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To identify the factors affecting the quality of life (QoL) in adults with keratoconus, using the disease-specific Keratoconus Outcomes Research Questionnaire (KORQ).In this cross-sectional study, 574 patients with keratoconus completed the 29-item KORQ (18-item activity limitations and 11-item symptoms subscales) and demographic information. Based on mean corneal curvature to grade keratoconus severity, participants were categorised into four groups: mild48 dioptres [D]; moderate: 48 to 53 D; advanced: 54 to 55 D and severe:55D. Rasch analysis was used to assess the psychometric properties and to score the KORQ. Multivariable regression was performed to determine the independent impact of age, sex, laterality, severity and duration of keratoconus, education, employment status and mode of treatment for keratoconus on activity limitations and symptoms.Mean (SD) age was 24.5 (5.1) years. 304 (53%), 160 (28%), 26 (4%) and 84 (15%) belonged to keratoconus groups 1, 2, 3 and 4, respectively. Rasch analysis demonstrated the 'activity limitations' and 'symptoms' KORQ subscales to possess good psychometric properties. Statistically significant associations were found between activity limitation score and the following measures: visual acuity (VA) in the better-seeing eye (r = -0.10, p = 0.01); VA in the worse-seeing eye (r = -0.09, p = 0.04) and ocular aberrations (r = -0.13, p = 0.008) in the worse-seeing eye. Statistically significant associations were also found between symptoms score and mean corneal curvature in the better-seeing eye (r = -0.10, p = 0.02). In regression models, female sex was associated with 21% worse symptom score than male (β = -0.33, 95% CI, -0.09, -0.59, p = 0.01) and working people experienced clinically and statistically significantly greater trouble from symptoms compared to those not working (β =0.44, 95% CI, 0.17, 0.70, p = 0.001).People with keratoconus have poorer QoL in terms of activity limitations if they have poorer VA and greater wavefront aberrations, and in terms of symptoms if they are female and employed.

Purpose To report the clinical outcomes of glaucoma management in patients with phacomatosis pigmentovascularis (PPV) treated over a period of 3 decades. Design Retrospective cohort study. Participants Fifty-five eyes of 38 patients (21 unilateral and 17 bilateral) with glaucoma in PPV managed at one institution between January 1990 and December 2019 with a minimum follow-up of 1 year. Methods Medical records of children with glaucoma in PPV were reviewed, and demographic and clinical data were collected. Surgical interventions included primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with mitomycin C (MMC), and transscleral cyclophotocoagulation (TSCPC). Complete success was defined as intraocular pressure (IOP) ≥ 6 and ≤ 16 mmHg without medications and qualified success as IOP ≤ 16 mmHg with the use of up to 2 medications. Main Outcome Measures Intraocular pressure, best-corrected visual acuity (BCVA), corneal clarity, antiglaucoma medications at preoperative and postoperative visits (last visit), and complications. Results Median age was 4 months (range, 0.2–252 months) at the time of glaucoma surgery. Thirty-nine eyes (74%) had primary CTT, 10 eyes (19%) had trabeculectomy with MMC, and 4 eyes (7%) with advanced glaucoma had TSCPC. Two eyes (3.6%) received medical treatment. Preoperative IOP reduced from a mean of 25.7 ± 8.4 mmHg on 0.8 ± 0.6 medications to 14.6 ± 5.2 mmHg on 0.4 ± 0.5 medications (P 20/40. Four of 10 eyes that underwent trabeculectomy with MMC developed retinal detachment and were managed surgically; however, all of these eyes had poor visual outcomes. There was no incidence of bleb leakage, bleb-related infection, or endophthalmitis. Conclusions Combined trabeculotomy-trabeculectomy is safe and effective as a primary procedure for management of glaucoma in PPV. Trabeculectomy augmented with MMC as a second procedure was associated with a higher rate of complications.

To investigate abandonment rates of near-vision low vision devices (LVDs) and factors that influence abandonment among patients attending a tertiary low vision rehabilitation centre in South India.Two hundred and eighty-six adults with low vision completed the modified device abandonment survey 1 year following device prescription. The survey included six questions: possession of device, timing of last use, reasons for abandonment, tasks for which the device was used, payment type and change in quality of life (QoL) from device use. The primary outcome measure was abandonment. Multivariate logistic regression analysis was used to investigate factors for abandonment.Three hundred and twelve near-vision devices were prescribed (mean, 1.09 device per patient.) Stand magnifiers (35%) followed by hand-held magnifiers (24%) were most frequently prescribed. Mean logMAR visual acuity (Snellen) in the better-seeing eye was 0.80 (6/38). Of the prescribed near-vision devices, 22% (95% CI, 17 to 27) were abandoned. Patients who abandoned the device were significantly older than those who did not (49.3 ± 17.2 vs. 43.5 ± 18.1 years; p = 0.03). In multivariable analysis, patients reporting no change in their QoL from device use had higher odds of abandoning the device (OR: 63.97; 95% CI, 23.77 to 172.12). Device-related (31%) and psychological (30%) factors were the most frequent reasons for abandonment. Among device-related issues, the most frequent reason was that patients felt the device was too complex to use (50%) followed by being too cumbersome to use (25%).The abandonment rate for near-vision LVDs in South India was comparable with that reported in high-income countries. Patients reporting no change in their QoL had a higher likelihood of abandoning the device compared with those who reported some change. Device-related and psychological factors were the most frequent reasons for abandonment. These results can be used to develop strategies to improve compliance with use of devices.

Purpose To evaluate the long-term outcomes of glaucoma management in patients with congenital ectropion uveae (CEU) over a period of three decades at a single large referral tertiary eye care center. Methods Retrospective chart review of all patients with CEU treated surgically from 1990 to 2019 was performed. Primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with and without mitomycin-C (MMC) (0.2 mg/mL for 1 min) and transscleral cyclophotocoagulation (TSCPC) were performed. Intraocular pressure (IOP) ≥6 and ≤16 mmHg without medications was considered as complete success and IOP≤ 16 mmHg with the use of upto 2 medications as qualified success. Results A total of 26 eyes of 21 patients were identified with a median age of 7 years (range, 6 days to 19 years) at the time of glaucoma surgery. Median follow-up was 51.1 months (range, 7–244.6 months). Primary CTT was performed in 17 eyes (65%), trabeculectomy in 5 eyes (19%) with application of MMC in 2 eyes, and 3 eyes (12%) underwent TSCPC. One painful blind eye (4%) underwent evisceration. Mean IOP reduced from 30.8 ± 7.6 mmHg on a mean of 1.3 ± 0.8 glaucoma medications preoperatively to a mean IOP of 15.2 ± 5.9 mmHg (P Conclusions CTT is a safe and efficacious primary procedure for management of early-onset glaucoma in CEU. Trabeculectomy with or without adjuvant MMC is a viable second line of treatment in late-onset glaucoma with CEU for IOP control.

PRECIS In this study, huge time delay was observed between first primary congenital glaucoma (PCG) symptom recognition by parents to ophthalmological diagnosis and this delay was unchanged over time. Bilateral affliction and mean presenting intraocular pressure (IOP) remained unaltered. PURPOSE To compare the trends in presentation of patients with PCG over 3 different time periods at 10-year intervals (1998, 2008, and 2018) managed by a single surgeon at one of the largest tertiary eye care centers in South India. METHODS Retrospective analysis of 313 eyes of 172 patients diagnosed to have PCG and treated at the L V Prasad Eye Institute (LVPEI) between January and December of the 3 specified years. Data collected included age at symptom recognition and at presentation, sex, affected eye, signs and symptoms, time between onset of symptoms and diagnosis (diagnostic delay), corneal clarity, and IOP. RESULTS Of the 172 patients, 48 (27.9%), 76 (44.2%), and 48 (27.9%) belonged to 1998, 2008, and 2018, respectively. Bilateral affliction (79% to 84%) was common and there was no sex predilection. The median age at recognition of first symptoms by caregivers/parents was 1 day (interquartile range, 1 to 30), and at diagnosis was 120 days (interquartile range, 30 to 378). Overall, presentation to LVPEI was delayed by >3 months in 80 (46.5%) children, and there was no statistically significant difference in the duration of delay over time (P=0.13). There was no significant difference in the mean presenting IOP over time (P>0.05). CONCLUSIONS We provide unique single center-based information of trends in the presentation of patients with PCG over 3 decades. Diagnostic delay was common, and a large number of characteristics of patients with PCG in South India have remained unchanged, particularly, age at onset and at diagnosis and laterality.

