Development of the National Eye Institute refractive error correction quality of life questionnaire: focus groups

To identify the content area for a questionnaire designed to measure the vision-targeted, health-related quality of life for persons with well-corrected refractive error.

Cross-sectional study.

Fifty-two focus groups were conducted with 414 patients from 5 geographically diverse ophthalmic and optometric sites to identify the content area of a questionnaire for use among persons with myopia and hyperopia.

A standard protocol was used to structure each focus group discussion, and groups were led by centrally trained moderators at each participating site. Results were summarized and analyzed using a standard set of codes. Qualitative and quantitative analyses were conducted.

Self-reported observations or comments about vision, vision correction, and other aspects of quality of life.

Among the 414 participants, 9262 mentions of comments were recorded. The most frequent comments reported by participants were about types of vision correction, followed by comments with their own vision and vision-related symptoms. The distribution of comments by topic domain was generally similar across types of correction and type of refractive error. The most frequent specific comments about glasses concerned problems with reading, adjustment between near and far vision, and appearance. The most frequent comments about contact lenses included those on symptoms such as dry eyes, itching and tired eyes, and headaches, and negative comments about ease of use. The most frequent comments among patients with surgical correction concerned fewer driving problems; fewer symptoms; and improvement in vision, recreation, and comfort. Participants provided equal numbers of positive and negative comments about glasses. Twice as many positive as negative comments were given by contact lens wearers, and 4 times as many positive comments were provided by patients who had undergone surgical correction.

Using focus groups, we were able to identify content areas and aspects of visual functioning in persons with refractive error that are not measured by standard visual acuity testing in the clinic or by other vision-targeted, health-related quality of life instruments such as the 25- or 51-item National Eye Institute-Visual Functioning Questionnaire. The similarity of problems mentioned across refractive error type and correction method suggests it will be possible to develop a single questionnaire with adequate content validity to compare the impact of different modes of correction in vision-targeted, health-related quality of life.