ICBO 2010: Documenting Changes In Quality of Life from Optometric - PowerPoint PPT Presentation

ICBO 2010: Documenting Changes In Quality of Life from Optometric Care WC Maples, O.D., M.S. Professor of Optometry Southern College of Optometry F ll Fellow: American Academy of Optometry, A i A d f O t t Australasian College of Behavioural Optometry, College of Optometrists in Vision Development

Quality of Life Defined Hofer S, Lim LL, Guyatt GH, Oldridge NB. The MacNew heart disease quality of life instrument: a Hofer 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 g frequency and severity but also an estimate of patients’ perception of health status before and after treatment. d ft t t t • • “Health is a state of complete physical mental and Health is a state of complete physical, mental and social well ‐ being, and not merely the absence of disease and infirmity.” •

Quality of Life Defined Hofer S Lim LL Guyatt GH Oldridge NB The MacNew heart disease quality of life instrument: a Hofer 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 in One 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 lead sic to the development of instruments to d i h d l f i quantify the patients’ perception of their health status before and after treatment” health status before and after treatment

Measuring Visual Symptoms and Signs Measuring 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 – Work – Enjoy Leisure Time (Reading, Crafts, Computers) Enjoy Leisure Time (Reading Crafts Computers) – Sports

COVD Quality of Life COVD 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 p 1995; 26: 194 ‐ 199.

T t R t Test Retest Reliability of COVD QOL Checklist t R li bilit f COVD QOL Ch kli t Maples WC. Test ‐ retest reliability of the College of Optometrists in Vision Development Quality of Life Outcomes Assessment. Optometry 2000; 71: 579 ‐ 85. • 19 1 st year OD Students at NSU • Given the COVD Checklist on 2 Occasions • Evaluated Evaluated – Wilcoxon Signed Rank Test – Spearman’s Rho Spearman s Rho – Likert Scale • T Test T Test

NSUCO QOL Study NSUCO QOL Study • All 30 Items Answered the Same (Wilcoxon Signed ( g Rank Test) • Five Highest the Same for Both; 3 of 5 of the Lowest the Same for Both the 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 Checklist Farrar R, Call M, Maples WC. A comparison of the visual symptoms between ADD/ADHD and normal children Optometry 2001; 72: 441 51 normal children. Optometry 2001; 72: 441 ‐ 51 • Farrar, Call & Maples ‐ 4 th Year Project p j • 24 ADD/ADHD and 19 Age Matched Controls • Compared Symptoms • All ADD/ADHD Currently Considered Managed by / Medications ‐ Amphetamines – Ritalin: Methylphenidate Hydrochloride y p y – Dexedrine: Dextroamphetamine Sulfate – Cylert: Pemoline – Adderal: Dextroamphetamine Sulfate, Amphetamine Adderal: Dextroamphetamine Sulfate Amphetamine Asperate, Dextroamphetamine Saccarate

Horner, McIver and Maples Capstone Thesis: NSU ‐ OCO • Variation of the Multi ‐ Center Study Variation of the Multi Center Study • 4 th year students go to 4 offices: 3 are Fellows of COVD: 1 is an Associate of COVD: 1 is an Associate • Went thorough records of VT patients who h d had a pre and post 30 item checklist d 30 i h kli completed • N=88 Patients in 4 offices

Horner, McIver and Maples p Combined: <.001 Significance 60 60 50 40 Pre 30 Post 20 10 10 0 Assoc Fellow 1 Fellow 2 Fellow 3

Farrar, Call, Maples ADD/QOL Farrar 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 p Controls – 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 Sx ADD vs Control: Total Mean Sx 40 35 30 30 25 ADD 20 20 Normal 15 10 5 0 Score

Significant ADD QL Significant ADD QL • Blur .32 to 1.32 Blur .32 to 1.32 • I Can’t 1.18 1.96 I Can t 1.18 1.96 • Words Run .21 .96 • Eye Hand .47 1.29 • Skips Skips .68 1.46 68 1 46 • Clumsy 42 1 13 Clumsy .42 1.13 • Dizzy .11 .58 • Time Use 1.34 2.33 • Copy • Copy .42 .77 42 77 • Change $ 37 1 29 • Change $ .37 1.29 • Avoid Read .26 .58 • Cope Poor .95 2.17 • Assign .84 1.94 • Assign 84 1 94 • Loses • Loses 1 16 2 58 1.16 2.58 • Forgets .84 1.58

