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Zhang J, Lin S, Cheng T, Xu Y, Lu L, He J, Yu T, Peng Y, Zhang Y, Zou H, Ma Y. RETFound-enhanced community-based fundus disease screening: real-world evidence and decision curve analysis. NPJ Digit Med 2024; 7:108. [PMID: 38693205 PMCID: PMC11063045 DOI: 10.1038/s41746-024-01109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/12/2024] [Indexed: 05/03/2024] Open
Abstract
Visual impairments and blindness are major public health concerns globally. Effective eye disease screening aided by artificial intelligence (AI) is a promising countermeasure, although it is challenged by practical constraints such as poor image quality in community screening. The recently developed ophthalmic foundation model RETFound has shown higher accuracy in retinal image recognition tasks. This study developed an RETFound-enhanced deep learning (DL) model for multiple-eye disease screening using real-world images from community screenings. Our results revealed that our DL model improved the sensitivity and specificity by over 15% compared with commercial models. Our model also shows better generalisation ability than AI models developed using traditional processes. Additionally, decision curve analysis underscores the higher net benefit of employing our model in both urban and rural settings in China. These findings indicate that the RETFound-enhanced DL model can achieve a higher net benefit in community-based screening, advocating its adoption in low- and middle-income countries to address global eye health challenges.
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Affiliation(s)
- Juzhao Zhang
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Senlin Lin
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Tianhao Cheng
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
| | - Yi Xu
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Lina Lu
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jiangnan He
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tao Yu
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yajun Peng
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuejie Zhang
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China.
| | - Haidong Zou
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China.
- National Clinical Research Center for Eye Disease, Shanghai, China.
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yingyan Ma
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China.
- National Clinical Research Center for Eye Disease, Shanghai, China.
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Kumar A, Ausayakhun S, Ausayakhun S, Apivatthakakul A, Liu Y, Snyder BM, Margolis TP, Keenan JD. Quality of Life Outcomes Among Patients Being Screened for Cytomegalovirus Retinitis in Thailand. Ocul Immunol Inflamm 2023:1-5. [PMID: 37801648 DOI: 10.1080/09273948.2023.2263091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Cytomegalovirus (CMV) retinitis can have debilitating impacts on quality of life (QOL), but few contemporary studies have characterized these ramifications. This study assessed the impact of CMV retinitis on vision-related QOL for those living with HIV/AIDS in Thailand. METHODS QOL was assessed as part of a prospective interventional cohort study of patients referred to a tertiary hospital in Thailand for CMV retinitis screening. A validated vision-related QOL questionnaire was administered at the baseline screening visit and at the 6-month study visit. Multivariable linear regression models were performed to determine the effect of CMV retinitis diagnosis on QOL score. RESULTS A total of 152 participants completed the QOL questionnaire at their initial clinic visit. At baseline, a diagnosis of CMV retinitis diagnosis was significantly associated with decreased QOL score: unilateral retinitis was associated with a 0.11 (95% CI: -0.26-0.03) decrement in QOL, and bilateral retinitis was associated with a 0.33 (95% CI: -0.51-0.16) decrement (joint P-value = 0.0009). For the 78 participants with a 6-month visit, changes in QOL from baseline were small and not significant. A diagnosis of CMV retinitis was still associated with decreased QOL score at 6 months (joint P-value = 0.03). CONCLUSIONS This study found that vision-related QOL was lower in those with CMV retinitis, especially with bilateral involvement, and did not improve after treatment among those with follow-up. These findings reinforce the debilitating clinical manifestations of this disease, and support efforts for earlier screening to detect CMV retinitis before impacts on QOL have occurred.
