Quality assessment of ophthalmic questionnaires: review and recommendations

Optom Vis Sci. 2013 Aug;90(8):720-44. doi: 10.1097/OPX.0000000000000001.


Purpose: The aim of this article was to systematically review all the available ophthalmic patient-reported outcome (PRO) instruments (questionnaires) that demonstrated interval measurement properties to identify the instruments with the highest psychometric quality for use in different eye diseases and conditions.

Methods: An extensive literature review was carried out to identify all existing ophthalmic PRO instruments. Instruments were then excluded if they did not have demonstrable interval measurement properties; the remaining instruments were reviewed. The quality of the following psychometric properties was assessed: content development (initial item development process), performance of the response scale, dimensionality (whether the instrument measures a single construct), measurement precision, validity (convergent, concurrent, discriminant, and known groups), reliability (test-retest), targeting (whether the items are appropriate [e.g., difficulty level] for the population), differential item functioning (whether subgroups of people respond differently to an item), and responsiveness.

Results: The search identified 48 PRO instruments that demonstrated interval measurement properties, and these were relevant to nine applications: glaucoma, dry eye, refractive errors, cataract, amblyopia and strabismus, macular diseases, adult low vision, children low vision, and others. These instruments were evaluated against the psychometric property quality criteria and were rated for quality based on the number of criteria met.

Conclusions: This review provides a descriptive catalog of ophthalmic PRO instruments to inform researchers and clinicians on the choice of the highest-quality PRO instrument suitable for their purpose.

Publication types

  • Review

MeSH terms

  • Eye Diseases*
  • Humans
  • Ophthalmology / standards*
  • Outcome Assessment, Health Care / standards*
  • Psychometrics / instrumentation
  • Quality Assurance, Health Care / standards*
  • Quality of Life
  • Reproducibility of Results
  • Surveys and Questionnaires / standards*
  • Validation Studies as Topic