Lim Yi Wen, Mohamad Nor Fadhilah, Moy Foong Ming, Kamalden Tengku Ain
Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre (UMERC), 50603, Kuala Lumpur, Malaysia.
Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Int Ophthalmol. 2025 May 17;45(1):191. doi: 10.1007/s10792-025-03552-z.
This study aims to translate, culturally adapt, and validate the Malay-Visual Disability Assessment (VDA) questionnaire and to assess its applicability in evaluating functional disability among cataract patients of a tertiary medical centre in Malaysia.
This cross-sectional, questionnaire-based study was divided into two phases. In Phase I, the pre-final version of Malay-VDA was validated by a panel of six experts, followed by cognitive debriefing with 10 respondents. Test-retest reliability was assessed using 35 participants. The reliability and validity of the Malay-VDA was tested using intraclass correlation coefficient (ICC) and content validity index (CVI). Phase II evaluated the visual function among 200 cataract patients using the validated Malay-VDA. Additionally, self-administered questionnaire was used to collect sociodemographic data of the respondents.
In Phase I, all items in Malay-VDA achieved an item-level CVI of > 0.8 for relevance and > 0.7 for clarity, with an overall CVI > 0.9. The test-retest reliability analysis demonstrated excellent reliability, with a single measures ICC of 0.998 (95% CI: 0.995-0.999, p < 0.001) and an average measures ICC of 0.999 (95% CI: 0.998-0.999, p < 0.001). In Phase II, out of the 200 respondents, they were more Chinese, females, had completed primary education and aged between 70 to 79 years. The respondents had higher VDA scores in distance domain with the mean (SD) scores of 16.57 (5.11), showing worst functional disability in distant activities, followed by difficulties in the mobility domain (mean (SD) scores of 10.15 (3.72)) and near domain (mean (SD) scores of 9.98 (2.76)). The mean score was found to be significantly higher in the poor vision group for all three domains. A positive correlation with moderate strength was found between total VDA score and best-corrected visual acuity (BCVA) with age adjusted (r = 0.575, p < 0.001).
The Malay-VDA demonstrated good reliability and validity, making it a suitable tool for local adaptation. This study highlighted that visual function was not solely determined by visual acuity, underscoring the importance of comprehensive functional assessment in cataract patients. Therefore, integrating visual function assessment into preoperative evaluations could enhance surgical decision-making.
本研究旨在对马来语视觉障碍评估（VDA）问卷进行翻译、文化调适和验证，并评估其在马来西亚一家三级医疗中心的白内障患者功能障碍评估中的适用性。
这项基于问卷的横断面研究分为两个阶段。在第一阶段，由六位专家组成的小组对马来语VDA的预终版进行验证，随后对10名受访者进行认知反馈。使用35名参与者评估重测信度。使用组内相关系数（ICC）和内容效度指数（CVI）测试马来语VDA的信度和效度。第二阶段使用经过验证的马来语VDA评估200名白内障患者的视觉功能。此外，使用自填式问卷收集受访者的社会人口学数据。
在第一阶段，马来语VDA中的所有项目在相关性方面的项目水平CVI均>0.8，在清晰度方面>0.7，总体CVI>0.9。重测信度分析显示出极佳的信度，单次测量的ICC为0.998（95%CI：0.995-0.999，p<0.001），平均测量的ICC为0.999（95%CI：0.998-0.999，p<0.001）。在第二阶段，200名受访者中，华人、女性居多，完成了小学教育，年龄在70至79岁之间。受访者在远距离领域的VDA得分较高，平均（标准差）得分为16.57（5.11），表明远距离活动中的功能障碍最严重，其次是行动领域（平均（标准差）得分为10.15（3.72））和近距离领域（平均（标准差）得分为9.98（2.76））。在所有三个领域中，视力差的组的平均得分均显著更高。在年龄调整后，VDA总分与最佳矫正视力（BCVA）之间发现了中等强度的正相关（r=0.575，p<0.001）。
马来语VDA表现出良好的信度和效度，使其成为适合本地调适的工具。本研究强调视觉功能并非仅由视力决定，突出了对白内障患者进行综合功能评估的重要性。因此，将视觉功能评估纳入术前评估可改善手术决策。