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Affiliation(s)
- Anika Kumar
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakarin Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yingna Liu
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Blake M Snyder
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Todd P Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Latif K, Nishida T, Moghimi S, Weinreb RN. Quality of life in glaucoma. Graefes Arch Clin Exp Ophthalmol 2023; 261:3023-3030. [PMID: 37017741 DOI: 10.1007/s00417-023-06050-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND An essential goal of glaucoma management is to prevent a patient's visual impairment that compromises their health-related quality of life (QOL). The disease itself, in addition to the medical or surgical treatment, can have a large impact on one's life. We aim to briefly review and evaluate aspects of QOL in glaucoma. METHODS The PubMed database was utilized for the literature examination of this review. Keywords that were searched included glaucoma, quality of life, vision-related QOL (VRQOL), quality of life questionnaire, and glaucoma therapy. RESULTS The main topics identified and analyzed during the literature review stages include factors affecting VRQOL, the assessment of VRQOL using questionnaires, QOL in early and severe glaucoma, glaucoma and activities of daily living, glaucoma treatments, and new advances in clinically assessing QOL. The study findings indicate a relationship between the deterioration of visual field and the quality of life. The investigation shows that visual loss can result in a range of daily life challenges, which include compromised mental health status and difficulties with driving, reading, and recognizing people. CONCLUSION Glaucoma-induced visual field loss can significantly impact different aspects of patients' life, and several methods exist for evaluating changes in quality of life. Quality of life assessments have their limitations as they are subjective. As potential future steps, we suggest exploring technological advancements such as virtual reality to improve patient care and outcomes.
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Affiliation(s)
- Kareem Latif
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, 9500 Campus Point Drive, La Jolla,, San Diego, CA, 92093-0946, USA
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, 9500 Campus Point Drive, La Jolla,, San Diego, CA, 92093-0946, USA.
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, 9500 Campus Point Drive, La Jolla,, San Diego, CA, 92093-0946, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, 9500 Campus Point Drive, La Jolla,, San Diego, CA, 92093-0946, USA
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Wasnik RN, Győri-Dani V, Vincze F, Papp M, Pálinkás A, Sándor J. Screening for Patients with Visual Acuity Loss in Primary Health Care: A Cross Sectional Study in a Deprived Hungarian Population. Healthcare (Basel) 2023; 11:1941. [PMID: 37444777 DOI: 10.3390/healthcare11131941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Screening for visual acuity loss (VAL) is not applied systematically because of uncertain recommendations based on observations from affordable countries. Our study aimed to evaluate the effectiveness of primary health care-based screening. A cross-sectional investigation was carried out among adults who did not wear glasses and did not visit an ophthalmologist in a year (N = 2070). The risk factor role of sociodemographic factors and the cardiometabolic status for hidden VAL was determined by multivariable linear regression models. The prevalence of unknown VAL of at least 0.5 was 3.7% and 9.1% in adults and in the above-65 population. Female sex (b = 1.27, 95% CI: 0.35; 2.18), age (b = 0.15, 0.12; 0.19), and Roma ethnicity (b = 2.60, 95% CI: 1.22; 3.97) were significant risk factors. Higher than primary school (bsecondaryschoolwithoutgraduation = -2.06, 95% CI: -3.64; -0.47; and bsecondaryschoolwithgraduation = -2.08, 95% CI: -3.65; -0.51), employment (b = -1.33, 95% CI: -2.25; 0.40), and properly treated diabetes mellitus (b = -2.84, 95% CI: -5.08; -0.60) were protective factors. Above 65 years, female sex (b = 3.85, 95% CI: 0.50; 7.20), age (b = 0.39, 95% CI: 0.10; 0.67), Roma ethnicity (b = 24.79, 95% CI: 13.83; 35.76), and untreated diabetes (b = 7.30, 95% CI: 1.29; 13.31) were associated with VAL. Considering the huge differences between the health care and the population's social status of the recommendation-establishing countries and Hungary which represent non-high-income countries, the uncertain recommendation of VAL screening should not discourage general practitioners from organizing population-based screening for VAL in non-affordable populations.
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Affiliation(s)
- Rahul Naresh Wasnik
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | | | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Magor Papp
- Semmelweis Health Promotion Center, Semmelweis University, 1089 Budapest, Hungary
| | - Anita Pálinkás
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Tseng YC, Gau BS, Hsieh YS, Liu TC, Huang GS, Lou MF. Physical function mediates the effects of sensory impairment on quality of life in older adults: Cross-sectional study using propensity-score weighting. J Adv Nurs 2023; 79:101-112. [PMID: 36017542 DOI: 10.1111/jan.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/24/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
AIMS To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life. DESIGN A cross-sectional study. METHODS Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function. RESULTS After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults. CONCLUSION Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function. IMPACT The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.