Purpose: The COVID-19 outbreak has adversely impacted all societal domains, including education. Home confinement, school closures, and distance learning impacted children, teachers, and parents’ lives worldwide. In this study, we aimed to examine the impact of COVID-19 lockdown on the lives, including education, of school-age children with vision impairment (VI) and their parents in India.\ud \ud Methods: Primary and secondary school children with VI were recruited from the Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India. A qualitative research methodology, utilising a self-constructed questionnaire with open and closed questions and stem and leaf design was employed to explore the experiences of school closure and its impact on education, and attending online classes during the COVID-19 lockdown. Textual data from responses to the questions were analysed using content analysis to identify themes pertinent to the cohort studied.\ud \ud Results: Forty-eight child-parent dyads were included. Median age of children was 10 years (range, 7-19 years) and 60% were male. Inherited retinal disorders were the major cause of VI (40%). Best-spectacle corrected visual acuity (better eye) ranged from 6/12 (0.3 logMAR) to 6/750 (2.09 logMAR). Six major themes were identified: (1) accessibility of technology (online learning and technology); (2) parental beliefs/concerns (harmful effects of technology, prioritization of normally sighted children, online classes considered a distraction); (3) support (peers, parents, teachers, private tuition); (4) socialization and physical activity, (5) socioeconomic status, and (6) near vision. \ud \ud Conclusions: Our study provides an understanding of the adverse impact of the lockdown on the lives of children with VI and their parents, especially related to education in India. The study identified critical factors that affect online learning and the participation of children with VI in these sessions. Policy makers and educators should implement effective measures for supporting online classes.

PURPOSE To evaluate the long-term visual and surgical outcomes, and associated risk factors for poor outcomes in patients with primary congenital glaucoma (PCG). METHODS Retrospective review of medical records of children who underwent combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C as the first surgical procedure by a single surgeon between January 1990 and December 2010. Success was defined as intraocular pressure (IOP)

To report the clinical outcomes of glaucoma management in patients with phacomatosis pigmentovascularis (PPV) treated over a period of 3 decades.Retrospective cohort study.Fifty-five eyes of 38 patients (21 unilateral and 17 bilateral) with glaucoma in PPV managed at one institution between January 1990 and December 2019 with a minimum follow-up of 1 year.Medical records of children with glaucoma in PPV were reviewed, and demographic and clinical data were collected. Surgical interventions included primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with mitomycin C (MMC), and transscleral cyclophotocoagulation (TSCPC). Complete success was defined as intraocular pressure (IOP) ≥ 6 and ≤ 16 mmHg without medications and qualified success as IOP ≤ 16 mmHg with the use of up to 2 medications.Intraocular pressure, best-corrected visual acuity (BCVA), corneal clarity, antiglaucoma medications at preoperative and postoperative visits (last visit), and complications.Median age was 4 months (range, 0.2-252 months) at the time of glaucoma surgery. Thirty-nine eyes (74%) had primary CTT, 10 eyes (19%) had trabeculectomy with MMC, and 4 eyes (7%) with advanced glaucoma had TSCPC. Two eyes (3.6%) received medical treatment. Preoperative IOP reduced from a mean of 25.7 ± 8.4 mmHg on 0.8 ± 0.6 medications to 14.6 ± 5.2 mmHg on 0.4 ± 0.5 medications (P0.0001) at last follow-up after surgery (77.7 ± 56.5 months). Thirty-seven eyes (67.3%) required medications preoperatively, and 22 eyes (40%) required medications at the last follow-up. Of 25 patients with available BCVA at last follow-up, 9 (36%) had ≥ 20/60; of these, 6 had20/40. Four of 10 eyes that underwent trabeculectomy with MMC developed retinal detachment and were managed surgically; however, all of these eyes had poor visual outcomes. There was no incidence of bleb leakage, bleb-related infection, or endophthalmitis.Combined trabeculotomy-trabeculectomy is safe and effective as a primary procedure for management of glaucoma in PPV. Trabeculectomy augmented with MMC as a second procedure was associated with a higher rate of complications.

Purpose Little is known about quality of life (QoL) and life satisfaction (LS) of treated primary congenital glaucoma (PCG) patients in adulthood. The purpose of this study was to assess the QoL and LS and their predictors among young adults treated for PCG during early childhood. Design Cross-sectional study. Participants Eighty-two participants with PCG (mean age, 22.5 years; standard deviation [SD], 4.6); 52% were male; 94% bilateral) recruited at L V Prasad Eye Institute. Methods Participants were asked to complete the 26-item World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire (items related to satisfaction with general health, physical, psychological, social relations, and environmental aspects) and the 5-item Satisfaction with Life Scale (SWLS) in the clinic visit. Clinical data including visual acuity (VA) and visual fields (VFs) were collated from medical records. Rasch analysis was used to optimize the psychometric properties, with higher scores indicating a higher degree of QoL and LS, for both the questionnaires. Linear regression models were used to examine associations between overall QoL and LS (in separate models), and sociodemographic and clinical variables. Main Outcome Measures The QoL and LS were measured using Rasch-transformed scores from the WHOQOL-BREF questionnaire and SWLS, respectively. Results Response rate was 93%. The overall mean (SD) Rasch-scaled scores for QoL were 0.93 (1.11) and 0.87 (1.32) for environment domain and 0.41 (1.56) logits for LS. Better QoL was significantly related to rural residence and higher education in both univariable and multivariable analyses and explained 13% variance. Higher LS was significantly related to marital status, unilateral affliction, and higher education in univariable analyses. However, multivariable regression analysis showed that only marital status was independently associated with higher LS and explained 8.8% of variance. Clinical and treatment variables (VF, surgical interventions, medications) were not independent predictors of QoL/LS. Conclusions Our results suggest that QoL and LS of treated patients with PCG during adult life are generally good and appear to be driven by factors other than clinical indices. Educational achievement appears to be linked to better QoL and LS, and clinicians should emphasize the importance and need for education in the continued care of these patients.

