Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2017 Dec 1;135(12):1345-1351. doi: 10.1001/jamaophthalmol.2017.4574.
Administration of a brief questionnaire to evaluate glaucoma symptoms would lend useful information for patient care.
To develop a shortened glaucoma symptom measure based on the Collaborative Initial Glaucoma Treatment Study (CIGTS) Symptom and Health Problem Checklist (SHPC) and evaluate its psychometric properties.
DESIGN, SETTING, AND PARTICIPANTS: This measure development study evaluated the factor structure of the 43-item SHPC that was obtained from CIGTS participants at baseline and every 6 months thereafter. These 607 participants were enrolled at 14 clinical centers in the United States and had newly diagnosed open-angle glaucoma. Their mean deviation (SD) from visual field testing was −5.5 (4.3) dB. Data were collected from October 1993 through April 1997.
The factor structure of the SHPC, confirmatory factor analysis of the resulting 18-item questionnaire (SHPC-18), the reliability of the SHPC-18, and associations of the 2 symptom subscales (Local Eye and Visual Function) of the SHPC-18 with visual field severity and 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ25) subscales.
Among the 607 participants (mean [SD] age at enrollment, 57.5 [10.9] years), 334 (55.0%) were men and 273 (45.0%) were women; 231 (38.1%) were African American. Exploratory factor analysis and longitudinal growth modeling documented Local Eye and Visual Function symptom subscales. Cronbach α values for mean weighted internal consistency were 0.83 and 0.89 for the Local Eye and Visual Function subscales, respectively, and remained stable over time. Scores on each subscale significantly correlated with the NEI-VFQ25 total score (r = −0.41 and r = −0.59, respectively) and with all subscale scores (P < .01). Participants with more severe glaucoma had higher (worse) mean (SD) scores than those with mild glaucoma at baseline on the Local Eye (4.68 [6.62] vs 3.07 [5.60]) and Visual Function (8.44 [11.45] vs 4.42 [8.94]; P < .05) SHPC-18 subscales. Participants who underwent trabeculectomy reported a higher frequency of any Local Eye symptoms than those treated with topical medications (eg, at 12 months, 153 of 269 [56.9%] vs 11 of 276 [40.9%]; P < .001).
These results suggest that the SHPC-18 is a reliable, responsive, and psychometrically sound measure of patient-reported, glaucoma-related symptoms. The measure is responsive to treatment and discriminates the severity of glaucoma. This shorter version of the original SHPC measure may be useful in clinical and research settings to better understand the influence of glaucoma symptoms on patients’ daily life.
评估青光眼症状的简短问卷的管理将为患者护理提供有用的信息。
基于合作初始青光眼治疗研究（CIGTS）症状和健康问题清单（SHPC）开发一个简短的青光眼症状测量方法，并评估其心理测量特性。
设计、设置和参与者：这项测量方法发展研究评估了从 CIGTS 参与者基线和此后每 6 个月获得的 43 项 SHPC 的因素结构。这 607 名参与者在美国的 14 个临床中心注册，他们患有新诊断的开角型青光眼。他们的平均偏差（SD）来自视野测试为−5.5（4.3）dB。数据收集于 1993 年 10 月至 1997 年 4 月。
SHPC 的因素结构、由此产生的 18 项问卷（SHPC-18）的验证性因子分析、SHPC-18 的可靠性，以及 SHPC-18 的 2 个症状子量表（局部眼部和视觉功能）与视野严重程度和 25 项国家眼科研究所视觉功能问卷（NEI-VFQ25）子量表的关联。
在 607 名参与者（平均[标准差]入组年龄，57.5[10.9]岁）中，334 名（55.0%）为男性，273 名（45.0%）为女性；231 名（38.1%）为非裔美国人。探索性因素分析和纵向增长模型记录了局部眼部和视觉功能症状子量表。局部眼部和视觉功能子量表的平均加权内部一致性的 Cronbach α 值分别为 0.83 和 0.89，且随时间保持稳定。每个子量表的分数与 NEI-VFQ25 总分（r=-0.41 和 r=-0.59）和所有子量表的分数（P<.01）显著相关。基线时，青光眼严重程度较高的参与者的局部眼部（4.68[6.62]与 3.07[5.60]）和视觉功能（8.44[11.45]与 4.42[8.94]）SHPC-18 子量表的平均（SD）评分高于青光眼轻度的参与者（P<.05）。接受小梁切除术的参与者报告任何局部眼部症状的频率高于接受局部药物治疗的参与者（例如，在 12 个月时，269 名参与者中有 153 名[56.9%]，而 276 名参与者中有 11 名[40.9%]；P<.001）。
这些结果表明，SHPC-18 是一种可靠、敏感和心理测量良好的患者报告的、与青光眼相关的症状测量方法。该测量方法对治疗有反应，并能区分青光眼的严重程度。原始 SHPC 测量方法的这种较短版本可能在临床和研究环境中有用，以更好地了解青光眼症状对患者日常生活的影响。
