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Clinical science
Cataract Symptom Scale: clarifying measurement
  1. V K Gothwal1,2,
  2. T A Wright1,
  3. E L Lamoureux3,4,5,
  4. K Pesudovs1
  1. 1
    NH&MRC Centre for Clinical Eye Research, Department of Ophthalmology, Flinders Medical Centre and Flinders University of South Australia, Bedford Park, Adelaide, Australia
  2. 2
    Meera and L B Deshpande Centre for Sight Enhancement, LV Prasad Eye Institute, Hyderabad, India
  3. 3
    Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Australia
  4. 4
    Vision CRC, Sydney, Australia
  5. 5
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  1. Correspondence to Dr K Pesudovs, NH&MRC Centre for Clinical Eye Research, Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia; konrad.pesudovs{at}


Aim: Previous psychometric evaluation of the Cataract Symptom Scale (CSS) focused on classic assessments of reliability and validity. The aim was to investigate the psychometric properties of the CSS using the Rasch measurement model.

Methods: 243 patients drawn from the Flinders Eye Centre cataract surgery waiting-list self-administered the CSS. Rasch analysis was used to investigate the following properties of the CSS: measurement a single construct (unidimensionality), discrimination between strata of patient ability (person separation) and targeting of item difficulty to person ability.

Results: The CSS discriminated between four strata of patients. However, some items did not contribute towards measurement of a single construct, indicating a secondary dimension. This comprised three mobility items, which formed a separate valid subscale. Elimination of these items resulted in the CSS being a unidimensional measure. However, further item deletion was required, as symptoms items did not measure the same construct. The resultant nine-item measure was unidimensional.

Conclusions: The CSS consists of two separate unidimensional constructs: mobility and visual disability. The reduced nine-item measure has good psychometric properties and is unidimensional. The CSS is essentially a measure of visual disability, and not cataract symptoms as it is claimed to be.

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  • Funding This research was supported in part by National Health and Medical Research Council (Canberra, Australia) Centre of Clinical Research Excellence Grant 264620. Konrad Pesudovs is supported by National Health and Medical Research Council (Canberra, Australia) Career Development Award 426765.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Flinders Clinical Research Ethics Committee, Flinders Medical Centre, South Australia.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.