Elsevier

Ophthalmology

Volume 110, Issue 12, December 2003, Pages 2285-2291
Ophthalmology

Development of the National Eye Institute refractive error correction quality of life questionnaire: Focus groups

https://doi.org/10.1016/j.ophtha.2003.08.021Get rights and content

Abstract

Objective

To identify the content area for a questionnaire designed to measure the vision-targeted, health-related quality of life for persons with well-corrected refractive error.

Design

Cross-sectional study.

Participants

Fifty-two focus groups were conducted with 414 patients from 5 geographically diverse ophthalmic and optometric sites to identify the content area of a questionnaire for use among persons with myopia and hyperopia.

Methods

A standard protocol was used to structure each focus group discussion, and groups were led by centrally trained moderators at each participating site. Results were summarized and analyzed using a standard set of codes. Qualitative and quantitative analyses were conducted.

Main outcome measure

Self-reported observations or comments about vision, vision correction, and other aspects of quality of life.

Results

Among the 414 participants, 9262 mentions of comments were recorded. The most frequent comments reported by participants were about types of vision correction, followed by comments with their own vision and vision-related symptoms. The distribution of comments by topic domain was generally similar across types of correction and type of refractive error. The most frequent specific comments about glasses concerned problems with reading, adjustment between near and far vision, and appearance. The most frequent comments about contact lenses included those on symptoms such as dry eyes, itching and tired eyes, and headaches, and negative comments about ease of use. The most frequent comments among patients with surgical correction concerned fewer driving problems; fewer symptoms; and improvement in vision, recreation, and comfort. Participants provided equal numbers of positive and negative comments about glasses. Twice as many positive as negative comments were given by contact lens wearers, and 4 times as many positive comments were provided by patients who had undergone surgical correction.

Conclusions

Using focus groups, we were able to identify content areas and aspects of visual functioning in persons with refractive error that are not measured by standard visual acuity testing in the clinic or by other vision-targeted, health-related quality of life instruments such as the 25- or 51-item National Eye Institute–Visual Functioning Questionnaire. The similarity of problems mentioned across refractive error type and correction method suggests it will be possible to develop a single questionnaire with adequate content validity to compare the impact of different modes of correction in vision-targeted, health-related quality of life.

Section snippets

Participating centers

Clinical sites for focus groups and pilot testing were selected in 1997 to insure geographic diversity, participation by both ophthalmologists and optometrists, and ability to recruit patients who met the eligibility criteria. The NEI-RQL focus groups were conducted at the ophthalmic or optometric practices of 5 academic medical centers, including The University of Alabama, Birmingham; The Massachusetts Eye and Ear Infirmary, Boston; The University of Illinois, Chicago; University of

Study population

Fifty-two focus groups were conducted from December 1997 through March 1998. Each focus group lasted from 1 to 2 hours. Table 1 provides a summary of the number of groups conducted and participants included in the analyses of focus groups, overall and by participating center. The focus groups consisted of a total of 414 participants, with a mean of 8 participants per group and a range of from 2 (one group only) to 15 participants. Two hundred forty-seven participants (60%) were myopes, 146

Discussion

Although focus groups have been successfully used in the design of the NEI-VFQ, a vision-targeted quality of life instrument16 the study population consisted of individuals with severe ophthalmic pathologies characterized by loss of central acuity, visual field, or both. During planning of this study, it was unknown whether people with eyes corrected to excellent levels of visual acuity as measured by standard tools such as Snellen acuity would experience enough problems related to functioning

Acknowledgements

This work was the joint product of many individuals. In particular, the authors recognize the contributions of focus group participants who generously shared their time and experiences. Technical Advisory Committee: Leon B. Ellwein, PhD, National Eye Institute; Anthony J. Adams, OD, PhD, University of California at Berkeley; Richard L. Abbott, MD, American Academy of Ophthalmology; A. Ralph Rosenthal, MD, Food and Drug Administration; Sally Shumaker, PhD, Wake Forest University School of

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    Reprint requests to NEIS Publications, The EMMES Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850-1707, USA. [email protected].

    The National Eye Institute was responsible for Technical Advisory Committee appointment and funded 90% of the project under a support contract (no. NO1-EY-6-2112) with The EMMES Corporation; additional funding was provided by the American Academy of Ophthalmology, Allergan, Inc., Bausch & Lomb, Inc., and others in industry.

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