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An evaluation of the Amblyopia and Strabismus Questionnaire using Rasch analysis

By Marta Vianya-Estopa, David B. Elliott and Brendan T. Barrett


noPURPOSE. To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia.\ud METHODS. The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality.\ud \ud RESULTS. Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional.\ud \ud CONCLUSIONS. The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus

Topics: Vision-related quality-of life (VR-QoL), Amblyopia and Strabismus Questionnaire (A&SQ), Psychosocial aspects, Employment, Stereo vision, Impact, Adults, Children, Validation, Surgery, Rasch analysis, REF 2014
Publisher: Association for Research in Vision and Ophthalmology
Year: 2010
DOI identifier: 10.1167/iovs.09-4381
OAI identifier:
Provided by: Bradford Scholars

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  2. Amblyopia & Strabismus Questionnaire: design and initial validation. doi
  3. (2007). Amblyopia and strabismus questionnaire (A&SQ): clinical validation in a historic cohort. Graefes Arch Clin Exp Ophthalmol. doi
  4. (2001). Applying the Rasch Model: Fundamental Measurement in the Human Sciences. London: Lawrence Erlbaum Associates;
  5. (2002). Binocular Vision and Ocular Motility: Theory and Management of Strabismus. doi
  6. Changes to control of adaptive gait in individuals with long-standing reduced stereoacuity. Invest Ophthalmol Vis Sci. doi
  7. Comparison of quality-of-life instruments in adults with strabismus. doi
  8. (1978). Congenital (infantile) esotropia: psychiatric aspects. J Pediatr Ophthalmol Strabismus.
  9. Consequences of amblyopia on education, occupation, and long term vision loss. doi
  10. Construct validation of the amblyopia and strabismus questionnaire (A&SQ) by factor analysis. Graefes Arch Clin Exp Ophthalmol. doi
  11. Detecting and evaluating the impact of multidimensionality using item fit statistics and principal component analysis of residuals.
  12. Development of a quality-of-life questionnaire for adults with strabismus. doi
  13. (2006). Does amblyopia affect educational, health, and social outcomes? doi
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  15. (2008). Effect of amblyopia on self-esteem in children. Optom Vis Sci.
  16. (2009). Grasping deficits and adaptations in adults with stereo vision losses. Invest Ophthalmol Vis Sci. doi
  17. (2010). Identifying amblyopia using associated conditions, acuity, and nonacuity features. doi
  18. Impact of large angle horizontal strabismus on ability to obtain employment. doi
  19. Maintaining instrument quality while reducing items: application of Rasch analysis to a self-report of visual function.
  20. Monocular and binocular reading performance in children with microstrabismic amblyopia. doi
  21. Negative social bias against children with strabismus. Acta Ophthalmol Scand. doi
  22. Opinion of headhunters about the ability of strabismic subjects to obtain employment. doi
  23. Opinions of dating agents about strabismic subjects’ ability to find a partner. doi
  24. Psychosocial aspects of mothers of children with strabismus. doi
  25. (1993). Psychosocial aspects of strabismus study. Arch Ophthalmol. doi
  26. (2006). Psychosocial impact of amblyopia and its treatment: a multidisciplinary study. Clin Exp Ophthalmol. doi
  27. (1997). Psychosocial implications of strabismus surgery in adults. J Pediatr Ophthalmol Strabismus.
  28. (2010). Reasonable mean-square fit values. Rasch Meas Trans.
  29. Strabismus and employment: the opinion of headhunters. doi
  30. Study of the psychosocial aspects of strabismus.
  31. The Activities of Daily Vision Scale for cataract surgery outcomes: re-evaluating validity with Rasch analysis. doi
  32. The amblyopia and strabismus questionnaire: English translation, validation, and subscales. doi
  33. The contribution of stereo vision to the control of braking. Accident Anal Prevent. doi
  34. (2007). The development, assessment and selection of questionnaires. Optom Vis Sci. doi
  35. (2008). The effect of amblyopia on fine motor skills in children. Invest Ophthalmol Vis Sci. doi
  36. (2007). The effects of strabismus on quality of life in adults. doi
  37. The emotional impact of amblyopia treatment in preschool children: randomized controlled trial. doi
  38. (2002). The measurement of vision disability. Optom Vis Sci.
  39. The negative psychosocial impact of strabismus in adults. doi
  40. The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. doi
  41. The psychosocial benefits of corrective surgery for adults with strabismus. doi
  42. The psychosocial effects of amblyopia study.
  43. (2004). The Quality of Life Impact of Refractive Correction (QIRC) Questionnaire: development and validation. Optom Vis Sci. doi
  44. (2006). The Refractive Status and Vision Profile: evaluation of psychometric properties and comparison of Rasch and summated Likert-scaling. Vision Res. doi
  45. (2001). The relevance of stereopsis for motorists: a pilot study. Graefes Arch Clin Exp Ophthalmol. doi
  46. (2006). The VF-14 and psychological impact of amblyopia and strabismus. Invest Ophthalmol Vis Sci.
  47. (2008). WINSTEPS Rasch measurement (computer program).

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