ICBO 2010: Documenting Changes In Quality of Life from Optometric Care

WC Maples, O.D., M.S.Professor of Optometry

Southern College of OptometryF ll A i A d f O t tFellow: American Academy of Optometry, 

Australasian College of Behavioural Optometry, College of Optometrists in Vision Development

Quality of Life DefinedHofer S Lim LL Guyatt GH Oldridge NB The MacNew heart disease quality of life instrument: aHofer S, Lim LL, Guyatt GH, Oldridge NB.  The MacNew heart disease quality of life instrument: a 

summary. Health Qual Life Outcomes 2004; 2‐3.

• “include not only an indication of changes in disease y gfrequency and severity but also an estimate of patients’ perception of health status before d ft t t tand after treatment.

•• “Health is a state of complete physical mental andHealth is a state of complete physical, mental and social well‐being, and not merely the absence of disease and infirmity.”

•

Quality of Life DefinedHofer S Lim LL Guyatt GH Oldridge NB The MacNew heart disease quality of life instrument: aHofer S, Lim LL, Guyatt GH, Oldridge NB.  The MacNew heart disease quality of life instrument: a 

summary. Health Qual Life Outcomes 2004; 2‐3.

• “One of the more important developments inOne of the more important developments in health care in the past decade may be the recognition that the patient’s perspective is as legitimate and valid as the clinician’s monitoring health care outcomes.  This has l d i h d l f ilead sic to the development of instruments to quantify the patients’ perception of their health status before and after treatment”health status before and after treatment

Measuring Visual Symptoms and SignsMeasuring Visual Symptoms and Signs

• USE OF CHECKLISTS

• Fits the Definition of QOL Instrument• Measures Pain/Discomfort (Measure of Morbidity)• Measures Impact on one’s ability to 

– Study– WorkEnjoy Leisure Time (Reading Crafts Computers)– Enjoy Leisure Time (Reading, Crafts, Computers)

– Sports

COVD Quality of LifeCOVD Quality of Life

• Mozlin is Chair of a COVD Task Force• Fellows are surveyed:  Most Frequent Symptoms• 30 Items Identified and Scored from 0 to 4 points (5 Point Scale)Point Scale)– Physical/Occupational– Psychological– Social– Somatic

– Mozlin R. Quality of life outcomes assessment. J Optom Vis Dev y p1995; 26: 194‐199.

T t R t t R li bilit f COVD QOL Ch kli tTest Retest Reliability of COVD QOL ChecklistMaples WC. Test‐retest reliability of the College of Optometrists in Vision Development Quality of Life Outcomes 

Assessment. Optometry 2000; 71: 579‐85.

• 19 1st year OD Students at NSU

• Given the COVD Checklist on 2 Occasions

• EvaluatedEvaluated – Wilcoxon Signed Rank Test

– Spearman’s RhoSpearman s Rho

– Likert Scale• T TestT Test

NSUCO QOL StudyNSUCO QOL Study

• All 30 Items Answered the Same (Wilcoxon Signed ( gRank Test)

• Five Highest the Same for Both; 3 of 5 of the Lowest the Same for Boththe Same for Both

• Ninety Percent Subjects Score the Same for Retest• Means and Standard Deviations Same (Likert Scale)( )

– X=9.27; 1 SD= 14.43; ½ SD= 7.21– Fail:  A Score Higher than 24; (17)

–GOOD TEST‐RETEST RELIABILITY

ADD/ADHD and the QOL ChecklistFarrar R, Call M, Maples WC.  A comparison of the visual symptoms between ADD/ADHD and 

normal children Optometry 2001; 72: 441 51normal children. Optometry 2001; 72: 441‐51

• Farrar, Call & Maples‐4th Year Projectp j• 24 ADD/ADHD and 19 Age Matched Controls• Compared Symptoms

