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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

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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 A i A d f O t t Fellow: American Academy of Optometry, Australasian College of Behavioural Optometry, College of Optometrists in Vision Development

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SLIDE 2

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

d ft t t t and after treatment.

  • “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.”

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SLIDE 3

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 d i h d l f i lead 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

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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

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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.

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SLIDE 6

T t R t t R li bilit f COVD QOL Ch kli t Test Retest Reliability of COVD QOL Checklist

Maples 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
  • Evaluated

Evaluated

– Wilcoxon Signed Rank Test – Spearman’s Rho Spearman s Rho – Likert Scale

  • T Test

T Test

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SLIDE 7

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

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SLIDE 8

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‐4th 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

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SLIDE 9

Horner, McIver and Maples

Capstone Thesis: NSU‐OCO

  • Variation of the Multi‐Center Study

Variation of the Multi Center Study

  • 4th year students go to 4 offices: 3 are Fellows
  • f COVD: 1 is an Associate
  • f COVD: 1 is an Associate
  • Went thorough records of VT patients who

h d d 30 i h kli had a pre and post 30 item checklist completed

  • N=88 Patients in 4 offices
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SLIDE 10

Horner, McIver and Maples p

Combined: <.001 Significance

60 50 60 30 40 Pre 10 20 Post 10 Assoc Fellow 1 Fellow 2 Fellow 3

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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)

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SLIDE 12

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

30 35 40 20 25 30 ADD 10 15 20 Normal 5 Score

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SLIDE 13

Significant ADD QL Significant ADD QL

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

Blur .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 13

Skips .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

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ADD and Vision Symptoms ADD and Vision Symptoms

  • Dizzy

Slow on Assignments Dizzy

  • Skips Words/Lines
  • Words Run Together

Slow on Assignments I Can’t Poor Time Use Words Run Together

  • Blurry
  • Trouble copying

Poor Time Use Making $$$$ Poor Coping Skill

  • Trouble copying
  • Avoids Reading

Poor Coping Skill Loses Things Forgets Things Forgets Things

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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 h 20 h f No more than 20 hours of VT Lenses as appropriate Pre COVD‐QOL compared to Post COVD‐QOL

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Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx

35 40 45 25 30 35 Pre 10 15 20 Post 5 42/ 17 /

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Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx

  • 1

1.08 .40

  • 9

.58 .15 1 1.08 .40

  • 2

1.06 .29

  • 3

1 42 55 9 .58 .15

  • 10

1.48 .69

  • 11

1 58 65 3 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

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SLIDE 18

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx

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

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Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx

  • 16

2.08 .52

  • 23

.98 .42 16 2.08 .52

  • 17

.90 .40

  • 18

1 31 53 23 .98 .42

  • 24

1.13 .52

  • 25

1 08 40 18 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

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SLIDE 20

Pre/Post COVD QOL Sx Pre/Post COVD QOL Sx

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

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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 – 3rd and 4th graders

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COVD‐QOL Used as a Pre/Post Test

Bl thi WB L di SL Th C ll f O t t i t i Vi i D l t QOL Bleything 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 Screened

N=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 scores

p ( ) p

  • VT improved COVD scores More
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SLIDE 23

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

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SLIDE 24

Vaughn et al: COVD‐QOL Short Form Parent vs Student Parent vs Student

7th Not Correlated‐Others <.001 Correlated 18 14 16 18 8 10 12 Student 4 6 8 Parent 2 3rd 5th 7th Total

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Vaughn et al: COVD‐QOL Reading

Stanford Standard Reading Score Stanford 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 0.1 3rd 5th 7th Total

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Vaughn et al: COVD‐QOL Math

Stanford Standard Math Score Stanford Standard Math Score All Scores Significant Predictor‐Parent 7th (.058) 0 6 0.5 0.6 0.3 0.4 Student 0 1 0.2 Parent 0.1 3rd 5th 7th Total

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Vaughn et al: COVD‐QOL Spelling

Stanford Standard Spelling Score Stanford Standard Spelling Score 5th & 7th Grade Student Scores Not Predictive 0 6 0.5 0.6 0.3 0.4 Student 0 1 0.2 Parent 0.1 3rd 5th 7th Total

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Vaughn et al: COVD‐QOL Total Battery

Stanford Total Battery Score Stanford 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 0.2 Parent 0.1 3rd 5th 7th Total

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Vaughn et al: Conclusions Vaughn et al: Conclusions

  • COVD‐QOL is a reliable and valid instrument to

COVD QOL is a reliable and valid instrument to document improvement in the morbidity factor (Quality of Life) in patients undergoing factor (Quality of Life) in patients undergoing

  • ptometric care, specifically lenses, hygiene

and vision therapy and vision therapy

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Academics and COVD‐QOL

Shin 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 Q to academic achievement

  • 258 =/> 20 and 761< 20

258 =/> 20 and 761< 20

  • Standardized Achievement Tests administered

by the school system by the school system

  • Full Exams Performed
  • Separated by those with high COVD‐QOL

scores to those with low scores

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SLIDE 31

COVD QOL and Academics

Shin 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 years

1019 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=25

Acc N 29; Verg N 28; Both N 25

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SLIDE 32

COVD QOL

Shin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic 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. GBO total of all who fall into the acc, vergence or both group)

COVD Scores

30

COVD Scores

10 20 Scores

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SLIDE 33

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 24 achievement 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 16 20 + 15 15.5 Acc Dys Verg Dys Comb Total

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SLIDE 34

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

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SLIDE 35

COVD Quality of Life and Social Science <20 vs 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 academic 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

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SLIDE 36

COVD QOL and Science <20 vs 20 & + Sx

Shin 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

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SLIDE 37

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

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

17 17.5 16 16.5 < 20 14 5 15 15.5 20 + 14 14.5 Acc Verg Both Total

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SLIDE 38

Conclusion Conclusion

  • The COVD‐QOL is a RELIABLE AND VALID

The COVD QOL is a RELIABLE AND VALID

  • Use in the Optometric Office to Document

Improvement in Quality of Life Issues that Improvement in Quality of Life Issues that Result from Optometric Vision Therapy

  • USE THE CHECKLIST TO DOCUMENT CARE!
  • Thank You!