Psychometric Evaluation and Computerized Adaptive Testing Simulations of Myopic Refractive Intervention Quality of Life Item Banks.

Purpose: To optimize the psychometric properties of myopia refractive intervention quality of life (QoL) item banks (IBs), and evaluate their performance using computerized adaptive testing (CAT) simulations.

Methods: In this clinical study, adults utilizing myopic refractive intervention modalities answered 204 items within seven IBs: Activity Limitation (AL); Comfort (CM); Concerns (CN); Convenience (CV); Emotional (EM); Mobility (MB); and Work (WK), referred to collectively as "MyoRICAT". The psychometric properties of each IB were assessed with Rasch analysis, and CAT simulations with 1000 respondents determined the average number of items needed to achieve moderate (standard error of measurement [SEM] = 0.387) and high (SEM = 0.30) precision levels.

Results: Of the 291 participants (mean age 34.02 ± 11.04 years; 65.64% female), 61 (20.96%) wore spectacles only, 123 (42.27%) used both spectacles and contact lenses, and 107 (36.76%) underwent laser refractive surgery. AL, CM, CN, CV, and EM showed satisfactory psychometric properties after minor amendments. WK lacked measurement precision owing to certain items being applicable only to specific subsets of refractive modalities. This IB was therefore retained as a fixed length rather than a CAT operationalized scale. Conversely, MB demonstrated such poor targeting that it was not considered further. In CAT simulations, the mean number of items required per IB ranged from 10 (CV) to 12 (AL) for moderate, and 15 (CV) to 19 (AL) for high measurement precision.

Conclusions: Five IBs demonstrated strong psychometric properties and potential CAT efficiency.

Translational relevance: MyoRICAT can provide a comprehensive measurement of the QoL impact of myopic refractive intervention modalities.