SIGNIFICANCE: The Indian translated and culturally adapted version of the vision-related activity limitation (VRAL) item bank is a validated instrument to assess the difficulty in performing daily activities by cataract patients and can also be used to capture self-reported changes in ability to perform daily activities after cataract surgery. PURPOSE: The purpose of this study was to document (a) translation, cross-cultural adaptation of VRAL item bank into an Indian language, and (b) its validation using Rasch analysis in a South Indian cataract population. METHODS: At the first stage, a translated Indian version of VRAL item bank was produced using recommended procedures. At the second stage, Rasch analysis was performed to investigate its psychometric properties in 787 cataract patients (mean age, 58.2 years; mean ± SD visual acuity [logMAR], 1.19 ± 0.96 at baseline in eye for surgery) including comparison with the original version. RESULTS: Post-translation equivalence of meaning was achieved, but some English phrases required cross-cultural adaptation. Subsequently, all items were appropriate for the Indian culture, and VRAL item bank demonstrated excellent measurement precision (7.39). Dimensionality assessment suggested that VRAL construct may contain other dimensions such as self-care and visual search, and mobility. Self-care and visual search formed a unidimensional measure but was highly correlated with main VRAL dimension, and the removal of its items weakened precision of the main VRAL dimension measurement. Taken together, evidence favored retaining self-care and visual search items in a larger VRAL item bank. Mobility subscale lacked adequate measurement precision, so it was not examined further; again, items were retained in VRAL scale because they strengthened its measurement properties. Majority of items (99%) did not demonstrate notable differential item functioning (>1.0 logit) by presenting visual acuity (median, 0.20 logMAR) in the better-seeing eye. CONCLUSIONS: Items in the translated Indian VRAL item bank measure the same construct as the English version and fulfilled the psychometric requirements for use in cataract patients. Refereed/Peer-reviewed

Purpose To compare the visual functioning (VF) and vision-related QoL (VRQoL) of children 8–18 years old treated for primary congenital glaucoma (PCG) and secondary childhood glaucoma. Design Cross-sectional study. Methods A total of 309 children 8–18 years old treated for PCG and secondary childhood glaucoma between 2000 and 2010 by a single pediatric glaucoma specialist were prospectively enrolled at LV Prasad Eye Institute, Hyderabad, India. Children completed 2 questionnaires, the LV Prasad Functional Vision Questionnaire–II (LVP-FVQ-II), and the Impact of Vision Impairment-Children (IVI-C) questionnaire. Rasch-calibrated scores from both these questionnaires were used to compare the VF and VFQoL between the 2 groups. Results Mean ages of the children were 12.2 and 12.6 years in the PCG (53%, median age at diagnosis = 5 months) and secondary glaucoma groups (47%, median age at diagnosis = 3 years), respectively. A majority (80%) of children had bilateral glaucoma and underwent filtering surgery (83%). Mean better eye logMAR visual acuity (VA) was comparable between PCG and secondary childhood glaucoma groups (0.49 vs 0.52, respectively; P = 0.59). Children with PCG reported significantly better VF and VRQoL than secondary childhood glaucoma patients. Unadjusted and adjusted childhood glaucoma group comparisons revealed secondary childhood glaucoma to be associated with worse VF and VRQoL compared to PCG (difference for VF, −0.83; 95% confidence interval [CI], −1.34 to 0.31; P = 0.002; 0.39; 95% CI, 0.16–0.62; P = 0.001 for VRQoL). Conclusions Results show that children with treated PCG experience significantly better VF and VRQoL than those with secondary childhood glaucoma, despite comparable VA and IOP.

SIGNIFICANCE Mobile devices such as tablet computers have become widely available as mainstream devices and are also used in some schools, but there is an absence of robust information regarding the efficacy of any optical/electronic low vision device or tablet computer in supporting education of young people with low vision. PURPOSE A randomized controlled trial (RCT) is needed to measure the impact of tablet computers on education, specifically on independent access to educational material, in children and young people with low vision. We conducted a pilot RCT to determine the feasibility of conducting a full-scale trial. METHODS This was a randomized multicenter pilot trial across two sites in the United Kingdom and one site in India. Forty children and young people aged 10 to 18 years with low vision (best-corrected visual acuity for distance between

PURPOSE: To evaluate the health-related quality of life (HRQoL) of children operated for primary congenital glaucoma (PCG) using the Kidscreen-27 questionnaire. METHODS: A total of 121 children (mean age, 11.8 years; SD, 2.8 years; 51% males) with unilateral or bilateral PCG who underwent glaucoma surgery in infancy (mean duration since surgery, 10.2 years; [SD] 4.2 years) by a single surgeon at a tertiary eye care centre were administered the Kidscreen-27 questionnaire (self-or interviewer administered in a face-to-face interview) during their routine follow-up visit. We investigated the measurement properties of Kidscreen-27 questionnaire using Rasch analysis and generated interval-level estimates of HRQoL. The main outcome measure was HRQoL (i.e., Rasch-derived Kidscreen score). Multivariable linear regression analyses assessed the influence of socio-demographic and clinical variables on the HRQoL of children with PCG. RESULTS: Majority (83%) of the children had bilateral PCG and congenital type of the disease (79%). Mean presenting acuity (logMAR) in the better eye was 0.32 (SD, 0.36; median, 0.18). Rasch analysis of Kidscreen-27 questionnaire indicated need for minor modifications following which a psychometrically robust unidimensional 23-item Kidscreen questionnaire emerged. In multivariable model, age of the child was independently associated with a 32% (β = −0.24 [95% CI, −0.11, −0.36]) increase in the HRQoL score. CONCLUSIONS: Despite undergoing successful glaucoma surgery, children with PCG reported reduced HRQoL. Younger children with PCG are more likely to experience this lowered HRQoL and ophthalmologists will need to be alert to this. Efforts must be made to improve the HRQoL of children with PCG.

Purpose We developed and validated an instrument to measure the quality of life (QoL) of caregivers of children with primary congenital glaucoma (PCG): the Caregiver's Congenital Glaucoma Quality of Life (CarCGQoL) questionnaire. Methods A total of 70 caregivers of children with PCG under follow-up at a tertiary eye care center in India participated in a series of focus groups, and pre- and pilot testing phases in the development of the 45-item CarCGQoL questionnaire. Subsequently, this instrument was administered to 111 caregivers of children with PCG awaiting glaucoma surgery. Response to each item was rated on a four-category scale. Rasch analysis was used to validate the instrument's psychometric properties, such as unidimensionality (by principal components analysis [PCA] of residuals), item fit to model, measurement precision (by person separation [PS]), response category performance, differential item functioning (DIF), and targeting of items to participant's QoL. Results Categories required reorganization resulting in a shortened rating scale of 3 categories. The instrument showed misfit to the Rasch model and lacked unidimensionality. Deleting 15 items (obtained through PCA of residuals) restored unidimensionality, but additional items misfit, necessitating item reduction. In addition, 2 items showed DIF and were deleted. Finally, a 20-item CarCGQoL instrument showed good fit and unidimensionality. Targeting was good (0.69 logits) and PS was 2.51, indicating good measurement precision. Conclusions We have developed a psychometrically robust 20-item caregiver derived questionnaire, the CarCGQoL, that is a valid and reliable measure of QoL of caregivers of children with PCG. Given its brevity, it is quick and easy to administer in the clinic, and has potential for use as an outcome measure in clinical trials of treatment of PCG.

Previous reports, albeit isolated, of vision and ocular screening of athletes with intellectual disability participating in the Special Olympics, UK, indicated high rates of refractive error and ocular morbidity; however, there have been no reports of similar sports events for this population from India. This study set out to evaluate the vision profile and ocular characteristics of athletes with intellectual disability attending the Special Olympics Lions Club International Opening Eyes (SOLCIOE) event in 2012 in India.A cross-sectional study was conducted, where a protocol-based ophthalmological assessment was performed by trained optometrists at a tertiary eye care center.Overall, 172 athletes (mean age 18.6 years, 70% male) with intellectual disability participated, and 138 (80%) were able to cooperate for complete or nearly complete vision and ocular assessment. A total of 56 (32%) had never had a previous vision or ocular health status examination. A total of 46 (32%) presented with low vision (World Health Organization definition6/18 to 3/60 in the better eye), 21% needed a first or updated spectacle prescription, and 28% had significant ocular pathology as the cause of visual loss.The proportions of refractive errors and ocular disorders in athletes with intellectual disability attending the SOLCIOE program in South India are similar to those reported for able-bodied school-aged children in urban and rural India. Like that of their able-bodied peers, the visual needs of children with intellectual disability are also not adequately being met.