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Affiliation(s)
- Ya-Chuan Tseng
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Bih-Shya Gau
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yeu-Sheng Hsieh
- Department of Bio-Industry Communication & Development, College of Bio-Resources & Agriculture, National Taiwan University, Taipei, Taiwan
| | - Tien-Chen Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Guey-Shiun Huang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Macedo AF, Hellström A, Massof R, Tuvesson H, Rask M, Ramos PL, Safipour J, Marteinsdottir I, Nilsson E, Fagerström C, Årestedt K. Predictors of problems reported on the EQ-5D-3L dimensions among people with impaired vision in northern Portugal. Health Qual Life Outcomes 2022; 20:132. [PMID: 36068600 PMCID: PMC9450368 DOI: 10.1186/s12955-022-02043-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss. Investigating predictors of individual EQ-5D health dimensions might reveal the underlying reasons. The aim of this study was to investigate predictors of health dimension ratings obtained with the EQ-5D-3L from participants with impaired vision representing a spectrum of eye diseases. METHODS Observational cross-sectional study with participants recruited at four public hospitals in Portugal. Outpatients with visual acuity of 0.30 logMAR(6/12) or worse in the better-seeing eye were invited to participate. Participants completed two instruments: the EQ-5D-3L (measures participants' perceived health-related quality-of-life) and the Massof Activity Inventory (measures visual ability-ability to perform vision-related activities). This study used logistic regression models to identify factors associated with responses to the EQ-5D-3L. RESULTS The study included 492 participants, mean age 63.4 years (range = 18-93), 50% females. The most common diagnosis was diabetic retinopathy (37%). The mean visual acuity in the better seeing eye was 0.65 logMAR (SD = 0.48) and the mean visual ability was 0.62 logits (SD = 2.04), the correlation between the two was r = - 0.511 (p < 0.001). Mobility and self-care were the health dimensions with the fewest problems (1% reported extreme problems), anxiety and depression the dimension with the most problems (24% reported extreme problems). ROC curve analysis showed that the EQ-5D index was a poor predictor of cases of vision impairment whilst visual ability given was a good predictor of cases of vision impairment. Visual ability was an independent predictor of the response for all dimensions, higher ability was always associated with a reduced odds of reporting problems. The odds of reporting problems were increased for females in 3 out of 5 dimensions. Comorbidities, visual acuity and age-category were predictors of the odds of reporting problems for one dimension each. CONCLUSIONS The odds of reporting problems for the five health dimensions of the EQ-5D-3L were strongly influenced by the ability to perform vision-related activities (visual ability). The EQ-5D index showed poor performance at detecting vision impairment. These findings are informative and relevant for the clinic and for research evaluating the impact of eye diseases and disease treatments in ophthalmology.
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Affiliation(s)
- Antonio Filipe Macedo
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden. .,Center of Physics, Optometry and Vision Science, University of Minho, Braga, Portugal.
| | - Amanda Hellström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Robert Massof
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Pedro Lima Ramos
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden
| | - Jalal Safipour
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Ina Marteinsdottir
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden
| | - Evalill Nilsson
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Research, Region Kalmar County, Kalmar, Sweden
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Liu YG, Wang CC, Huang Q, Zhang L, Liu Y. Association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults. Front Public Health 2022; 10:857307. [PMID: 35979465 PMCID: PMC9376298 DOI: 10.3389/fpubh.2022.857307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveLong-term untreated vision and hearing impairments can negatively impact physical and mental wellbeing. We investigated the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.Methods:This was a prospective cohort study of 9,492 participants from the China Health and Retirement Longitudinal Study (CHARLS) carried out in 2011, 2013, 2015, and 2018. This study used self-reported vision and hearing status to determine the degree of impairment. Depressive symptoms were examined using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with a total score of ≥ 12 indicating depressive symptoms. A Cox proportional hazards model adjusted for age, sex, residence, marital status, educational level, smoking history, alcohol consumption, hypertension, diabetes, heart disease, digestive disease, arthritis, wearing glasses, and hearing aids was used to estimate the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.Results:Of the 9,492 participants [mean (SD) age at CHARLS baseline, 58.12 (9.00) years], 3,238 (34.11%) participants reported incident depressive symptoms during the 7-year follow-up period. Participants who self-reported only vision impairment [hazard ratios (HR): 1.14, 95% confidence intervals (CI): 1.05–1.24], only hearing impairment (HR: 1.24, 95% CI: 1.06–1.46), and both vision and hearing impairments (HR: 1.25, 95% CI: 1.08–1.45) were independently associated with a greater increase in the hazard risk of incident depressive symptoms compared to those without vision and hearing impairments. An increase in participants' vision and hearing scores was associated with a significant increase in the hazard risk of incident depressive symptoms (HR: 1.04, 95% CI: 1.03–1.06).Conclusion:Vision and hearing status was associated with increased depressive symptoms among middle-aged and older Chinese adults during the 7-year follow-up period. Participants' use of glasses and hearing aids did not improve their depressive symptoms. Our findings may facilitate the development of effective treatments to prevent and treat vision and hearing impairments, thereby enhancing the physical and mental wellbeing of middle-aged and older adults.
