December 2012
Volume 53, Issue 13
Free
Letters to the Editor  |   December 2012
Author Response: Validation of the National Eye Institute Visual Function Questionnaire-25 (NEIVFQ-25) in Age-Related Macular Degeneration
Author Affiliations & Notes
  • Peggy Orr
    Retina Division, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • Anne M. Rentz
    United BioSource Corporation, Center for Health Outcomes Research, Bethesda, Maryland; and
  • Mary Kay Margolis
    United BioSource Corporation, Center for Health Outcomes Research, Bethesda, Maryland; and
  • Dennis A. Revicki
    United BioSource Corporation, Center for Health Outcomes Research, Bethesda, Maryland; and
  • Chantal M. Dolan
    Genentech, Inc., South San Francisco, California.
  • Shoshana Colman
    Genentech, Inc., South San Francisco, California.
  • Jennifer T. Fine
    Genentech, Inc., South San Francisco, California.
  • Neil M. Bressler
    Retina Division, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
Investigative Ophthalmology & Visual Science December 2012, Vol.53, 7950. doi:10.1167/iovs.12-11224
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      Peggy Orr, Anne M. Rentz, Mary Kay Margolis, Dennis A. Revicki, Chantal M. Dolan, Shoshana Colman, Jennifer T. Fine, Neil M. Bressler; Author Response: Validation of the National Eye Institute Visual Function Questionnaire-25 (NEIVFQ-25) in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(13):7950. doi: 10.1167/iovs.12-11224.

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      © ARVO (1962-2015); The Authors (2016-present)

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We appreciate the opportunity to respond to the letter written by Khadka, McAlinden, and Pesudovs. 1 They are correct that we do not report all aspects of validity of the NEI VFQ-25 and, in particular, we did not perform Rasch analyses. 2 The scope of our article, as mentioned in the objective, was to address the relationship between patient-reported data from the NEI VFQ-25 and more objective measures of visual function and performance, such as visual acuity, reading speed, and contrast sensitivity. By demonstrating convergent validity of these measures, we have additional evidence that when a patient states that she/he has difficulty performing vision-related everyday functions (such as reading newspaper print), she/he does have difficulty reading an eye chart or performing well on a reading speed test. To our knowledge, this is the largest study (N = 90) of this type of convergent validity among a group of patients diagnosed with age-related macular degeneration (AMD). 
Because the NEI VFQ-25, we believe, is the most widely-used patient-reported instrument in AMD studies, 3,4 we believe it is important to confirm these relationships in an appropriate patient-specific population. We support the value of Rasch analyses and believe that they represent another way of validating and understanding how instruments work. However, we believe that the traditional psychometric analyses, some of which are presented in our work, still have a place in providing evidence regarding the validity of measures. Of note, the composite scale of the NEI VFQ-25 has shown satisfactory psychometric properties in Rasch analyses 5 and, in a recent study comparing the scoring techniques of the Rasch analysis, the standard scoring method of the NEI VFQ-25, and the Massof technique, all three scoring methods were very highly correlated (>0.99), notwithstanding evidence of ceiling and floor effects in the standard scoring. 6,7 In addition, when the relevant appendix items are added to the near vision activities scale, its properties improve dramatically. 6 Note that in our study we used the 3 additional appendix items for the near and distance activities subscales. 2  
In summary, we believe that our report does provide evidence to support the validity of the NEI VFQ-25. Validation of a patient-reported measure is an ongoing process involving accumulating evidence on the psychometric characteristics from various sources, and with additional evidence there is more confidence in the measurement properties of the instrument. 
References
Khadka J McAlinden C Pesudovs K. Validation of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in age-related macular degeneration. Invest Ophthalmol Vis Sci . 2012;53:1276. [CrossRef] [PubMed]
Orr P Rentz AM Margolis MK Validation of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in age-related macular degeneration. Invest Ophthalmol Vis Sci . 2011;52:3354–3359. [CrossRef] [PubMed]
Matchar DB Suner IJ Samsa GP Measuring Quality of Life for Patients With Age-Related Macular Degeneration, Vol. 2012. Rockville, MD: Agency for Healthcare Research and Quality, 2006.
Finger RP Fleckenstein M Holz FG Quality of life in age-related macular degeneration: a review of available vision-specific psychometric tools. Qual Life Res . 2008;17:559–574. [CrossRef] [PubMed]
Marella M Pesudovs K Keeffe JE The psychometric validity of the NEI VFQ-25 for use in a low-vision population. Invest Ophthalmol Vis Sci . 2010;51:2878–2884. [CrossRef] [PubMed]
Dougherty BE Bullimore MA. Comparison of scoring approaches for the NEI VFQ-25 in low vision. Optom Vis Sci . 2010;87:543–548. [CrossRef] [PubMed]
Massof RW. An interval-scaled scoring algorithm for visual function questionnaires. Optom Vis Sci . 2007;84:689–704. [CrossRef] [PubMed]
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