/• All ADD/ADHD Currently Considered Managed by Medications‐Amphetamines– Ritalin:  Methylphenidate Hydrochloridey p y– Dexedrine:  Dextroamphetamine Sulfate– Cylert:  PemolineAdderal: Dextroamphetamine Sulfate Amphetamine– Adderal:  Dextroamphetamine Sulfate, Amphetamine Asperate, Dextroamphetamine Saccarate

Horner, McIver and MaplesCapstone Thesis: NSU‐OCO

• Variation of the Multi‐Center StudyVariation of the Multi Center Study

• 4th year students go to 4 offices:  3 are Fellows of COVD: 1 is an Associateof COVD:  1 is an Associate

• Went thorough records of VT patients who h d d 30 i h klihad a pre and post 30 item checklist completed

• N=88 Patients in 4 offices

Horner, McIver and MaplespCombined: <.001 Significance

60

50

60

30

40

Pre

10

20Post

0

10

Assoc Fellow 1 Fellow 2 Fellow 3

Farrar, Call, Maples ADD/QOLFarrar R, Call M, Maples WC.  A comparison of the visual symptoms between ADD/ADHD and p p y p

normal children. Optometry 2001; 72: 441‐51

• ADD’s Have Significantly more QOL Symptoms than g y Q y pControls– ADD= 39.44;       Controls= 22.53

• 14 of 33 Items for the ADD are Significantly Higher than in the Control Group– 3 Somatic– 3 Somatic – 4 Physical/Occupational– 3 Social– 4 Psychological (1 Added‐Copes Poorly with Change)

ADD vs Control: Total Mean SxADD vs Control: Total Mean Sx

30

35

40

20

25

30

ADD

10

15

20Normal

0

5

Score

Significant ADD QLSignificant ADD QL

• Blur .32 to 1.32 • I Can’t 1.18 1.96Blur .32 to 1.32

• Words Run .21  .96

• Skips 68 1 46

I Can t   1.18  1.96

• Eye Hand .47  1.29

• Clumsy 42 1 13Skips .68  1.46

• Dizzy .11  .58

• Copy 42 77

Clumsy  .42  1.13

• Time Use 1.34  2.33

• Change $ 37 1 29• Copy .42  .77

• Avoid Read .26  .58

• Assign 84 1 94

• Change $ .37  1.29

• Cope Poor .95  2.17

• Loses 1 16 2 58• Assign      .84  1.94 • Loses 1.16  2.58

• Forgets .84  1.58

ADD and Vision SymptomsADD and Vision Symptoms

• Dizzy Slow on AssignmentsDizzy

• Skips Words/Lines

• Words Run Together

Slow on Assignments

I Can’t

Poor Time UseWords Run Together

• Blurry

• Trouble copying

Poor Time Use

Making $$$$

Poor Coping Skill• Trouble copying

• Avoids Reading

Poor Coping Skill

Loses Things

Forgets ThingsForgets Things

Measuring Quality of LifeMaples WC Bither M Efficacy of vision therapy as assessed byMaples WC.  Bither M. Efficacy of vision therapy as assessed by the COVD Quality of Life checklist. Optometry 2002;73:492‐8 

Multi‐Office Study (6 offices)Multi Office Study (6 offices)

N=62

h 20 h fNo more than 20 hours of VT

Lenses as appropriate

Pre COVD‐QOL compared to Post COVD‐QOL

Pre/Post COVD QOL SxPre/Post COVD QOL Sx

354045

253035

Pre

101520 Post

05

42/17/

Pre/Post COVD QOL SxPre/Post COVD QOL Sx

• 1 1.08 .40 • 9 .58 .151 1.08 .40

• 2 1.06 .29

• 3 1 42 55

9 .58 .15

• 10 1.48 .69

• 11 1 58 653 1.42 .55

• 4 1.30 .29

• 5 1 26 65

11 1.58 .65

• 12 1.92 .66

• 13 1 81 65• 5 1.26 .65

• 6 1.11 .39

• 7 1 08 34

• 13 1.81 .65

• 14 1.76 .79

• 15 1 29 48• 7 1.08 .34

• 8 2.44 .88

• 15 1.29 .48

Pre/Post COVD QOL SxPre/Post COVD QOL Sx

2 5

2

2.5

1.5Pre

0.5

1 Post

01 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Pre/Post COVD QOL SxPre/Post COVD QOL Sx

