Patient-reported outcome measurement has become accepted as an important component of comprehensive outcomes research. Researchers wishing to use a patient-reported measure must either develop their own questionnaire (called an instrument in the research literature) or choose from the myriad of instruments previously reported. This article summarizes how previously developed instruments are best assessed using a systematic process and we propose a system of quality assessment so that clinicians and researchers can determine whether there exists an appropriately developed and validated instrument that matches their particular needs. These quality assessment criteria may also be useful to guide new instrument development and refinement. We welcome debate over the appropriateness of these criteria as this will lead to the evolution of better quality assessment criteria and in turn better assessment of patient-reported outcomes.

Normative contrast sensitivity (CS) data were obtained using the commercially available Pelli-Robson chart from the dominant eye of 30 young (mean (+/- SD) age 22.5 +/- 4.3 years) and 42 older (mean (+/- SD) age 70.2+/- 6.7 years) subjects with normal healthy eyes. The majority of young subjects were found to have a CS of 1.80 log units or above. The majority of the older subjects were found to have a CS of 1.65 log units or above. CS results were obtained using both sides (A and B) of the Pelli-Robson chart from 30 (15 young and 15 older) of these subjects. These measurements were repeated under identical conditions, 2 weeks later. There was no significant difference between the results from sides A and B of the chart. The CS scores were shown to be repeatable to within +/- 0.15 log units or +/- 1 step. Therefore a significant change in CS score is +/- 2 steps or 0.30 log units. Slight improvements in reliability could be obtained by more careful permutation of letters on each step and a smaller step size. The restriction against these changes is the ensuing increased chart size.

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The 20-item QIRC questionnaire, which quantifies the QOL of people with refractive correction by spectacles, contact lenses, and refractive surgery in the prepresbyopic age group, was developed using Rasch analysis and shown to be valid and reliable. The use of Rasch scaling allows scores to be treated as a valid continuous variable. QIRC has broad applicability for cross-sectional and outcomes research.

Normative contrast sensitivity (CS) data were obtained using the commercially available Pelli-Robson chart from the dominant eye of 30 young (mean (+/- SD) age 22.5 +/- 4.3 years) and 42 older (mean (+/- SD) age 70.2+/- 6.7 years) subjects with normal healthy eyes. The majority of young subjects were found to have a CS of 1.80 log units or above. The majority of the older subjects were found to have a CS of 1.65 log units or above. CS results were obtained using both sides (A and B) of the Pelli-Robson chart from 30 (15 young and 15 older) of these subjects. These measurements were repeated under identical conditions, 2 weeks later. There was no significant difference between the results from sides A and B of the chart. The CS scores were shown to be repeatable to within +/- 0.15 log units or +/- 1 step. Therefore a significant change in CS score is +/- 2 steps or 0.30 log units. Slight improvements in reliability could be obtained by more careful permutation of letters on each step and a smaller step size. The restriction against these changes is the ensuing increased chart size.

Despite careful traditional validation, the ADVS data contained inadequacies exposed by Rasch analysis. Through Rasch scaling, particularly with response scale reduction, the ADVS can be improved, but additional questions seem to be needed to suit the more able, including patients undergoing second eye cataract surgery. There remains a need to develop Rasch-scaled measures of visual disability for use in ophthalmic outcomes research.

The study provides additional evidence to support the need for second eye cataract surgery. Second eye surgery may be particularly important to improve mobility orientation and the avoidance of falls.