthalmol 1999; 83: 546–52

    Article  PubMed  CAS  Google Scholar 

  48. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14: an index of functional impairment in patients with cataract. Arch Ophthalmol 1994; 112: 630–8

    Article  PubMed  CAS  Google Scholar 

  49. Tielsch JM, Steinberg EP, Cassard SD, et al. Preoperative functional expectations and postoperative outcomes among patients undergoing first eye cataract surgery. Arch Ophthalmol 1995; 113: 1312–8

    Article  PubMed  CAS  Google Scholar 

  50. Cassard SD, Patrick DL, Damiano AM. Reproducibility and responsiveness of the VF-14. Arch Ophthalmol 1995; 113: 1508–13

    Article  PubMed  CAS  Google Scholar 

  51. Alonso J, Espallargues M, Andersen TF, et al. International applicability of the VF-14: an index of visual function in patients with cataracts. Ophthalmology 1997; 104: 799–807

    PubMed  CAS  Google Scholar 

  52. Musch DC, Farjo AA, Meyer RF, et al. Assessment of health-related quality of life after corneal transplantation. Am J Ophthalmol 1997; 124: 1–8

    PubMed  CAS  Google Scholar 

  53. Uusitalo RJ, Tarkkanen A. Outcomes of small incision cataract surgery. J Cataract Refract Surg 1998; 24: 212–21

    PubMed  CAS  Google Scholar 

  54. Boisjoly H, Gresset J, Fontaine N, et al. The VF-14 index of functional visual impairment in candidates for a corneal graft. Am J Ophthalmol 1999; 128: 38–44

    Article  PubMed  CAS  Google Scholar 

  55. Linder M, Chang TS, Scott IU, et al. Validity of the visual function index (VF-14) in patients with retinal disease. Arch Ophthalmol 1999; 117: 1611–6

    Article  PubMed  CAS  Google Scholar 

  56. Uusitalo RJ, Brans T, Cand M, et al. Evaluating cataract surgery gains by assessing patient’s quality of life using VF-7. J Cataract Refract Surg 1999; 25: 989–94

    Article  PubMed  CAS  Google Scholar 

  57. Castells X, Alonso J, Ribo C, et al. Comparison of the results of first and second cataract eye surgery. Ophthalmology 1999; 106: 676–82

    Article  PubMed  CAS  Google Scholar 

  58. Frost NA, Sparrow JM, Durant JS, et al. Development of a questionnaire for measurement of vision-related quality of life. Ophthalmic Epidemiol 1998; 5: 185–210

    Article  PubMed  CAS  Google Scholar 

  59. Hazel CA, Petre KL, Armstrong RA, et al. Visual function and subjective quality of life compared in subjects with acquired macular disease. Invest Ophthalmol Vis Sci 2000; 41: 1309–15

    PubMed  CAS  Google Scholar 

  60. Leidy NK, Revicki DA, Geneste B. Recommendations for evaluating the validity of quality of life claims for labeling and promotion. Value Health 1999; 2: 113–27

    Article  PubMed  CAS  Google Scholar 

  61. Mangione CM, Phillips RS, Seddon JM, et al. Development of the activities of daily vision scale: a measure of visual functional status. Med Care 1992; 30: 1111–26

    Article  PubMed  CAS  Google Scholar 

  62. Mangione CM, Orav EJ, Lawrence MG, et al. Prediction of visual function after cataract surgery: a prospectively validated model. Arch Ophthalmol 1995; 113: 1305–11

    Article  PubMed  CAS  Google Scholar 

  63. Mangione CM, Gutierrez PR, Lowe G, et al. Influence of age-related maculopathy on visual functioning and health-related quality of life. Am J Ophthalmol 1999; 128: 45–53

    Article  PubMed  CAS  Google Scholar 

  64. Superstein R, Boyaner D, Overbury O. Functional complaints, visual acuity, spatial contrast sensitivity, and glare disability in preoperative and postoperative cataract patients. J Cataract Refract Surg 1999; 25: 575–81

    Article  PubMed  CAS  Google Scholar 

  65. Valbuena M, Bandeen-Roche K, Rubin GS, et al. Self-reported assessment of visual function in a population-based study: The SEE Project. Invest Ophthalmol Vis Sci 1999; 40: 280–8

    PubMed  CAS  Google Scholar 

  66. Revicki DA, Rothman M, Luce B. Health-related quality of life assessment and the pharmaceutical industry. Pharmacoeconomics 1992; 1 (6): 394–408

    Article  PubMed  CAS  Google Scholar 

  67. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16 (3): 297–334

    Article  Google Scholar 

  68. Hays R, Anderson R, Revicki DA. Assessing reliability and validity of measurement in clinical trials. In: Staquet MJ, Hays RD, Fayers PM, editors. Quality of life assessment in clinical trials. New York: Oxford University Press, 1998

    Google Scholar 

  69. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale NJ: Lawrence Erlbaum Associates, 1988

    Google Scholar 

  70. Klein R, Moss SE, Klein BEK, et al. The NEI-VFQ-25 in people with long-term type 1 diabetes mellitus. Arch Ophthalmol 2001; 119: 733–40

    PubMed  CAS  Google Scholar 

  71. Mangione CM, Lee PP, Hays RD. Measurement of visual functioning and health-related quality of life in eye disease and cataract surgery. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia (PA): Lippincott-Raven Publishers; 1996: 1045–51

    Google Scholar 

  72. Weinberger M, Oddone EZ, Samsa GP, et al. Are health-related quality of life measures affected by the mode of administration? J Clin Epidemiol 1996; 49: 135–40

    Article  PubMed  CAS  Google Scholar 

  73. Cook DJ, Guyatt GH, Juniper E, et al. Interviewer vs self-administered questionnaires in developing a disease-specific, health-related quality of life instrument for asthma. J Clin Epidemiol 1993; 46: 529–34

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Funding provided by Lilly Research Centre. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mary Kay Margolis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Margolis, M.K., Coyne, K., Kennedy-Martin, T. et al. Vision-Specific Instruments for the Assessment of Health-Related Quality of Life and Visual Functioning. Pharmacoeconomics 20, 791–812 (2002). https://doi.org/10.2165/00019053-200220120-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200220120-00001

Keywords

Navigation