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Affiliation(s)
- Yun-Guang Liu
- Department of Public Health, Qinghai University Medical College, Xining, China
| | - Chao-Cai Wang
- Department of Infection Disease, Qinghai Center for Disease Prevention and Control, Xining, China
| | - Qian Huang
- Department of Public Health, Qinghai University Medical College, Xining, China
| | - Le Zhang
- Department of Public Health, Qinghai University Medical College, Xining, China
| | - Yan Liu
- Department of Public Health, Qinghai University Medical College, Xining, China
- *Correspondence: Yan Liu
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Coleman AL, McLeod SD. Screening for Impaired Visual Acuity in Older Adults. JAMA 2022; 327:2090-2091. [PMID: 35608845 DOI: 10.1001/jama.2022.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anne L Coleman
- Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Stephen D McLeod
- Department of Ophthalmology, School of Medicine, University of California, San Francisco
- Francis I. Proctor Foundation, University of California, San Francisco
- American Academy of Ophthalmology, San Francisco, California
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Prevalence, Causes, and Risk Factors of Visual Impairment in Emiratis and Non-Emiratis of Dubai: A Subnational Population-Based Cross-Sectional Survey. J Ophthalmol 2022; 2022:9726230. [PMID: 35535048 PMCID: PMC9078847 DOI: 10.1155/2022/9726230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To study the prevalence, causes, and risk factors of visual impairment (VI) among the Dubai Emiratis and non-Emiratis. Methods The survey was a population-based cross-sectional eye health study conducted 2019-2020. Cluster sampling was used to randomly select local (Emirati) and expatriate (non-Emirati) Dubai residents aged 40 years and older. Ocular examinations were conducted in selected eye clinics to determine the visual acuity (VA) and cause(s) of VI if any. Trained nurses, optometrists, and ophthalmologists did the examinations. VA was measured using ETDRS visual chart. The World Health Organization VI and blindness definitions and classifications for the cause(s) of VI were used. Results A total of 892 participants were included in the final analysis. The mean age [SD] was 52.09 [9.48] years, with 55.8% as males. Prevalence of presenting mild, moderate, and severe VI was 4.7% (2.94–7.11%), 1.8% (0.78–3.5%), and 0% for Emiratis, and 3.6% (2.06–5.76), 1.6% (0.63–3.21), and 0% for non-Emiratis, respectively. Four Emirati participants were blind, with a prevalence of 0.9% (0.25%–2.28%). Men had lower likelihood of VI than women (odds ratio [OR] (95% CI): 0.42 (0.24–0.77)) after adjustment for covariates. Diabetes (OR (95% CI): 1.91 (1.04–3.52)) was an independent risk factor for VI. Higher education level was associated with a lower likelihood of VI (OR (95% CI): 0.34 (0.13–0.89). Leading causes of VI among Emiratis were uncorrected refractive error (52%) and cataract (17.2%). Glaucoma, optic atrophy, and absent globe were the causes of blindness. Conclusions Prevalence of VI is comparably low with leading causes readily treatable. An effective strategy to improve spectacle correction and cataract services would reduce the VI burden.