Background The Patient-Health Questionnaire (PHQ-9) is a widely used screening instrument for depression. Recently, its properties as a measure were investigated using Rasch analysis in an Australian population with visual impairment (VI) and it was demonstrated to possess excellent measurement properties, but the response scale required shortening (modified PHQ-9). However, further validation was recommended to substantiate its use with the growing population of VI. Therefore, we aimed to use Rasch analysis to evaluate the measurement properties of the modified PHQ-9 in an Indian population with VI. Methods 303 patients with VI (mean age 40.2 years; 71% male) referred to Vision Rehabilitation Centres were administered the PHQ-9 by trained interviewer. Rasch analysis was used to investigate the psychometric properties of the modified PHQ-9. Results Rasch analysis showed good fit to the model, no misfitting items and an acceptable person separation reliability (0.82). Dimensionality testing supported combining 9 items to create a total score. Targeting was sub-optimal (−1.30 logits); more difficult items are needed. One item (‘trouble falling asleep’) showed notable differential item functioning, DIF (1.18 logits) by duration of VI. Limitations The generalisability of these results might be restricted to patients with VI presenting to a tertiary eye care centre. Conclusions Except for DIF, the performance of the modified PHQ-9 is consistent with that of the original, albeit in a different cultural context (Indian population with VI). Clinicians/researchers can readily use the modified PHQ-9 without formal training in Rasch procedures given the provision of ready-to-use spreadsheets that convert raw to Rasch-scaled scores. However the conversions will apply only if the sample being tested is similar to that of the present study.

To validate the Indian-translated Impact of Vision Impairment for Children (IVI_C), a vision-related quality of life (VRQoL) instrument, and to investigate the effect of sociodemographic and ocular characteristics on VRQoL.The 24-item IVI_C was administered face to face to 221 children with vision impairment (VI) (mean age, 12.6 years; male, 68%) referred to the Vision Rehabilitation Centres. Rasch analysis was used to investigate the IVI_C for key indices such as measurement precision as measured by person separation (minimum recommended value, 2.0), unidimensionality (i.e., whether all the items contribute toward measurement of a single underlying construct as assessed by item fit and principal component analysis of residuals), targeting of items to participants' VRQoL (i.e., matching of item difficulty to participant ability; ideal targeting,1.0 logits). Univariate analysis was performed to determine if the person scores of IVI_C were significantly different across participant subgroups stratified by sociodemographic and ocular characteristics, including the severity of VI.The IVI_C showed misfit to the model and lacked unidimensionality. Principal component analysis confirmed the presence of an additional construct, mobility, but it did not possess adequate person separation when assessed individually. Deleting the mobility-related items restored unidimensionality, but additional items misfit, necessitating item reduction. Finally, a 17-item IVI_C possessed good measurement precision (person separation, 2.04), was unidimensional (albeit not purely), and consisted of items that fit the Rasch model and were well targeted to the participants' VRQoL (targeting 0.76 logits). There was no statistically significant difference in the VRQoL across subgroups stratified by age, sex, type of school, cause of VI, duration of vision loss, and severity of VI (p0.05 for all).The revised 17-item IVI_C is shorter and has better psychometric properties than the original version in school-aged children with VI in India, and the responses are unrelated to sociodemographic and clinical variables. Although it has the potential for use in cross-sectional and outcomes research in children with VI, caution should be exercised while interpreting the 17-item IVI_C scores given the presence of slight multidimensionality.

PURPOSE Visual impairment (VI) negatively affects quality of life (QoL). Utilities represent a way of measuring the QoL impact associated with a particular health state, like VI, and are also useful in economic evaluations of health care interventions. Utilities can be determined either directly or indirectly. Here we determine whether the Vision and Quality of Life Index, VisQoL (indirect approach), is acceptable to use in patients with VI in an urban setting in South India; whether the VisQoL utility values, derived from an Australian sample of both visually impaired and normally sighted participants, demonstrate agreement (if any) with direct utilities, determined by time trade-off (TTO), from visually impaired South Indian patients; and determine the relationship between utilities and self-reported visual disability. METHODS Three hundred forty-nine adults with VI were administered the two-item TTO item, six-item VisQoL, and the 16-item Andhra Pradesh Eye Disease-Visual Function Questionnaire (APEDS-VFQ) in a face-to-face interview. The VisQoL utilities were derived from the utility scoring algorithm. Rasch-scaled scores of the APEDS-VFQ were obtained using the conversion scores sheets. Agreement between TTO and utilities VisQoL was assessed using the Bland-Altman method. RESULTS All participants (response rate, 100%) completed the VisQoL as compared with 72% for the TTO. There was no statistically significant difference in the mean utilities from the two methods (0.65 ± 0.31 by TTO vs. 0.66 ± 0.27 by VisQoL, p = 0.67). However, the 95% limits of agreement on the Bland-Altman plot were wide (-0.65, 0.67), implying a lack of agreement between the methods. The VisQoL relates relatively strongly with APEDS-VFQ as compared with TTO (TTO vs. APEDS-VFQ, r = -0.23, VisQoL vs. APEDS-VFQ, r = -0.66, z = -6.70; p < 0.001 for both). Older participants, female, and those with less than 12 years of education had lower utilities. CONCLUSIONS The direct (TTO) and indirect (VisQoL) methods of utility evaluation tend to disagree in our patients with VI. Given the high completion rates of the VisQoL as compared with the TTO, the VisQoL may be a suitable alternative for utility assessment in an Indian population.

PURPOSE: To explore the psychometric properties of the revised Olweus Bully/Victim Questionnaire (OBVQ) in children with visual impairment (VI) using Rasch analysis. METHODS: One hundred fifty Indian children with VI between 8 and 16 years (mean age, 11.6 years; 69% male; mean acuity in the better eye of 0.80 logMAR [Snellen, 20/126]) were administered the revised OBVQ. The 40-item revised OBVQ was developed to assess victimization (i.e., being bullied) and bullying (bullying others) in normally sighted schoolchildren. Only 16 items are used for Rasch analysis and are divided into two parts: I (victimization, eight items) and II (bullying others, eight items). Separate Rasch analysis was conducted for both parts, and the psychometric properties investigated included behavior of rating scale, extent to which the items measured a single construct (unidimensionality by fit statistics and principal component analysis [PCA] of residuals); ability to discriminate among participants' victimization and bullying behaviors (measurement precision as assessed by person separation reliability [PSR] minimum recommended value, 0.80); and targeting of items to participants' victimization and bullying. RESULTS: Response categories were misused for both parts I and II, which required repair before further analysis. Measurement precision was inadequate for both parts (PSR, 0.64 for part I and 0.19 for part II), indicating poor discriminatory ability. All items fit the Rasch model well in part I, indicating unidimensionality that was further confirmed using PCA of residuals. However, an item misfit in part II that required deletion following which the remaining items fit and PCA of residuals also supported unidimensionality. Targeting was -0.58 logits for part I, indicating that the items were matched well with the participants' victimization. By comparison, targeting was suboptimal for part II (-1.97 logits). CONCLUSIONS: In its current state, the revised OBVQ is not a valid psychometric instrument to assess victimization and bullying among children with VI. Language: en

Previous Rasch analysis of the Andhra Pradesh Eye Disease Study-Visual Function Questionnaire (APEDS-VFQ) lacked comprehensiveness, specifically, dimensionality (whether it measures single/multiple constructs). Therefore, using the Rasch model this study provides a detailed assessment of psychometric properties of the APEDS-VFQ.A total of 351 visually impaired adults (mean age, 43.3 years) were verbally administered the APEDS-VFQ. Rasch analysis was used to assess the psychometric properties of the instrument.Participants could distinguish only three categories of difficulty, so response categories were reduced from five to three. A single item ("reading small prints in newspaper/magazines", infit mean square 1.54) misfit the model. The overall pattern of fit statistics for item and person measures suggested that the underlying construct (visual ability) is not unidimensional. When the items were grouped into subsets based on functional requirements (resolution, contrast sensitivity, illumination and peripheral vision) and separate person measures were estimated for each of these domains, the first principal component contained the visual ability and accounted for 72% of the variance. Item measure distributions could be divided into 18 strata, and item-separation reliability was 0.99. Person measures could be divided into three statistically distinct strata and the person-separation reliability was 0.81.The APEDS-VFQ is a precise measure of visual ability in visually impaired adults in India. Similar to other visual function questionnaires developed for the Western population, our results demonstrate that visual ability is a two-factor composite latent variable; one dimension heavily influences reading and the other most heavily influences peripheral vision (mobility).

