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Results From Focus Groups With Visually Impaired Persons

Carol M. Mangione, MD, MSPH; Sandra Berry, MS; Karen Spritzer, MS; Nancy K. Janz, PhD; Ronald Klein, MD, MPH; Cynthia Owsley, PhD; Paul P. Lee, MD, JD

Arch Ophthalmol. 1998;116:227-233.

Objective  To identify the content area for a questionnaire designed to measure vision-targeted health-related quality of life and to determine whether problems with vision-related functioning are qualitatively similar across different common eye diseases.

Design  Twenty-six condition-specific focus groups were conducted with 246 patients from 5 geographic regions to identify the content area for a questionnaire for use among persons with diabetic retinopathy, glaucoma, macular degeneration, cytomegalovirus retinitis, and cataract. A standard protocol was used to structure each focus group discussion. Sessions were audiotaped, transcribed, and coded in preparation for a content analysis.

Settings  Five university-based ophthalmology practices and 1 nonprofit eye care foundation.

Participants  Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. All eligible persons were older than 21 years, spoke English, and had sufficient cognitive function to provide informed consent.

Results  Among the 246 participants, 2623 problems with vision-related functioning were mentioned. The mean number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glaucoma. For the sample overall, reading problems were mentioned most frequently, followed by driving, general problems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each problem were difficulty or ease of performance (13%), psychological distress associated with performance of the activity (11%), and complete inability to participate in a visual activity (11%).

Conclusion  An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual functioning in everyday life. Although participants mentioned problems that were unique to their disease, across conditions the problems mentioned were similar. These findings provide empirical evidence of content validity for a vision-targeted, health-related quality-of-life survey designed for use across conditions.

From the RAND Health Program, RAND, Santa Monica, Calif (Drs Mangione and Lee and Mss Berry and Spritzer); Department of Medicine, UCLA School of Medicine, Los Angeles, Calif (Dr Mangione); School of Public Health, University of Michigan, Ann Arbor (Dr Janz); Department of Ophthalmology, University of Wisconsin School of Medicine, Madison (Dr Klein); Department of Ophthalmology, University of Alabama at Birmingham School of Medicine (Dr Owsley); and Doheny Eye Institute and the Department of Ophthalmology, University of Southern California, Los Angeles (Dr Lee).

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