Purpose.: To determine the psychometric validity of the National Eye Institute-Visual Function Questionnaire (NEI VFQ-25) and its subscale structure for use in people with low vision. Methods.: Two hundred thirty-two participants completed the NEI VFQ-25. Rasch analysis was used to test the psychometric performance of the questionnaire and each subscale. Factor models were hypothesized and tested with confirmatory factor analysis (CFA) and subsequently validated with Rasch analysis. Results.: For the overall scale, two rating scales had to be dichotomized and three misfitting items removed to improve fit to the Rasch model. There was evidence of multidimensionality, indicating that the scale would benefit from scale splitting. For the NEI VFQ-25 subscale structure, six of the original 12 subscales could not fit the Rasch model because of item insufficiency (fewer than two items) and the remaining six displayed poor item fit characteristics indicating that the NEI VFQ-25 does not have a viable subscale structure. CFA supported a two-factor model with visual functioning (10 items) and socioemotional (9 items) scales. Most goodness-of-fit statistics were within the recommended range of values. The factor loadings of items on their respective scales were statistically significant (P < 0.001) and ranged between 0.59 and 0.84. The two scales individually fitted the Rasch model and were found to be unidimensional with adequate psychometric characteristics. Conclusions.: The native NEI VFQ-25 is a better performing instrument when split into visual functioning and socioemotional scales. These scales possess valid parameters for assessment of the impact of low vision in this population.

Purpose.: To determine the unique contribution of vision-specific distress in predicting depressive symptoms in people with vision impairment attending a tertiary eye care clinic. Methods.: In this cross-sectional study, interview-administered surveys were conducted with 143 adult patients who had presenting visual acuity <0.3 logMAR. Depressive symptoms were assessed with the Patient Health Questionnaire-9 and vision-specific distress was assessed with the Impact of Vision Impairment (IVI) Questionnaire emotional well-being subscale. In addition, level of restriction of participation in common daily activities due to vision impairment was assessed with the IVI and measures of general physical health and social support were included. Results.: Twenty-one (14.7%) of 143 participants reported clinically significant depressive symptoms and an additional 27.3% (n = 39) had mild depressive symptoms. Vision-specific distress was the strongest unique predictor of depressive symptoms (β = 0.37, P < 0.001), with physical health (β = −0.22, P < 0.01), age (β = −0.18, P < 0.05), and experience of a negative life event (β = 0.15, P < 0.05) also contributing significantly to depressive symptoms. Results also indicated that vision-specific distress mediates the impact of participation restriction due to vision impairment on depressive symptoms. Conclusions.: An assessment of vision-specific distress may be a useful tool with which to identify those at risk of depression or in need of early intervention in eye care or rehabilitation settings. Depression treatment approaches or depression prevention strategies for people with vision impairment may benefit from a focus on vision-specific distress.

Purpose.: To validate the German–translated Impact of Vision Impairment (IVI) questionnaire, a vision-specific quality of life (QoL) scale, and determine the relationship between the severity of vision impairment, ocular conditions, and VRQoL. Methods.: This cross-sectional study was clinic based, with 184 patients with low vision recruited from an outpatient clinic at a German eye hospital. Participants underwent a clinical examination and completed the German IVI scale. The validity of the IVI scale was assessed using Rasch analysis. The main outcome measure was the overall functional and emotional score provided by the IVI. Results.: Overall, there were more female (n = 111, 60.3%) than male participants. Participants' mean ± SD age and visual acuity in the better eye were 69.0 ± 15.5 years and. 0.41 ± 0.35 logMAR, respectively. The main cause of vision loss was age-related macular degeneration (n = 54, 29.3%). Rasch analysis demonstrated the validity of the German IVI to assess VRQoL through two subscales: vision-specific functioning and emotional well-being. In adjusted multivariate analysis models, those with mild or moderate/severe vision impairment reported significantly poorer vision-specific functioning (mean change, −6.5, P = 0.018 and −11.98, P < 0.001 for mild and moderate to severe VI, respectively) and emotional well-being (mean change, −2.35; P = 0.043 and −3.13, P = 0.004 for mild and moderate/severe VI respectively) compared with non–visually impaired patients. Conclusions.: Using a psychometrically valid German IVI, even mild vision impairment was independently associated with poor VRQoL. These findings reinforce the importance of early preventative and rehabilitative efforts to prevent longitudinal deterioration in vision loss.

Purpose.: To validate the Impact of Vision Impairment for Children (the IVI_C), a new vision-specific pediatric instrument designed to assess the affect of impaired vision on quality of life (QoL) in children. Methods.: The IVI_C was administered to vision-impaired and normally sighted students, 8 to 18 years of age. Reliability and validity were tested, and the IVI_C was subjected to Rasch analysis to assess the scale unidimensionality, measurement characteristics, response options, and targeting. Results.: The mean (SD) presenting bilateral distance visual acuity (VA) for the vision-impaired group (n = 122) was 1.10 (0.79) logMAR and 1.15 (0.80) logMAR for near VA. After the initial response categories were collapsed from five to three, content validity was further supported by good person and item fit parameters. The person separation index (PSI) was 0.85, which indicates that the IVI_C can assess QoL across children of several participation levels. The scale was shown to be unidimensional after principal components analysis (PCA) of the residuals (t-test; P = 0.48, P = 0.34). Significant differences in overall person measures between the vision-impaired and normally sighted groups substantiated the scale discriminant validity (ANOVA; F = 78.75; P < 0.0001). Guttman split-half correlations for temporal, mode (face-to-face and telephone), and interobserver administrations were 0.95, 0.90, and 0.86, respectively, supporting scale reliability. Conclusions.: The modified IVI_C is a unidimensional, reliable, and valid scale for assessing QoL of children with vision impairment. It provides a valid means of assessing the outcomes of interventions and needs in children with vision impairment.

People living in low- and middle- income countries (LMICs) meet significant challenges in accessing ear and hearing care (EHC) services. We conducted a scoping review to identify and summarise such barriers, to recognise gaps in the literature, and to identify potential solutions. Reviewers independently screened titles, abstracts and full-text articles and charted data. We undertook thematic analysis of supply and demand side dimensions of access, and summarised findings mapped against the Levesque framework. Of 3048 articles screened, 62 met inclusion criteria for review. Across the five access dimensions, supply-side constraints were more frequently described, the most common being a shortage of EHC workforce or appropriate facilities, despite high demand. We identified a thin geographical spread of literature on barriers to accessing EHC services in LMICs, reflecting low availability of such services. LMICs face a diverse range of demand and supply side challenges including workforce, equipment and resource shortages, and challenges for the majority of the population to pay for such services. There is a need for many LMICs to develop health policy and programmes in EHC, including integration into primary care, scaling up the EHC workforce through increased training and education, and improving EHC literacy through public health measures.