To examine the psychometric characteristics of the World Health Organization Quality of Life instrument—modified Indian version (modified WHOQOL) and its subscales in adults with visual impairment (VI) using Rasch analysis. Cross-sectional data were of people aged ≥40 years with VI (n = 1,333) who responded to the modified WHOQOL in the Andhra Pradesh Eye Disease Study, India. Rasch analysis was used to explore the instrument and its subscales for key indices such as measurement precision by person separation reliability, PSR (i.e., discrimination between strata of participants’ health-related QOL [HRQOL], recommended minimum value 0.8), unidimensionality (i.e., measurement of a single construct), and targeting (i.e., matching of item difficulty to participants’ HRQOL). Rasch-guided iterative approach including category re-organization to enable threshold ordering and item deletion to overcome multidimensionality resulted in a unidimensional 9-item WHOQOL and a 6-item level of independence (LOI) subscale with adequate PSR (0.81 and 0.82, respectively). Targeting was sub-optimal for both (−1.58 logits for WHOQOL and −2.55 logits for the subscale). Remaining subscales were dysfunctional. The WHOQOL and LOI subscale can be improved and shortened, and the Rasch-revised versions are likely to assess the HROQL of VI patients best because of their brevity, reliability, and unidimensionality.

Aim To investigate the psychometric properties of the three scales (general functioning, psychosocial impact, visual symptoms) of the Indian vision function questionnaire (INDeVFQ) using the Rasch measurement model. Methods 236 visually impaired patients referred to vision rehabilitation centres were administered the 33item INDeVFQ. Rasch analysis was used to investigate the scales for the following properties: precision by person separation (ie, discrimination between strata of patient ability, recommended minimum value 2.0), unidimensionality (ie, measurement of a single construct) and targeting (ie, matching of item difficulty to patient ability). Results Only the general functioning scale possessed adequate measurement precision (person separation 3.49). However, it lacked unidimensionality as some items did not contribute towards the measurement of a single construct indicating a secondary dimension. This comprised seven mobility items, which formed a separate valid subscale with good targeting (� 0.57 logits). Deleting these items restored unidimensionality but a misfitting item required removal. Following this the 13 items fit and were visual functioning related. However, targeting was suboptimal (� 1.13 logits). Conclusions The general functioning scale of the INDeVFQ consists of two separate unidimensional constructs: visual functioning and mobility. Both these Rasch scaled versions with good psychometric properties are effective tools for the assessment of visually impaired patients in India.

Purpose: Many questionnaires for the measurement of visual impairment exist. One, the Houston Vision Assessment Test (HVAT), takes a different approach: the patient is asked to rate overall impairment and the proportion attributed to vision, then through multiplication the visual and non-visual (physical) impairments are calculated. The purpose of this study was to determine whether the scores derived from this approach can be considered to be measures. Methods: The participants were 193 cataract patients awaiting surgery (mean age 74.1 ± 9.8 years, 54 per cent female and 53.6 per cent were awaiting first eye surgery), who self-administered the HVAT, which consists of 10 questions, whereby impairment on each activity and the proportion attributable to vision is rated. Therefore, total, visual and physical impairments are calculated. For each question, multiplying the impairment (five response categories) by the proportion due to eyesight (five categories) gives 10 possible levels of visual impairment. Assessment of the multiplicative rating scales included frequency of category use and hierarchical ordering of response categories using category thresholds. Summary statistics of Rasch analysis were generated for the rating scale and overall questionnaire performance. Results: In the multiplicative scale, higher response categories were under-utilised and thresholds were disordered, indicating that the categories did not function as intended. Some of the dysfunction arose from disordered thresholds in the ‘proportion due to eyesight scale’, but repairing this gave little improvement to the multiplicative scale. The ill-defined nature of the disordered categories precluded further repair by combining categories. Measurement precision, as indicated by person separation reliability, was poor (0.70). Conclusion: Rasch analysis demonstrated that the categories of the multiplied rating scale of the HVAT were not ordered, as the user would expect; this precludes measurement. This provides evidence against the use of multiplicative rating scales in quality-of-life questionnaires. It would be better to use a single rating scale for each construct of interest.

Purpose: To determine whether the eight subscales of the Refractive Status and Vision Profile (RSVP) questionnaire provide valid measurement. Methods: Two hundred patients, recruited from a refractive surgery clinic and general optometric practice, self-administered the 42-item RSVP questionnaire. Psychometric properties investigated included measurement of a single construct (unidimensionality), item fit to construct, measurement precision (represented by person separation), targeting of item difficulty to patient’s quality of life (QOL), and differential item functioning. Results: Only two subscales (“concern” and “driving”) showed adequate person separation, indicating that they could discriminate patients’ QOL. However, both demonstrated poor targeting (7.02 logits for “driving” and 1.11 logits for “concern”). One-third of items in each subscale suffered from differential item functioning. Conclusions: None of the RSVP subscales are valid for assessment of QOL in patients with refractive error, thereby indicating the RSVP should be considered as a single questionnaire without subscales.

Purpose We assess parent-child agreement regarding child's health-related quality of life (HRQoL) in children operated for congenital glaucoma (CG). Methods A total of 121 children aged 8 to 18 years (mean age, 11.8 years) operated for CG (mean duration since surgery, 10.2 years) and their parents (mean age, 36.5 years) completed the child and parent versions of the Kidscreen-27 questionnaire, respectively. Psychometric properties of Kidscreen-27 were assessed using Rasch analysis, and child-parent agreement regarding child's HRQoL was investigated using the Bland-Altman limits of agreement (LoA) method. Results Minor modifications in the rating scale and deletion of few misfitting items resulted in a psychometrically robust Kidscreen-23 questionnaire. Average parental HRQoL score was higher than the child's own ratings, with a significant difference between their scores (mean ± standard deviation [SD] difference = 0.53 ± 2.58 logits, P = 0.02; lower LoA [95% CI], -4.52 [-5.31 to -3.72] and upper LoA [95% CI], 5.58 [4.79-6.38]). The range of child-parent agreement was wide and bidirectional, with parents tending to underestimate and overestimate their child's HRQoL. Younger children and girls showed greater discordance in their HRQoL with parental reports than adolescents and boys, respectively. Conclusions Discordance between CG child's self-report of HRQoL and parent's report indicate that both groups perceive the broader impact of living with CG very differently. Translational relevance The HRQoL as reported by the child with CG and by his/her parent should be viewed as being complementary, rather than interchangeable. Both assessments should be taken into account in clinical practice and research studies.

