Konrad Pesudovs
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Konrad Pesudovs is Foundation Professor and Chair of Discipline of Optometry and Vision Science at Flinders University. His main research interest is ophthalmology outcomes research; incorporating optical, visual and patient-centred measurement into the holistic measurement of outcomes in ophthalmology.
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ItemPatient-centered measurement in ophthalmology - a paradigm shift( 2006)Ophthalmologists and researchers in ophthalmology understand what a rapidly evolving field ophthalmology is, and that to conduct good research it is essential to use the latest and best methods. In outcomes research, one modern initiative has been to conduct holistic measurement of outcomes inclusive of the patient's point of view; patient-centred outcome. This, of course, means including a questionnaire. However, the irony of trying to improve outcomes research by being inclusive of many measures is that the researcher may not be expert in all measures used. Certainly, few people conducting outcomes research in ophthalmology would claim to be questionnaire experts. Most tend to be experts in their ophthalmic subspecialty and probably simply choose a popular questionnaire that appears to fit their needs and think little more about it. Perhaps, unlike our own field, we assume that the field of questionnaire research is relatively stable. This is far from the case. The measurement of patient-centred outcomes with questionnaires is a rapidly evolving field. Indeed, over the last few years a paradigm shift has occurred in patient-centred measurement.
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ItemValidity of the Adaptation to Age-related Vision Loss Scale in an Australian Cataract Population(Spanish Council of Optometry, 2009)Purpose: The Adaptation to Age-related Vision Loss (AVL) scale was developed to measure the adjustment of older adults who are adapting to late-life vision loss. The purpose of this study was to assess whether the AVL scale satisfies the Rasch model in a cataract population. Methods: The 24-item AVL scale (18 negatively and 6 positively coded) was mailed to 436 cataract patients for self-administration whilst they were on the waiting list for cataract surgery at the Flinders Eye Centre, Adelaide, South Australia. Rasch analysis was performed to determine whether the items were measuring a single construct (unidimensionality) as examined with fit statistics and principal components analysis (PCA) of the residuals. The ability of the scale to distinguish between the levels of adaptation of the participants (person separation) was investigated, with a value ≥ 2.0 established as the minimum acceptable. Results: The AVL scale was unable to differentiate sufficiently between participants’ levels of adaptation, indicating poor person separation. One item did not fit the construct, causing misfit. Furthermore, the five positively worded items did not appear either to measure the same construct as other items, resulting in lack of unidimensionality evidenced by PCA. Following the deletion of these items, the AVL scale was one-dimensional but a single item continued to misfit, so it had to be deleted, resulting in an 18-item AVL scale. Even so, the discriminating abilities of the scale continued to be poor. Conclusions: The AVL scale is not an appropriate measure of adaptation to vision loss in a cataract population.
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ItemGeriatric Vision Care – a New Look at the Old(Spanish Council of Optometry, 2009)World-wide, Optometry is expanding its scope of practice in many jurisdictions. The campaign to use therapeutic pharmaceutical agents (TPAs) is on-going in most countries and optometrists are increasingly becoming involved in co-managing glaucoma and the ocular complications of diabetes, interfacing with systemic and ophthalmic specialists. Optometrists continue to define their role as members of the healthcare team by serving as post-operative care specialists following refractive and cataract surgeries. In addition, Optometry continues to be a leader in pediatric eye care and pediatric eye research, including working with children with learning disabilities and children with special needs (multiple-challenges). While low vision, contact lenses and orthoptics (vision training/binocular vision) remain staples of the traditional domain, they should not be ignored at the expense of new growth. Even as we struggle, some ask, “is the time ripe for Optometry to begin to recognize its own subspecialties?” Although all optometrists graduate as primary eye care providers, as the profession expands special interest practitioners have laid claim to areas of expertise such as sports vision specialist, rehabilitation vision specialist, neurooptometric specialty and so on. Just as medicine, and then ophthalmology before us, recognized sub-disciplines, should Optometry mature along a similar path?
