Activities of Daily Vision Scale: what do the subscales measure?

PURPOSE Previous Rasch analysis of the Activities of Daily Vision Scale (ADVS) did not address psychometric properties of its subscales or provide detailed assessment of dimensionality (whether the ADVS measures one or multiple constructs). This study was designed to examine these properties. METHODS Two hundred thirty-two participants (mean age, 74.2 years) awaiting cataract surgery self-administered the ADVS. Rasch analysis was used to assess the ADVS and its five subscales for unidimensionality (by principal components analysis, [PCA]), precision by person separation (discrimination between strata of participant ability), and targeting (matching of item difficulty to participant ability). Adequate person separation (minimum acceptable value, 2.0) is the fundamental requirement for measurement. RESULTS Only the near vision subscale had adequate measurement properties (person separation, 2.30). The entire ADVS showed a misfit to the Rasch model and lacked unidimensionality. PCA confirmed the presence of two additional traits-driving and glare disability-but neither possessed adequate person separation when assessed individually. Deleting these traits restored unidimensionality, but additional items misfit, necessitating item reduction. Finally, an eight-item ADVS-Near Vision Scale showed good fit and unidimensionality. Its contents were identical with the original near vision subscale. Targeting was suboptimal (2.30 logits). CONCLUSIONS Only one subscale, near vision, met the criteria for measurement. The revised eight-item ADVS-Near Vision subscale is a unidimensional measure of visual disability in cataract patients with mild visual disability. However, it is limited by measurement of near visual ability only. For more comprehensive measurement of visual disability, other questionnaires such as Catquest-9SF are preferable for cataract surgery outcomes assessment.