Purpose To test the assumption that the National Eye Institute Visual Function Questionnaire (NEI VFQ) measures visual functioning, assess the validity of its subscales, and, if flawed, revise the questionnaire and derive a shortened version with sound psychometric properties. Setting Flinders Medical Centre, Adelaide, Australia. Methods Patients from the cataract surgery waiting list self-administered and completed the 39-item NEI VFQ (NEI VFQ-39). Rasch analysis was applied, and the psychometric performance of the entire questionnaire and each subscale was tested. Instrument revision was performed in the context of Rasch analysis statistics. Results Five hundred thirty-six patients (mean age 73.8 years) completed the questionnaire. Response categories for 2 question types were not used as intended so dysfunctional categories were combined. The NEI VFQ-39 and the 25-item version (NEI VFQ-25) had good precision but evidence of multidimensionality (more than 1 construct in 1 score), questions that did not fit the construct, suboptimum targeting of item difficulty to person ability, and dysfunctional subscales (8 NEI VFQ-39; 12 NEI VFQ-25). Questions could be reorganized into 2 constructs (a visual functioning scale and a socioemotional scale) that, after misfitting questions were removed, gave valid measurement of each construct and preserved 3 subscales. Removing redundancy from these long-form subscales yielded valid short-form scales. Conclusions Several NEI VFQ subscales were not psychometrically sound; as an overall measure, it is flawed by multidimensionality. This was repaired by segregation into visual functioning and socioemotional scales. Valid long and short forms of the scales could enhance application of the questionnaire. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose To examine the psychometric properties of the Visual Activities Questionnaire (VAQ) and each of its subscales in a modern cataract population using Rasch analysis and if flawed, to revise the VAQ and create a valid measure that maximizes its measurement properties. Setting Flinders Eye Centre, Flinders Medical Centre, Adelaide, Australia. Methods Patients with cataract in 1 or both eyes drawn from the surgical waiting list were mailed the 33-item VAQ for self-administration. The following were examined for the entire questionnaire and each subscale: whether items measured a single construct (unidimensionality), the behavior of response categories, the ability to differentiate between patients' visual abilities (person separation), matching of item difficulty to participant ability (targeting), and whether items function similarly across subgroups of participants (differential item functioning [DIF]). Results The VAQ was completed by 561 patients. Response categories were used as intended. The VAQ discriminated the visual ability of the population (person separation, 4.88) but had suboptimum targeting, misfitting items, significant multidimensionality, DIF, and 4 dysfunctional subscales. Elimination of items causing multidimensionality resulted in a reduced 13-item VAQ that met all validity criteria for satisfactory instrument performance. Only 1 valid subscale (peripheral vision) could be preserved in the 13-item VAQ. Conclusions The VAQ in its native form was multidimensional and contained subscales with poor psychometric properties. The revised unidimensional 13-item VAQ was more appropriate for application in cataract outcomes assessment. Ideally, more items should be included to improve the targeting of item difficulty to more able cataract patients.

Purpose: The Impact of Cataract Surgery (ICS) questionnaire was designed to assess cataract surgery outcomes. The aim of this study was to describe the psychometric properties of the ICS questionnaire using the Rasch model in a cataract population. Methods: Ninety-one patients waiting to undergo cataract surgery in the first or second eye at the Flinders Medical Centre, Adelaide, South Australia self-administered the four-item ICS questionnaire. Rasch analysis was performed to assess behaviour of response categories, ability to differentiate between participants’ visual abilities (person separation; minimum acceptable 2.0), if items measure a single underlying construct [i.e. unidimensionality assessed by fit statistics and further by principal components analysis (PCA)] and matching of item difficulty to participant ability (targeting; ideal

Purpose: The 5-item Cataract Symptom Score (CSS) was developed using classical test theory to determine appropriate timing for cataract surgery, its outcomes, and whether the symptoms included bother cataract patients. The purpose of this study was to investigate the psychometric properties of the 5-item CSS using Rasch analysis. Methods: Responses from 113 patients awaiting cataract surgery to the 5-item CSS (bothered by double or distorted vision, glare or halos, blurry vision, colors looking different and worsening of vision) were subjected to Rasch analysis. The use of response categories (threshold order), ability of CSS to discriminate between participants' severity of symptoms (person separation, recommended minimum value 2.0), matching of item difficulty to severity of symptoms (targeting), and ability of items to measure a single construct (unidimensionality) were investigated. Results: Participants used the response categories as intended. However person separation (1.74) was inadequate, suggest...

Purpose. To validate visual disability questionnaire (VDQ) in patients with low vision in India, and explore whether the two latent traits “importance” and “difficulty” associated with performance of daily activities are valid and independent constructs. Methods. The VDQ consisting of 25 items was administered verbally to 137 subjects with low vision aged 16 to 89 years. Responses for each item were rated for importance and difficulty using a 5-category Likert scale. Rasch analysis was used to estimate interval measures of response ratings. Results. Subjects could discriminate only three response categories for importance and difficulty. Content validity was demonstrated by good separation indices for importance (4.24 and 2.59 for the item and person parameters, respectively) and difficulty ratings (7.64 and 3.33, respectively). High reliability scores were recorded for importance (0.95 and 0.87) and difficulty ratings (0.98 and 0.92). The most important items were “grooming” (1.15 logits) and “reading newspaper” (0.97 logits). Although “threading a needle” was the least important item (2.79 logits), it was the most difficult task (3.13 logits). The least difficult item was moving around in familiar places (2.51 logits). A poor correlation was observed between the item measures (r 0.19, p 0.34) and also between person measures (r 0.18, p 0.03) of importance and difficulty. Conclusions. The VDQ is a valid questionnaire with importance and difficulty ratings found to be independent constructs. This questionnaire could be used to prioritize the goals for rehabilitation intervention in patients with low vision. (Optom Vis Sci 2009;86:E826–E835)

PurPose: The Adaptation to Age-related Vision Loss (AVL) scale was developed to measure the adjustment of older adults who are adapting to late-life vision loss. The purpose of this study was to assess whether the AVL scale satisfies the Rasch model in a cataract population. Methods: The 24-item AVL scale (18 negatively and 6 positively coded) was mailed to 436 cataract patients for self-administration whilst they were on the waiting list for cataract surgery at the Flinders Eye Centre, Adelaide, South Australia. Rasch analysis was performed to determine whether the items were measuring a single construct (unidimensionality) as examined with fit statistics and principal components analysis (PCA) of the residuals. The ability of the scale to distinguish between the levels of adaptation of the participants (person separation) was investigated, with a value ≥ 2.0 established as the minimum acceptable. results: The AVL scale was unable to differentiate sufficiently between participants’ levels of adaptation, indicating poor person separation. One item did not fit the construct, causing misfit. Furthermore, the five positively worded items did not appear either to measure the same construct as other items, resulting in lack of unidimensionality evidenced by PCA. Following the deletion of these items, the AVL scale was one-dimensional but a single item continued to misfit, so it had to be deleted, resulting in an 18-item AVL scale. Even so, the discriminating abilities of the scale continued to be poor. ConClusions: The AVL scale is not an appropriate measure of adaptation to vision loss in a cataract population. (J Optom 2009;2:142-147 ©2009 Spanish Council of Optometry)

People suffering from low vision, a condition caused by a variety of eye-related diseases and/or disorders, find their ability to read greatly improved when text is magnified between 2 and 6 times. Assistive devices currently on the market are either geared towards reading text far away (∼20 ft.) or very near (∼2 ft.). This is a problem especially for students suffering from low vision, as they struggle to flip their focus between the chalkboard (far-field) and their notes (near- field). A solution to this problem is of high interest to eye care facilities in the developing world - no devices currently exist that have the aforementioned capabilities at an accessible price point. Through consultation with specialists at L.V. Prasad Eye Institute in India, the authors propose, design and demonstrate a device that fills this need, directed primarily at the Indian market. The device utilizes available hardware technologies to electronically capture video ahead of the user and zoom and display the image in real-time on LCD screens mounted in front of the user's eyes. This design is integrated as a wearable system in a glasses form-factor.

