Konrad Pesudovs

Purpose: To evaluate spectacle independence in healthy individuals and cataract patients with different types of intraocular lenses (IOLs) and refractive targets using a Dutch translation of The Patient-Reported Spectacle Independence Questionnaire (PRSIQ). The PRSIQ is a patient-reported outcome measure that assesses patient need for, wearing of, and functioning without spectacles for distance, intermediate, and near vision. Setting: Amphia Hospital, Breda, the Netherlands. Design: Prospective, observational, cross-sectional, single-center study. Methods: The English questionnaire was translated to Dutch following the ISPOR guidelines. 361 participants across various groups were included: healthy individuals aged younger than and older than 50 years and cataract patients with bilateral implantation of monofocal, enhanced monofocal, toric monofocal, monofocal with a myopic target, extended depth-of-focus (EDOF), or trifocal IOLs. Results: Dichotomous scoring showed significantly different rates of complete spectacle independence: 28 of 49 (57%) for trifocals, 8 of 47 (17%) for EDOFs, 2 of 44 (5%) for monofocals, 1 of 50 (2%) for enhanced monofocals, 0 of 25 (0%) for toric monofocals, 1 of 46 (2%) for myopic targets, and 10 of 50 (20%) and 1 of 50 (2%) for healthy participants younger than and older than 50 years. Participants with minimal refractive errors reported complete spectacle independence in 20 of 28 (71%) with trifocals and 5 of 21 (24%) with EDOF IOLs. Rasch analysis showed that the questionnaire was multidimensional and thus failed to support interval scaling. Conclusions: The Dutch PRSIQ-NL demonstrated significant differences in self-reported complete spectacle independence across IOL types and refractive targets using dichotomous scoring. Rasch analysis showed PRSIQ-NL cannot be used for interval-scaled measurements. The PRSIQ-NL is valuable for clinical and research applications to evaluate spectacle independence using dichotomous scoring.

Background: In this study we explore the quality-of-life impact of vitreous floaters, and identify all possible issues that may be relevant to a person experiencing floaters, with the aim to define the content of a floaters-specific patient-reported outcome measure, which can help determine the disease burden and benefit of treatment for a patient with floaters. Methodology: Semi-structured telephone interviews were conducted with patients with floaters. The topic guide was based on an extensive literature review and expert opinion. Interview transcripts were coded into all possible quality-of-life issues that may be relevant to a person experiencing floaters. We grouped these into quality-of-life domains and subdomains, using an earlier framework of quality of life in other ophthalmic diseases. Results: We categorized the patients’ reports ( N = 44) into 11 quality-of-life domains: activity limitations, visual symptoms, ocular symptoms, general symptoms, health concerns, emotional well-being, social well-being, mobility issues, economic impact, inconveniences, and the need to use coping strategies. Conclusions: Vitreous floaters result in specific quality-of-life issues that have not been adequately measured with previous patient-reported outcome measures. When compared to other eye conditions, three previously unidentified issues stand out among patients with floaters: the effects of different lighting conditions, intermittent vision impairment caused by eye movements, and the importance of seeking understanding and support from healthcare providers. Eye care clinicians should recognize these issues when evaluating patients with floaters. The present patient-driven determination of relevant quality-of-life issues can guide initiatives in floaters-specific patient-reported outcome measures.

Background: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. Methods: A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modeled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60). Estimates are age-standardized using the GBD standard population. Results: In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract blind 60% female, MSVI 59% female. From 1990 to 2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by −27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%). Conclusions: The number of people blind and with MSVI due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery.

Understanding the quality-of-life (QoL) impacts of amblyopia and strabismus from the perspectives of patients using validated tools would enable eye care practitioners to provide better clinical management. Item banks are advanced patient reported outcome measures with several advantages over traditional QoL assessment. This paper describes the development of amblyopia and strabismus-specific QoL item banks for two distinct country settings: Australia (high-income) and India (low-middle income) and examines the unique QoL issues. Using a bottom-up systematic approach, the content for the item banks was identified from three sources: existing self-report amblyopia and strabismus questionnaires (n = 22), qualitative literature (n = 5) and prospective qualitative studies in Australia (n = 49) and India (n = 30). The initial item pool underwent item evaluation, construction, and pre-testing to form optimal sets of representative items. The Indian item pools were first developed in English and translated into Hindi and Tamil using a rigorous translation protocol. The differences in QoL experiences that emanated from the qualitative studies and the number of common and unique items in the final item pools were compared. The final Australian and Indian item pools comprised 312 and 277 items, respectively, covering 11 QoL domains. Two hundred and sixty items (79%) were common to both countries, and 21% were unique. Of the 11 domains, except for activity limitation (64.5%), visual symptoms (73.3%) and emotional impact (75.5%) domains, all other domains had over 80% of items common to both countries. The unique items can be attributed to differences in QoL experiences, individual perspectives, culture, lifestyle, country setting and health systems. Amblyopia has a multifaceted impact on QoL irrespective of the country settings. Despite a huge overlap in QoL impacts between Australia and India, both countries had unique issues, especially activity limitations. The study developed comprehensive, country-specific item pools for Australia and India.