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ItemValidity of a visual impairment questionnaire in measuring cataract surgery outcomes [post print](Elsevier, 2008-06)PURPOSE: To test the validity of the Impact of Visual Impairment (IVI) questionnaire in a cataract population. SETTING: Flinders Eye Centre, Flinders Medical Centre, Flinders University, Adelaide, South Australia. METHODS: Cataract patients recruited from a hospital waiting list completed the IVI questionnaire. The scale was assessed for fit to the Rasch model. Unidimensionality, item and person fit to the model, response category performance, differential item functioning (whether different subgroups responded differently), and targeting of item difficulty to patient ability were assessed. RESULTS: Overall, the IVI questionnaire performed well; there were ordered thresholds, person separation reliability was 0.97, and it was free from differential item functioning. One item (worry about eyesight getting worse) misfit the model and was removed. There was evidence of multidimensionality, indicating that the overall IVI score should be discarded; however, the 3 subscales (reading and accessing information, mobility and independence, and emotional well-being) functioned well. Several items calibrated differently in cataract patients compared with low-vision patients, indicating different issues are important to each population and that there is a need for population-specific conversion algorithms. Targeting of the IVI items was biased toward more impaired patients. CONCLUSIONS: The 3 subscales of the IVI questionnaire functioned well in a cataract population. However, additional items targeting the less impaired patients, especially second-eye cataract patients, would improve measurement.
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ItemRepeatability of corneal first-surface wavefront aberrations measured with Pentacam corneal topography [Post print](Elsevier, 2008-05)PURPOSE: To assess the repeatability of corneal wavefront aberrations derived from Pentacam (Oculus) corneal topography. SETTING: Flinders Eye Centre, Flinders Medical Centre, Bedford Park, South Australia, Australia. METHODS: Forty-five normal participants and 10 participants with keratoconus were tested. Intraobserver and interobserver repeatability was determined using 4 observers within and between sessions. Topographical maps were exported to external software, and corneal first-surface wavefront aberrations were calculated using a 10th-order Zernike expansion over a 6.0 mm optical zone. Repeatability was determined with Bland-Altman limits of agreement and expressed as the coefficient of repeatability (COR). RESULTS: Initial data showed high wavefront aberrations in normal participants and poor repeatability. Topographical maps showed extrapolated topography in zones without data acquisition; maps with less than 6.0 mm of complete data were excluded in the final analysis. The mean wavefront aberrations for normal participants remained high, but repeatability improved. The COR relative to the magnitude of wavefront aberrations was high (average 100%) across all modal pairs and orders, although best for total higher-order root mean square. Participants with keratoconus had higher magnitude wavefront aberrations and poorer repeatability but similar COR to average wavefront aberration ratios. Examination of raw elevation data showed poor repeatability. CONCLUSIONS: Wavefront aberrations calculated from Pentacam corneal topography were large in magnitude, and reliability was poor, largely due to variability in corneal elevation data. Intraobserver and interobserver reliability within and between sessions was comparable. The Pentacam was not reliable in measuring corneal wavefront aberrations.
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ItemPatient-centred measurement in ophthalmology - a paradigm shift(BioMed Central - http://www.biomedcentral.com, 2006-06)Ophthalmologists and researchers in ophthalmology understand what a rapidly evolving field ophthalmology is, and that to conduct good research it is essential to use the latest and best methods. In outcomes research, one modern initiative has been to conduct holistic measurement of outcomes inclusive of the patient's point of view; patient-centred outcome. This, of course, means including a questionnaire. However, the irony of trying to improve outcomes research by being inclusive of many measures is that the researcher may not be expert in all measures used. Certainly, few people conducting outcomes research in ophthalmology would claim to be questionnaire experts. Most tend to be experts in their ophthalmic subspecialty and probably simply choose a popular questionnaire that appears to fit their needs and think little more about it. Perhaps, unlike our own field, we assume that the field of questionnaire research is relatively stable. This is far from the case. The measurement of patient-centred outcomes with questionnaires is a rapidly evolving field. Indeed, over the last few years a paradigm shift has occurred in patient-centred measurement.