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Kolli A, Mozaffarian RS, Kenney EL. Food Insecurity and Vision Impairment Among Adults Age 50 and Older in the United States. Am J Ophthalmol 2022; 236:69-78. [PMID: 34653357 DOI: 10.1016/j.ajo.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To test the hypothesis that food insecurity is associated with greater prevalence of vision impairment (VI). DESIGN Cross-sectional, nationally representative survey of US adults. METHODS Adults 50 years and older were included. Food security category (ie, full, marginal, low, or very low) was assessed by the US Household Food Security Survey Module. Objective presenting VI (PVI) and self-reported VI (SRVI) were assessed by examination and survey, respectively. Separate logistic regression models were constructed with food insecurity category as a predictor of PVI or SRVI. Models were adjusted for age, gender, race, education, income, cigarette use, alcohol use, body mass index, and physical activity. Age-stratified analyses (age 50 through 64 years vs 65 years and older) were also conducted. RESULTS Mean age of participants (n = 10,078) was 63.4 years; 8,518 (89.9%) were fully food secure, 1,033 (7.2%) had PVI, and 2,633 (20.1%) had SRVI. Compared with full food security, adjusting for sociodemographic confounders, those with marginal (adjusted odds ratio [aOR], 1.31; 95% CI, 0.97-1.76), low (aOR, 1.61; 95% CI, 1.17-2.23), and very low (aOR, 2.71; 95% CI, 1.75-4.20) food security had higher odds of PVI. Compared with full food security, those with marginal (aOR, 1.58; 95% CI, 1.23-2.02), low (aOR, 1.46; 95% CI, 1.11-1.92), and very low (aOR, 1.85; 95% CI, 1.41-2.41) food security had higher odds of SRVI. The associations between food insecurity and PVI were greater in magnitude in those 65 years and older compared with those age 50 through 64 years. CONCLUSIONS In this nationally representative sample of US adults 50 years and older, severe food insecurity was increasingly associated with greater prevalence of VI in a dose-response manner.
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Affiliation(s)
- Ajay Kolli
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA.
| | - Rebecca S Mozaffarian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Kolli A, Seiler K, Kamdar N, De Lott LB, Peterson MD, Meade MA, Ehrlich JR. Longitudinal Associations Between Vision Impairment and the Incidence of Neuropsychiatric, Musculoskeletal, and Cardiometabolic Chronic Diseases. Am J Ophthalmol 2022; 235:163-171. [PMID: 34543661 PMCID: PMC8863581 DOI: 10.1016/j.ajo.2021.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare the incidence and hazard of neuropsychiatric, musculoskeletal, and cardiometabolic conditions among adults with and without vision impairment (VI). DESIGN Retrospective cohort study. METHODS The sample comprised enrollees in a large private health insurance provider in the United States, including 24 657 adults aged ≥18 years with VI and age- and sex-matched controls. The exposure variable, VI, was based on low vision and blindness International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM), diagnosis codes. Physician-diagnosed incident neuropsychiatric, musculoskeletal, and cardiometabolic diseases were identified using ICD codes. Separate Cox proportional hazards regression models were used to assess the association of VI with incidence of 30 chronic conditions, adjusting for Elixhauser Comorbidity Index. Analyses were stratified by age 18-64 years and ≥65 years. RESULTS In individuals with VI aged 18-64 years (n=7478), the adjusted hazard of neuropsychiatric (HR 2.1, 95% CI 1.9, 2.4), musculoskeletal (HR 1.8, 95% CI 1.7, 2.0), and cardiometabolic (HR 1.8, 95% CI 1.7, 2.0) diseases was significantly greater than in matched controls (mean 5.5 years follow-up). Similar associations were seen between patients with VI aged ≥65 years (n=17 179) for neuropsychiatric (HR 2.4, 95% CI 2.1, 2.7), musculoskeletal (HR 1.8, 95% CI 1.6, 1.9), and cardiometabolic (HR 1.7, 95% CI 1.4, 2.0) diseases. VI was associated with a higher hazard of each of the 30 conditions we assessed, with similar results in both age cohorts. CONCLUSION Across the life span, adults with VI had an approximately 2-fold greater adjusted hazard for common neuropsychiatric, musculoskeletal, and cardiometabolic disorders compared with matched controls without VI.