PURPOSE To evaluate the outcomes of multidisciplinary low vision rehabilitation (LVR) in adults with low vision (LV) in India using the Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ-48) and the Impact of Vision Impairment (IVI) questionnaire. METHODS Consecutive adults with LV referred for the first time to the Centre for Sight Enhancement were administered the 28-item IVI and VA LV VFQ-48 before and after LVR (4 months). Rasch-scaled scores were generated for the IVI and the VA LV VFQ-48 along with each of their subscales at both the time points. Effect size (ES) was calculated using Cohen's d coefficient. RESULTS Two hundred fifty-five patients completed the LVR program. Following LVR, the linear measures revealed significant improvements in vision-related quality of life (VRQoL) using the IVI at follow-up (P < 0.0001), with large ES for reading and accessing information (ES = 1.0) and relatively moderate ES for overall IVI (ES = 0.63) and mobility subscale (ES = 0.53). No significant improvement was found on emotional well-being subscale (ES = 0.18; P = 0.06). Similarly, significant improvements in VRQoL (P < 0.0001) were found for the VA LV VFQ-48 at follow-up, albeit moderate ES for the overall visual ability (ES = -0.67) and its subscales (reading [ES = -0.72], mobility [ES = -0.45], visual information [ES = -0.47), visual motor [ES = -0.54]). CONCLUSIONS Regardless of the instrument used for assessment, our multidisciplinary LVR program resulted in statistically significant improvements in visual functioning and VRQoL of those adults with LV deemed appropriate for intervention (dropout rates were high); however, the improvements were modest, and the clinical relevance of these small improvements may be limited. Nonetheless, further studies should attempt to increase the completion rates in order to draw strong inferences.

Purpose The aim of the study was (1) to determine the need for spectacles in children in Southern India with coloboma, microphthalmos and microcornea, (2) to describe their refractive errors and (3) to assess their needs for low vision aids (LVAs). Methods Children with congenital eye anomalies were recruited from special education for the blind, schools for the mentally handicapped, community-based rehabilitation programmes and hospital records in Andhra Pradesh, India. All those with at least light perception vision (PU in one eye and who had navigational vision were refracted. Those whose distance vision in their better eye improved with refraction were prescribed spectacles. Those unable to read NI0 were assessed for LVAs for near. Those with distance visual acuity of < 6/18 in the better eye were assessed for telescopes to aid distance vision. Results Ninety-nine children with coloboma, microcornea or microphthalmos had functional vision. Eight unilateral cases were excluded. Ninety-one bilateral cases were refracted and assessed for LVAs. The vision in 52 children (57%) improved in the better- seeing eye by 1 or more lines of Snellen acuity with spectacles. Spectacles were prescribed most frequently for myopia associated with choroidal coloboma. After refraction, all 19 children with a visual acuity of 6/18 or better could read NI0, and 43 of the 72 children (60%) with a visual acuity of

PURPOSE: To evaluate the extent of visual recovery after multi-disciplinary approach of treatment in serious ocular injuries; to determine the prognostic factors associated with poor final visual outcome and suggest adequate precautionary measures. METHODS: A retrospective analysis of 325 consecutive patients with direct ocular trauma who were examined and treated at a tertiary eye care centre in South India over a 3-year period was undertaken. RESULTS: Males (86.8%) outnumbered the females (13.2%) and children ( Language: en

The authors describe a case of an endocapsular hematoma that occurred in a 69-year-old Pseudophakic diabetic male following mitomycin C (MMC) augmented trabeculectomy for neovascular glaucoma (NVG). The clinical course of the patient is described, and the unique features of this case are presented and discussed. The endocapsular hematoma absorbed in 6 weeks with conservative management. The patient regained the preoperative visual acuity of 20/30, and his intraocular pressure was controlled without any glaucoma medication. The iris neovascularization regressed. This case is the first report of an endocapsular hematoma following glaucoma filtering surgery in a Pseudophakic eye with neovascular glaucoma. [Ophthalmic Surg and Lasers 1999;30:389-393.]

* BACKGROUND AND OBJECTIVE: To evaluate long-term intraocular pressure (1OP) control and visual outcome of patients with phacolytic glaucoma. * PATIENTS AND METHODS: Forty-five consecutive eyes of 45 patients with phacolytic glaucoma operated on between January 1990 and December 1995 and who had completed at least 1 year of followup were included in the study. Of the 45 eyes, 17 eyes underwent extracapsular cataract extraction (ECCE) with primary posterior chamber intraocular lens (PC IOL) implantation (group 1). The rest of the eyes (n = 28) underwent only ECCE (group 2) in view of satisfactory aphakic vision in the contralateral eye. Preoperative IOP, visual acuity, and anterior segment appearance were compared with postoperative data. * RESULTS: IOP was controlled (IOP < 21 mm Hg) in all of the patients without any antiglaucoma medication, with a mean follow-up of 29.11 ± 16.25 months (range 12 to 60) and 43.2 ± 21.5 (12 to 78) months in groups 1 and 2, respectively. The IOP remained controlled without antiglaucoma medication even in the patients where the desired visual recovery was not obtained due to glaucomatous disc damage because of delayed presentation (2 to 3 weeks or more). A visual acuity of 20/40 or better was achieved in 76.5% and 60.7% in groups 1 and 2, respectively. Eighteen of the 45 patients initially presented with light perception without projection. Eight of these 1 8 patients (44%) regained a visual acuity of 20/40 or better. There was no significant intraoperative and postoperative complication in any patient. * CONCLUSIONS: ECCE with or without primary PC IOL implantation is safe and curative in patients with phacolytic glaucoma. The addition of trabeculectomy to cataract extraction seems to be superfluous in the control of IOP in patients with phacolytic glaucoma operated on within 2 to 3 weeks of the onset of symptoms. Light perception without projection is not a contraindication for cataract surgery in phacolytic glaucoma. [Ophthalmic Surg Lasers 1998;29:880-889.]

Purpose To determine the visual success outcomes following treatment in an urban private eye hospital in India. Methods A retrospective survey was done of 4122 consecutive files of fee-paying patients admitted to a private eye hospital in Hyderabad during a 3-month period in 1996. Data obtained a minimum of 4 months after completion of treatment included age, sex, diagnosis and distance visual acuity in the best eye. Results After completion of treatment 86.5% of patients had normal vision, 10.9% had low vision and 2.5% were blind. Of the people with low vision or blindness after treatment, 81.7% had a best corrected visual acuity of between 6/18 and 6/60. The 4 most common causes of low vision after treatment were unoperated cataract (20.4%), glaucoma (13.3%), diabetic retinopathy (12.4%) and retinitis pigmentosa (10.2%). Conclusion The visual success rates in an urban Indian private eye hospital appear high with nearly 90% of patients achieving normal vision after the completion of treatment.

A healthy child was brought to our emergency department 2 h after birth with a diagnosis of suspected unilateral congenital glaucoma of the left eye. There was a history of forceps assisted delivery. Examination showed conjunctival chemosis, congestion and corneal oedema, more prominent centrally and paracentral vertical fold across the diameter of the cornea (figure 1). The right …

We determined if the Impact of Vision Impairment (IVI) is a valid questionnaire to measure the vision-related quality of life (VRQoL) in keratoconus patients, and investigated if the VRQoL varied with disease severity in this sample.WE RECRUITED 160 CONSECUTIVE BILATERAL KERATOCONUS PATIENTS (MEAN AGE 23.3 YEARS, 63% MALE) FROM AN INDIAN TERTIARY EYE CARE CENTER. PARTICIPANTS UNDERWENT A CLINICAL EXAMINATION AND COMPLETED THE IVI. PARTICIPANTS WERE DIVIDED INTO THREE GROUPS BASED ON THE AVERAGE OF THE STEEP KERATOMETRY (K) READINGS: mild (average Sim K45 diopters [D]), moderate (average Sim K 45-52 D), and severe (average Sim K52 D). Rasch analysis was used to validate the IVI and the VRQoL scores thus obtained were compared across the disease groups.THE MAJORITY (63%) OF PATIENTS HAD SEVERE, WHILE THE REMAINDER (37%) HAD MODERATE KERATOCONUS. RASCH ANALYSIS DEMONSTRATED THE VALIDITY OF THE IVI TO ASSESS VRQOL THROUGH TWO SUBSCALES: vision-specific functioning (VF) and emotional well-being (EWB). There was no significant difference in VF (mean change -0.16, P = 0.55) and EWB scores (mean change -0.32, P = 0.23) between moderate and severe keratoconus groups.The revised IVI subscales have interval-level measurement properties, which support their suitability to measure VRQoL in this keratoconus sample. Patients with moderate or severe keratoconus had similar, but higher VRQoL scores as assessed by the revised IVI subscales, indicating lack of impact of the disease on their VRQoL. However, this does not exclude the possibility of finding an impact in other populations.

