Development of a short version of the visual function questionnaire using item-response theory.
OBJECTIVE
In clinical ophthalmology as in other fields, measuring patient-reported outcomes imposes a burden on patients. To decrease that burden, we used item-response theory (IRT) to develop and test a short version of the National Eye Institute's Visual Function Questionnaire (VFQ).


METHODS
We analyzed VFQ data from 276 adults in Japan. Most of them had glaucoma, cataract, or macular degeneration. Their visual acuity (Snellen fraction) averaged 20/120 (range: 20/13 to 20/2000) for the better eye, and 20/200 (range: 20/13 to 20/2000) for the worse eye. We used a polytomous IRT model, the Generalized Partial Credit Model as implemented in software for parameter scaling of rating data (PARSCALE). To select items for inclusion in the short version we examined each item's location on the latent-trait continuum, its slope, and its frequency of missing data. We also ensured representation of all 7 domains that are important in Japan. To examine the characteristics of the resulting scale, we computed its test information (an index of precision that can vary with the value of the latent trait), and carried out validation testing.


RESULTS
From 32 of the original VFQ items, we selected 11. The scale comprising those 11 items (the VFQ-J11) had test information greater than 9 for values of the latent trait between -2.0 and +0.8. The item thresholds were well-targeted for patients with vision problems. Scores on the VFQ-J11 correlated strongly and in the expected direction with measures of visual field and corrected visual acuity. As expected for a valid measure, those scores also improved by a large amount (almost one standard deviation) after cataract surgery.


CONCLUSIONS
This 11-item instrument can provide reliable and the valid data on visual functioning in patients with ophthalmic problems. It is expected to be less of a burden on respondents, while it maintains good psychometric properties.
Department of Epidemiology and Healthcare Research, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan ; iHope International, Kyoto and Tokyo, Japan.
Shunichi
S
Fukuhara
Takafumi
T
Wakita
Masakazu
M
Yamada
Yoshimune
Y
Hiratsuka
Joseph
J
Green
Kotaro
K
Oki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000503:physiopathology; D005260:Female; D005901:Glaucoma / Q000503:physiopathology; D006801:Humans; D007564:Japan; D008268:Macular Degeneration / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014785:Vision, Ocular / Q000502:physiology; D055815:Young Adult