Martin Jem, Bradley Chris, Kran Barry S, Ross Nicole C
Department of Specialty, Advanced Care and Vision Science, New England College of Optometry, Boston, MA, United States.
Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Front Ophthalmol (Lausanne). 2024 Nov 29;4:1495000. doi: 10.3389/fopht.2024.1495000. eCollection 2024.
Cerebral Visual Impairment (CVI) is the leading cause of pediatric visual impairment. Given the diversity of clinical presentations of CVI, we are interested in whether questionnaires appropriately target the spectrum CVI cases, specifically the Teach-CVI Screening Tool. Rasch analysis is a standard psychometric technique for assessing the targeting of questionnaire items, however this analysis technique has not yet been applied to this questionnaire.
We performed a retrospective review of clinical CVI cases from the NECO Center for Eye Care at Perkins School for the Blind from January 2016 to December 2022. Electronic medical records were reviewed to identify patients with an ICD-9 or ICD-10 code of CVI or other neurological visual impairment. Age, gender, diagnoses, visual acuity, contrast sensitivity, visual fields, ocular alignment, and Teach-CVI responses were collected. We applied the method of successive dichotomizations, a polytomous Rasch model, to estimate item measures and person measures from the survey. Targeting of questionnaire items to the sample population was explored by comparing estimated item measures to person measures. Multiple linear regression was used to determine which factors influence patient visual ability (i.e., Teach-CVI person measure).
119 patient records were included, 54% of which were male. The mean age was 8.9 years (SD = 6.12) with a range of 0 to 33 years of age. Mean visual acuity was 0.46 logMAR (SD = 0.40), or 20/57. The majority of patients in the sample had a co-occurring visual disorder in addition to CVI (84%), the most frequent being strabismus (69.9%) or visual field loss (25.3%). Item measures ranged from -2.67 to 1.77 logits (SD = 0.76), with a mean of 0 logit by convention. Estimated person measures ranged from -2.19 to 3.08 logits (SD = 1.10) with a mean of -0.03 logit. The range of item measures covered 93.3% of the person measures, and all person measures, except one, were within one logit of an item measure. Visual measures were not statistically significantly associated with Teach-CVI person measures.
The findings from this study suggest that the Teach-CVI survey is well targeted and an appropriate patient reported outcome measure for CVI.
脑性视觉障碍（CVI）是儿童视力障碍的主要原因。鉴于CVI临床表现的多样性，我们想了解问卷调查是否能恰当地针对CVI病例谱，特别是Teach-CVI筛查工具。Rasch分析是评估问卷项目针对性的一种标准心理测量技术，然而这种分析技术尚未应用于该问卷。
我们对2016年1月至2022年12月期间珀金斯盲人学校NECO眼科护理中心的临床CVI病例进行了回顾性研究。查阅电子病历以确定患有CVI或其他神经性视力障碍的ICD-9或ICD-10编码的患者。收集年龄、性别、诊断、视力、对比敏感度、视野、眼位和Teach-CVI应答。我们应用连续二分法，即一种多分类Rasch模型，从调查中估计项目测量值和人员测量值。通过比较估计的项目测量值和人员测量值，探讨问卷项目对样本人群的针对性。使用多元线性回归来确定哪些因素影响患者的视觉能力（即Teach-CVI人员测量值）。
纳入119份患者记录，其中54%为男性。平均年龄为8.9岁（标准差=6.12），年龄范围为0至33岁。平均视力为0.46 logMAR（标准差=0.40），即20/57。样本中的大多数患者除CVI外还伴有视力障碍（84%），最常见的是斜视（69.9%）或视野缺损（25.3%）。项目测量值范围为-2.67至1.77 logits（标准差=0.76），按照惯例平均为0 logit。估计的人员测量值范围为-2.19至3.08 logits（标准差=1.10），平均为-0.03 logit。项目测量值范围覆盖了93.3%的人员测量值，除一个之外的所有人员测量值都在项目测量值的一个logit范围内。视觉测量值与Teach-CVI人员测量值无统计学显著关联。
本研究结果表明，Teach-CVI调查针对性良好，是一种适用于CVI的患者报告结局测量方法。