Background To estimate global and regional trends from 2000-2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. Methods A systematic review and meta-analysis of published population studies and grey literature from 2000-2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modelled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI; presenting visual acuity <6/18,≥3/60) and blindness (presenting visual acuity <3/60). Estimates are age-standardised using the GBD standard population. Results In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract; blind 60% female, MSVI 59% female. From 1990-2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by -27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%). Conclusions: Vision impairment due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery.

Purpose: To evaluate the psychometric properties of refractive error‐specific quality of life (QoL) item banks and assess their performance using computerised adaptive testing (CAT) simulations. Methods: In this cross‐sectional study a 392‐item questionnaire, grouped under 11 QoL domains, was interviewer‐administered to 305 people with refractive error [mean age ± S.D., 30.5 ± 14.1 (range (18 to 83) years; male, 50.5%; mean ± S.D. spherical equivalent refractive error −2.4 ± 2.9 (range: −15.0 to +11.0) Dioptres; spectacles ( n = 257), contact lens ( n = 37), refractive surgery ( n = 25), uncorrected refractive error ( n = 57)]. Rasch analysis was conducted on each QoL domain using the Andrich rating scale model to investigate parameters including response category functioning, person‐ and item‐reliability, infit and outfit statistics, unidimensionality, targeting, differential item functioning and local item dependency. The resulting item banks underwent CAT simulations in 1,000 cases with 'high' and 'moderate' precision stopping rules. Results: Rasch analysis iterations resulted in 13 refractive error‐specific item banks (Convenience, Health concerns, Economic, Activity limitation, Mobility, Emotional, Social, Visual symptoms frequency, Visual symptoms severity, Visual symptoms bothersome, Comfort symptoms frequency, Comfort symptoms severity and Comfort symptoms bothersome), containing a total of 366 items. The item banks had good psychometric properties including satisfactory measurement precision, infit and outfit statistics and unidimensionality. In CAT simulations, the mean number of items required to achieve high and moderate measurement precision was 9.4 and 4.7, respectively. Conclusion: Overall, refractive error‐specific QoL item banks show promise in their ability to comprehensively and precisely evaluate a range of quality of life parameters. These items banks when administered using a CAT system offer unique outcome tools for implementation in clinical trials, healthcare and research.

PURPOSE : This exploratory qualitative research was conducted to understand the quality of life (QoL) impacts of adult uveitis to develop a uveitis QoL item bank, and we present here the results of qualitative analysis of uveitis patient experience. METHODS : A qualitative approach with phenomenological study design was employed to explore the common QoL domains in uveitis. Data were collected using focus groups and face-to-face interviews. The sessions were audio-recorded, transcribed verbatim, and analysed thematically. NViVo software was used to perform qualitative analysis. RESULTS : Eight focus groups and 10 interviews were conducted with 41 patients with uveitis. Seven QoL domains were identified, namely symptoms, emotional, activity limitation, health concerns, convenience, social, and economic impact. Although these QoL domains have been previously identified in other eye diseases, the sub-themes within each QoL domain were unique to uveitis. Participants described a variety of symptoms including increased light sensitivity, blurred vision, pain, redness, and tearing. Participants repeatedly described feeling frustrated due to prognostic uncertainty and associated discomfort. Participants were concerned about the frequent relapses of inflammation, as well as side-effects from long-term systemic medications. Uveitis affected their ability to perform daily tasks such as using computers, driving, and reading books. Direct financial impacts included reduced work hours and the costs of treatment and specialist care. CONCLUSION : Participants with uveitis experience many symptoms in addition to medication-related inconveniences and activity limitations. The QoL issues identified will be used to develop a uveitis-specific QoL item bank.