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Affiliation(s)
- Ajay Kolli
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Kristian Seiler
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Lindsey B. De Lott
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Ophthalmology & Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark D. Peterson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle A. Meade
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Joshua R. Ehrlich
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Ophthalmology & Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA,Institute for Social Research, University of Michigan, Ann Arbor, MI USA
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12
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Senra H, Hernandez-Moreno L, Moreno N, Macedo AF. Anxiety levels moderate the association between visual acuity and health-related quality of life in chronic eye disease patients. Sci Rep 2022; 12:2313. [PMID: 35145163 PMCID: PMC8831583 DOI: 10.1038/s41598-022-06252-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/13/2022] [Indexed: 01/15/2023] Open
Abstract
The current study examines the potential moderating effect of depression and anxiety on the relationship between visual acuity and health-related quality of life in patients with chronic eye diseases. Of the 71 patients, 37 (52%) were female and 34 (48%) were male, age (mean ± SD) was 69 ± 12 years. A significant multivariate regression model was found for patients' health-related quality of life (EQ-5D-5L index) (R2 = 0.43, p < 0.001), in which visual acuity (logMAR) (p < 0.001), anxiety (HADS-A) (p = 0.007), and age of diagnosis (p = 0.04) were independently associated with health-related quality of life (EQ-5D-5L). The moderation model for anxiety (R2 = 0.47, F = 5.91, p < 0.001) revealed a significant interaction of visual acuity and levels of anxiety in relation to health-related quality of life. Conditional effects analysis suggested that higher logMAR values (which indicate more vision loss) were associated with lower EQ-5D-5L index (indicating worse health-related quality of life), this relationship being stronger (even more negative), when levels of anxiety are high. Clinical and rehabilitation services providing care for chronic eye disease patients should include regular checks for patients' levels of anxiety, even in patients who still have preserved visual acuity, to help preventing a synergistic source of long-term poor quality of life and disability.
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Affiliation(s)
- Hugo Senra
- grid.8051.c0000 0000 9511 4342Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), University of Coimbra, Coimbra, Portugal ,grid.8356.80000 0001 0942 6946School of Health and Social Care, University of Essex, Colchester, UK
| | - Laura Hernandez-Moreno
- grid.10328.380000 0001 2159 175XLow Vision and Visual Rehabilitation Lab, Department and Center of Physics—Optometry and Vision Science, University of Minho, Braga, Portugal
| | | | - António Filipe Macedo
- grid.8148.50000 0001 2174 3522Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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13
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Chai S, Ge Y, Wan Y, Xia H, Dong R, Ren X, Yuan H, Hou Q, Yang J, Li X. Visual functional defects in patients with type 2 diabetes mellitus: a questionnaire based cross-sectional study. Int Ophthalmol 2022; 42:2205-2218. [PMID: 35119607 DOI: 10.1007/s10792-022-02220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the impact of type 2 diabetes mellitus (T2DM) on visual functions, identify different modifiers as risk or protective factors, and find out how these factors affect patients' visual symptoms and visual functions as a whole. METHODS We performed an online survey among 1030 participants (400 patients, 630 non-patients). Demographic features and severity of disease were documented, while visual functions were evaluated using National Eye Institute Visual Functioning questionnaire-25 (NEI VFQ-25). Independent t-test, analysis of variance, linear and nonlinear regression models were used to assess all data. RESULTS Scores other than color vision among T2DM patients were significantly lower compared with non-T2DM participants. There was significant difference after stratification of age and education, but no significant difference between different genders was observed. Parameters including duration of T2DM, fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) negatively impacted on the scores, with 20 years' of diabetic duration, 10 mmol/L of FPG, 7.5% of HbA1c being potential cut-off points. Poorer best corrected visual acuity (BCVA) and diagnosis of diabetic retinopathy were risk factors, while they simultaneously produced mediation effect, contributing 5%-78% of effect in the deterioration of visual functions caused by longer diabetic duration and higher blood glucose. CONCLUSION Significant visual impairments and faster deterioration in visual functions were seen in T2DM patients, with older age, lower educational level, longer diabetic duration, poorer blood glucose administration, limited BCVA, and the presence of diabetic retinopathy identified as risk factors. Average BCVA and diabetic retinopathy also yielded mediation effect as diabetic duration lengthened and blood glucose elevated.
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Affiliation(s)
- Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, People's Republic of China
| | - Yimeng Ge
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Yu Wan
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Huaqin Xia
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Ruilan Dong
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Xiaotong Ren
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Hao Yuan
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Qingyi Hou
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Jiarui Yang
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China.
| | - Xuemin Li
- Department of Opthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China.