• 16 2.08 .52 • 23 .98 .4216 2.08 .52

• 17 .90 .40

• 18 1 31 53

23 .98 .42

• 24 1.13 .52

• 25 1 08 4018 1.31 .53

• 19 2.32 .86

• 20 1 92 77

25 1.08 .40

• 26 1.74 .92

• 27 1 05 56• 20 1.92 .77

• 21 1.87 .92

• 22 58 23

• 27 1.05 .56

• 28 2.03 1.15

• 29 95 45• 22 .58 .23 • 29 .95 .45

• 30 1.37 .53

Pre/Post COVD QOL SxPre/Post COVD QOL Sx

2 5

2

2.5

1.5Pre

0.5

1 Post

016 17 18 19 20 21 22 23 24 25 26 27 28 29 30

COVD QOL Short Form DevelopedCOVD QOL Short Form Developed

• 30 Item A Clinical Device30 Item A Clinical Device• 19 Item A Screening Device

– 30 Item Confusing30 Item Confusing– Long– Dropped the “0” and “Seldom”Dropped the  0  and  Seldom

• Shown Reliable– AdultsAdults– 3rd and 4th graders

COVD‐QOL Used as a Pre/Post TestBl thi WB L di SL Th C ll f O t t i t i Vi i D l t QOLBleything WB, Landis SL. The College of Optometrists in Vision Development‐QOL 

Questionnaire in a socially at‐risk population of youth. Optom Vis Dev 2008;38:82‐90.

• N=123 Special High School Students ScreenedN=123 Special High School Students Screened

• N=55 Referred Received Examinations

d ( 2 ) C l ( 33) l• Rx and VT (N=24); Control (N=33) Rx only

• Significant Differences Between COVD Pass and Fail

• Both Groups (Rx) Improved with COVD scoresp ( ) p

• VT improved COVD scores More

COVD‐QOL Short Form

Vaughn, Maples, Hoenes. The association between vision quality of life and academics 

measured by the College of Optometrists in Vision Development Quality of Life questionnaire. Optometry 2006;77:116‐23.

• 91 3rd 5th and 7th Grade Students and Parents91 3 , 5 and 7 Grade Students and Parents given the Checklist

• Research Question:• Research Question:– Do Parents and Children see Eye to Eye

D S P di A d i B h i– Do Symptoms Predict Academic Behavior

Vaughn et al: COVD‐QOL Short FormParent vs StudentParent vs Student

7th Not Correlated‐Others <.001 Correlated

18

14

16

18

810

12

Student

46

8 Parent

02

3rd 5th 7th Total

Vaughn et al: COVD‐QOL ReadingStanford Standard Reading ScoreStanford Standard Reading Score

All Scores Significant Predictor Except Student 5th & 7th

0 7

0 5

0.6

0.7

0 3

0.4

0.5

Student

0.2

0.3 Parent

0

0.1

3rd 5th 7th Total

Vaughn et al: COVD‐QOL MathStanford Standard Math ScoreStanford Standard Math Score

All Scores Significant Predictor‐Parent 7th  (.058)

0 6

0.5

0.6

0.3

0.4

Student

0 1

0.2Parent

0

0.1

3rd 5th 7th Total

Vaughn et al: COVD‐QOL SpellingStanford Standard Spelling ScoreStanford Standard Spelling Score

5th & 7th Grade Student Scores Not Predictive

0 6

0.5

0.6

0.3

0.4

Student

0 1

0.2Parent

0

0.1

3rd 5th 7th Total

Vaughn et al: COVD‐QOL Total BatteryStanford Total Battery ScoreStanford Total Battery Score