Purpose The L. V. Prasad-Functional Vision Questionnaire (LVP-FVQ) was developed using Rasch analysis to assess self-reported difficulties in performing daily tasks in school children with visual impairment (VI) in India. However, the LVP-FVQ has psychometric problems of inadequate measurement precision and lack of detailed assessment of dimensionality. Furthermore, items pertaining to use of technology are lacking. The aim of this study was to present the development and validation of the second version of LVP-FVQ (LVP-FVQ II). Methods Development of LVP-FVQ II involved extracting items from other similar questionnaires (albeit developed for Western populations) and focus group discussions of children with VI and their parents that resulted in a 32-item pilot questionnaire. Overall, six items from the LVP-FVQ were retained. The questionnaire underwent pilot testing in 25 such children, following which a 27-item LVP-FVQ II emerged, and this was administered to 150 children with VI. Response to each item was rated on a three-category scale. Rasch analysis was used to validate the LVP-FVQ II. Results Rating scale was used by participants as was intended to. Four mobility-related items required deletion, as these did not contribute toward measurement of a single construct, indicating a secondary dimension. Deletion of the four items resulted in the 23-item unidimensional LVP-FVQ II, with good measurement precision, effective targeting of item difficulty to participant ability, and lack of notable differential item functioning. The LVP-FVQ II has high reliability, indicating that it is effectively able to discriminate between visual disability of school children in India, and is valid across age, gender, duration of VI, and location of residence. Conclusions Given the superior measurement properties and the interval-level scores, the LVP-FVQ II appears to offer advantages over LVP-FVQ in assessment of difficulties in performing daily tasks in this population. It can be adapted for use in other developing countries.

PURPOSE To evaluate the impact of glaucoma on visual functioning in Indians. METHODS Patients attending the glaucoma service who had undergone a comprehensive glaucoma evaluation were recruited. Better mean deviation (MD, using Humphrey Field Analyzer program 24-2) between two eyes was used to classify participants into mild, moderate, and severe visual field (VF) loss groups. Participants were administered the Glaucoma Quality of Life-15 (GQL-15) questionnaire. Rasch analysis was used to validate the GQL-15 and its four subscales. Linear regression was used to determine associations between GQL-15 scores and VF loss after adjusting for sociodemographic variables. RESULTS A total of 198 patients (mean age ± SD, 59.8 ± 12.3 years; 67% male) were recruited. Participants with severe VF loss (39%) followed by mild loss (35%) comprised the largest group. Rasch analysis resulted in a 10-item reliable and valid questionnaire: the Glaucoma Activity Limitation-10 (GAL-10). Although a single subscale, "peripheral vision," met requirements of the Rasch model, it could not be preserved in the GAL-10. In multivariate analyses, the middle-income group (compared with higher income) and severe VF-loss (compared with mild VF-loss) participants reported significantly poorer functioning on GAL-10 ([β = 0.84; 95% confidence interval (CI), 0.16-1.52; P = 0.02] and [β = 1.19; 95% CI, 0.61-1.78; P < 0.000], respectively). None of these associations were, however, clinically significant. CONCLUSIONS Glaucoma patients in India, especially those with severe VF loss, face significant challenges in performing daily tasks and in mobility. It is important to prevent progression such that activity limitation is minimized in glaucoma patients.

PURPOSE Both the long form visual functioning scale (LFVFS(39)) and visual functioning scale (VFS) are measures of visual functioning (VF) that represent the Rasch-scaled versions of the NEI-VFQ(39) and the Indian vision function questionnaire (IND-VFQ), respectively. The objectives of this study were to investigate if the 15-item LFVFS(39) and 13-item VFS of the IND-VFQ meet the assumptions of the Rasch model and measure the same construct, VF, in an Indian visually impaired (VI) population. METHODS Data from 120 VI adults administered both instruments concurrently, were fitted to the Rasch measurement model to demonstrate that each instrument satisfies the assumptions of the model (including unidimensionality by principal components analysis); and both instruments can be cocalibrated onto a single underlying continuum of VF. RESULTS Both instruments required category reorganization for optimal rating scale functioning and possessed similar measurement precision (person separation = 2.76). Separate analysis of each instrument (eigenvalues, 2.3 and 1.9 for LFVFS(39) and VFS of IND-VFQ, respectively) and the pooled 28-item analyses (eigenvalue, 2.8) satisfied the assumptions of the Rasch model, including unidimensionality. Furthermore, all items fit in the separate and pooled analyses. Separate item and person measures for each instrument correlated strongly with estimates from the pooled data (r > 0.9 for all, P < 0.0001). CONCLUSIONS; Both the LFVFS(39) and VFS of the IND-VFQ measure the same construct, VF, and with equal measurement precision in an Indian VI population. Both instruments can be calibrated onto a single metric, thereby, enabling a comparison of their measurement range of VF.

Purpose: To investigate the effect of rating scale designs (question formats and response categories) on item difficulty calibrations and assess the impact that rating scale differences have on overall vision-related activity limitation (VRAL) scores. Methods: Sixteen existing patient-reported outcome instruments (PROs) suitable for cataract assessment, with different rating scales, were self-administered by patients on a cataract surgery waiting list. A total of 226 VRAL items from these PROs in their native rating scales were included in an item bank and calibrated using Rasch analysis. Fifteen item/content areas (e.g., reading newspapers) appearing in at least three different PROs were identified. Within each content area, item calibrations were compared and their range calculated. Similarly, five PROs having at least three items in common with the Visual Function (VF-14) were compared in terms of average item measures. Results: A total of 614 patients (mean age ± SD, 74.1 ± 9.4 years) participated. Items with the same content varied in their calibration by as much as two logits; “reading the small print” had the largest range (1.99 logits) followed by “watching TV” (1.60). Compared with the VF-14 (0.00 logits), the rating scale of the Visual Disability Assessment (1.13 logits) produced the most difficult items and the Cataract Symptom Scale (0.24 logits) produced the least difficult items. The VRAL item bank was suboptimally targeted to the ability level of the participants (2.00 logits). Conclusions: Rating scale designs have a significant effect on item calibrations. Therefore, constructing item banks from existing items in their native formats carries risks to face validity and transmission of problems inherent in existing instruments, such as poor targeting. Refereed/Peer-reviewed

This case documents unilateral congenital glaucoma associated with congenital lower lid entropion. A 2-year-old female infant was referred for evaluation and treatment of right-side buphthalmos caused by congenital glaucoma associated with bilateral congenital lower lid entropion that was prominent on the right side and present at birth. Examination disclosed a lower eyelid entropion of the right side that was treated surgically by reinserting the disinserted retractor aponeurosis to anterior inferior tarsal border. After three weeks, the patient was successfully treated with primary combined trabeculotomy-trabeculectomy for congenital glaucoma. The entropion of the left lower lid was asymptomatic and did not require any surgery. Buphthalmos caused by congenital glaucoma may be associated with congenital lower lid entropion and the association may be causal or coincidental. [Ophthalmic Surg Lasers 2001;32:149-151]