Preliminary Psychometric Evaluation of an Ultraviolet Radiation-Related Questionnaire in a Case-Control Sample

Due to the absence of change in survival over the last 50 years for uveal melanoma patients, prevention is critical to improving outcomes. The association between ultraviolet radiation (UVR) exposure and uveal melanoma remains controversial, warranting further research. This study aimed to preliminarily assess the validity of a questionnaire designed to retrospectively measure the amount of UVR exposure to the face, ocular, and periocular region over the course of an individual's life.

A case-control study was performed. Two groups were enrolled between May 2023 and August 2025. The UVR-related case group included participants with facial, periocular, and ocular surface malignancies related to UVR exposure, including squamous cell carcinomas and basal cell carcinomas. The control group included participants with conditions believed to be non-UVR related, such as thyroid-related orbitopathy and glaucoma. All participants completed a questionnaire assessing lifetime UVR exposure. The questionnaire comprised three domains: diagnosis, sun behaviors and exposures, and other medical history. Responses related to UVR exposure were scored and aggregated, generating a total UVR exposure index for each participant, with higher scores representing greater UVR exposure. Three sub-indices were also generated: a protective behavior index, an adverse reactions index, and an exposure index. Mean index scores were used to preliminarily assess questionnaire validity.

There were 355 participants in this study; 50% (n = 177) had a UVR-related diagnosis. This case group had a mean UVR exposure index score of 48.5, while the control group had a mean UVR exposure index score of 39.9 (p < 0.001). For the adverse reactions sub-index, mean scores were 26.5 in the case group and 21.3 in the control group (p < 0.001). For the exposure sub-index, the case group had a mean score of 56.9 compared to 47.0 in the control group (p < 0.001). There was no significant difference in the mean score between the case and control groups for the protective behavior sub-index.

Those with a UVR-related diagnosis had significantly greater total UVR exposure, more adverse reactions to UVR, and a higher UVR exposure index than those with a non-UVR-related disease, providing preliminary evidence supporting questionnaire construct validity for exposure to the face, periocular, and ocular surface. Reported use of protective behaviors did not appear to be different between groups. This questionnaire shows preliminary promise for evaluating sun exposure, including reflected light and childhood periocular exposure, in ocular or periocular conditions potentially related to UVR.