ADD and Vision Symptoms ADD and Vision Symptoms • Dizzy Dizzy Slow on Assignments Slow on Assignments • Skips Words/Lines I Can’t • Words Run Together Words Run Together Poor Time Use Poor Time Use • Blurry Making $$$$ • Trouble copying • Trouble copying Poor Coping Skill Poor Coping Skill • Avoids Reading Loses Things Forgets Things Forgets Things

Measuring Quality of Life Maples WC Bither M Efficacy of vision therapy as assessed by Maples 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 No more than 20 hours of VT h 20 h f Lenses as appropriate Pre COVD ‐ QOL compared to Post COVD ‐ QOL

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx 45 40 35 35 30 25 Pre 20 Post 15 10 5 0 42/ 17 /

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx • 1 1 1.08 .40 1.08 .40 • 9 9 .58 .58 .15 .15 • 2 1.06 .29 • 10 1.48 .69 • 3 3 1.42 .55 1 42 55 • 11 11 1.58 .65 1 58 65 • 4 1.30 .29 • 12 1.92 .66 • 5 • 5 1 26 1.26 .65 65 • 13 • 13 1 81 1.81 .65 65 • 6 1.11 .39 • 14 1.76 .79 • 7 • 7 1 08 1.08 .34 34 • 15 • 15 1 29 1.29 .48 48 • 8 2.44 .88

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx 2 5 2.5 2 1.5 Pre Post 1 0.5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx • 16 16 2.08 .52 2.08 .52 • 23 23 .98 .98 .42 .42 • 17 .90 .40 • 24 1.13 .52 • 18 18 1 31 1.31 .53 53 • 25 25 1 08 1.08 .40 40 • 19 2.32 .86 • 26 1.74 .92 • 20 • 20 1 92 1.92 .77 77 • 27 • 27 1 05 1.05 .56 56 • 21 1.87 .92 • 28 2.03 1.15 • 22 • 22 .58 58 .23 23 • 29 • 29 .95 95 .45 45 • 30 1.37 .53

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx 2 5 2.5 2 1.5 Pre Post 1 0.5 0 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

COVD QOL Short Form Developed COVD QOL Short Form Developed • 30 Item A Clinical Device 30 Item A Clinical Device • 19 Item A Screening Device – 30 Item Confusing 30 Item Confusing – Long – Dropped the “0” and “Seldom” Dropped the 0 and Seldom • Shown Reliable – Adults Adults – 3 rd and 4 th graders

COVD ‐ QOL Used as a Pre/Post Test Bl Bleything WB, Landis SL. The College of Optometrists in Vision Development ‐ QOL thi WB L di SL Th C ll f O t t i t i Vi i D l t QOL Questionnaire in a socially at ‐ risk population of youth. Optom Vis Dev 2008;38:82 ‐ 90. • N=123 Special High School Students Screened N=123 Special High School Students Screened • N=55 Referred Received Examinations • Rx and VT (N=24); Control (N=33) Rx only d ( 2 ) C l ( 33) l • Significant Differences Between COVD Pass and Fail • Both Groups (Rx) Improved with COVD scores p ( ) 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 3 rd 5 th and 7 th Grade Students and Parents 91 3 , 5 and 7 Grade Students and Parents given the Checklist • Research Question: • Research Question: – Do Parents and Children see Eye to Eye – Do Symptoms Predict Academic Behavior D S P di A d i B h i

Vaughn et al: COVD ‐ QOL Short Form Parent vs Student Parent vs Student 7 th Not Correlated ‐ Others <.001 Correlated 18 18 16 14 12 10 Student 8 8 Parent 6 4 2 0 3rd 5th 7th Total

Vaughn et al: COVD ‐ QOL Reading Stanford Standard Reading Score Stanford Standard Reading Score All Scores Significant Predictor Except Student 5 th & 7 th 0.7 0 7 0.6 0.5 0 5 0.4 Student 0 3 0.3 Parent 0.2 0.1 0 3rd 5th 7th Total