5th & 7th Grade Student & 7th Grade Parent (.076) Scores Not Predictive

0 6

0.5

0.6

0.3

0.4

Student

0 1

0.2Parent

0

0.1

3rd 5th 7th Total

Vaughn et al: ConclusionsVaughn et al: Conclusions

• COVD‐QOL is a reliable and valid instrument toCOVD QOL is a reliable and valid instrument to document improvement in the morbidity factor (Quality of Life) in patients undergoingfactor (Quality of Life) in patients undergoing optometric care, specifically lenses, hygiene and vision therapyand vision therapy

Academics and COVD‐QOLShin  HS. Relationship between accommodative and vergence dysfunctions and academic achievement for primary school children. Ophthal Physio Opt 

2009;29:615‐24.  

• Compared the COVD‐QOL Short Form scores p Qto academic achievement

• 258 =/> 20 and 761< 20258 =/> 20 and 761< 20

• Standardized Achievement Tests administered by the school systemby the school system

• Full Exams Performed

• Separated by those with high COVD‐QOL scores to those with low scores

COVD  QOL and AcademicsShin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic 

achievement for primary school children. Ophthal Physio Opt 2009;29:615‐24.

• 1019 parents/children 9 to 13 years1019 parents/children 9 to 13 years

• 258 had COVD Sx =?> 20 

6 20• 761 < 20

• Looked at Accommodative and Vergence Dysfunctions and Academic Function

• 114 Given Full Exams 82 (71.9%) have Accom, ( ) ,Verg or Both

• Acc N=29; Verg N=28; Both N=25Acc N 29; Verg N 28; Both N 25

COVD  QOL Shin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academicShin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic achievement for primary school children. Submitted for publication. . Ophthal Physio Opt 2009;29:615‐24.  

GBO total of all who fall into the acc, vergence or both group)

COVD Scores30

COVD Scores

10

20

0 Scores

COVD  QOL and Reading Compares < 20 COVD to 20 +Shin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic 

hi t f i h l hild S b itt d f bli ti O hth l Ph i O t 2009 29 615 24achievement for primary school children. Submitted for publication. . Ophthal Physio Opt 2009;29:615‐24. All Significant

17.5

18

16.5

17

< 20

15.5

1620 +

15

15.5

Acc Dys Verg Dys Comb Total

COVD  QOL and Math < 20 Sx to 20 & + Sx

Shin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic 

achievement for primary school children. Submitted for publication. . Ophthal Physio Opt 2009;29:615‐24.All Significant but Vergence

18

17

17.5

16

16.5< 20

20 +

14 5

15

15.5

14.5

Acc Verg Both Total

COVD Quality of Life and Social Science <20 vs 20 & + SxShin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic achievement for primary school children Submitted for publication Ophthal Physioacademic achievement for primary school children. Submitted for publication. . Ophthal Physio 

Opt 2009;29:615‐24. Math  All Sign but Vergence

16

16.5

15

15.5

< 20

13 5

14

14.5 20 +

13

13.5

Acc Verg Both  Total

COVD QOL and Science <20 vs 20 & + SxShin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic p g y

achievement for primary school children. Submitted for publication. Ophthal Physio Opt 2009 Only Total Sign

16.5

17

16< 20

15

15.5 20 +

14.5

Acc Verg Both Total

COVD  QOL and Total Score < 20 vs 20 & + Sx

Shin HS Park SC Park CM Relationship between accommodative and vergence dysfunctions and academicShin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic 

achievement for primary school children. Submitted for publication. Ophthal Physio Opt 2009.  All Sign  

17

17.5

16

16.5

< 20

14 5

15

15.5 20 +

14

14.5

Acc Verg Both  Total

ConclusionConclusion

• The COVD‐QOL is a RELIABLE AND VALIDThe COVD QOL is a RELIABLE AND VALID 

• Use in the Optometric Office to Document Improvement in Quality of Life Issues thatImprovement in Quality of Life Issues that Result from Optometric Vision Therapy

• USE THE CHECKLIST TO DOCUMENT CARE!

• Thank You!