title: An evaluation of the Amblyopia and Strabismus Questionnaire using Rasch analysis.
abstract: OBJECTIVE
  To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia.
  
  
  METHODS
  The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality.
  
  
  RESULTS
  Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional.
  
  
  CONCLUSIONS
  The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus.
authors.affiliation: School of Optometry and Vision Science, University of Bradford, Bradford, United Kingdom.
authors.forename: Marta
authors.initials: M
authors.lastname: Vianya-Estopa
authors.forename: David B
authors.initials: DB
authors.lastname: Elliott
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Barrett
mesh_terms: D000550:Amblyopia / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D013285:Strabismus / Q000523:psychology*; D011795:Surveys and Questionnaires; D014792:Visual Acuity