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14
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Visual Field Loss Impacts Vision-Specific Quality of Life by Race, Ethnicity: The Multiethnic Ophthalmology Cohorts of California Study. Ophthalmology 2022; 129:668-678. [PMID: 35026303 DOI: 10.1016/j.ophtha.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the impact of Visual Field Loss (VFL) on Vision-Specific Quality of Life (VSQOL) by race, ethnicity and age DESIGN: Pooled analysis of cross-sectional data from three population-based, prospective cohort studies PARTICIPANTS: The Multiethnic Ophthalmology Cohorts of California Study (MOCCaS) participants included 6,142 Latinos, 4,582 Chinese Americans, and 6,347 African Americans from Los Angeles County. METHODS 17,071 adults 40 years and older completed comprehensive interviews and ophthalmic examinations from 2000 to 2018. VFL was measured using the Humphrey SITA Standard 24-2 test as decibels (dB) of mean deviation (MD). Multivariable linear regression was used to evaluate the impact of VFL in the better-seeing eye on self-reported VSQOL scores, adjusting for sociodemographic and clinical covariables. Hierarchical modeling was performed to determine the best-fit model after considering main effects and interactions by race, ethnicity and age. MAIN OUTCOME MEASURES VSQOL scores were measured using the 25 Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Item response theory (IRT) was used to model vision-related task and well-being composite scores, while classical test theory (CTT) was used to calculate 11 vision subscales. RESULTS The impact of VFL on VSQOL varied by race and ethnicity. 5-point reductions in task and well-being scores were reached after mild-to-moderate VFL for Latinos (6.7 dB and 7.5 dB), mild-to-moderate VFL for Chinese Americans (7.0 dB and 8.7 dB), and moderate-to-severe VFL for African Americans (10.1 dB and 12.9 dB), respectively. Differences met statistical significance when comparing Latinos and African Americans (P < 0.01). VFL had the largest effect on driving among all participants. Driving difficulties was the only VSQOL outcome modified by age; participants 65 years and older scored 0.487 lower points per MD of VFL (P < 0.01). Subscales most affected by VFL included role function, mental health, and dependency. CONCLUSIONS Race and ethnicity modified the impact of VFL on VSQOL, even after adjusting for sociodemographic covariates. In MOCCaS, Latinos and Chinese Americans reported a greater change in VSQOL than African Americans for the same level of VFL. Future work should assess whether findings were due to socioeconomic or cultural differences in perception of visual function.
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15
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Khadka J, Schoneveld PG, Pesudovs K. Comparing the measurement properties of visual analogue and verbal rating scales. Ophthalmic Physiol Opt 2021; 42:205-217. [PMID: 34786749 DOI: 10.1111/opo.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Utilising Rasch analysis on the Keratoconus Outcome Research Questionnaire (KORQ) data, we explored the hypothesis that the KORQ with discrete verbal rating scale (VRS) would demonstrate better psychometric properties and provide less noise in measurement than with a visual analogue scale (VAS). METHODS The KORQ is a keratoconus-specific patient-reported outcome measure; it has activity limitation and symptoms scales. The KORQ scales with two different rating scales (VAS and a discrete 4-response VRS) were completed by self-administration by people with keratoconus. For each KORQ scale, Rasch analysis-based psychometric properties were compared between the two versions. Rasch analysis was also used to optimise rating scale functioning when disordered thresholds were observed. RESULTS 118 (mean age ± SD, 46.4 ± 0.4 years) and 169 (45.4 ± 14.7 years) people completed the KORQ with VAS and VRS, respectively. Both scales demonstrated high measurement precision. However, the VAS rating scale was disordered (6 out of 11 categories dysfunctional) and had two misfitting items. Conversely, the VRS had ordered categories and no misfitting items. For the disordered VAS, ordering was achieved only after collapsing 11 categories into four categories. In comparison to the KORQ with VRS, the repaired VAS had lower measurement precision, test information, variance explained by the measure, poor targeting, and reduced measurement range. CONCLUSIONS The KORQ demonstrated superior psychometric properties when measured using a VRS than with a VAS. This illustrates the advantages of verbal rating scales for a patient-reported outcome measurement over a visual analogue scale.
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Affiliation(s)
- Jyoti Khadka
- Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Konrad Pesudovs
- The University of New South Wales, Sydney, New South Wales, Australia
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