Assessing the construct validity and responsiveness of Preference Based Measures (PBMs) in cataract surgery patients

Katie Breheny, William Hollingworth, Rebecca Kandiyali, Padraig Dixon, Abi Loose, Pippa Craggs, Mariusz Grzeda, John Sparrow

Research output: Contribution to journalArticle (Academic Journal)peer-review

8 Citations (Scopus)
109 Downloads (Pure)


Purpose: The validity and responsiveness of the EQ-5D-3L in visual conditions has been questioned, inspiring development of a vision ‘bolt-on’ domain (EQ-5D-3L+VIS). Developments in preference-based measures (PBM) also includes the EQ-5D-5L and the ICECAP-O capability wellbeing measure. This study aimed to examine the construct validity and responsiveness of the EQ-5D-3L, EQ-5D-5L, EQ-5D3L+VIS and ICECAP-O in cataract surgery patients for the first time, to inform choice of PBM for economic evaluation in this population.

Methods: The analyses used data from the UK Predict-CAT cataract surgery cohort study. PBMs and the Cat-PROM5 (a validated measure of cataract quality of life (QOL)) were completed before surgery and 4-8 weeks after. Construct validity was assessed using correlations and known group differences evaluated using regression. Responsiveness was evaluated using effect sizes and analysis of variance to compare change scores between groups, defined by patient-reported and clinical outcomes.

Results: The sample comprised 1,315 patients at baseline. No PBMs were associated with visual acuity and only the ICECAP-O (Spearman’s rs = -0.35), EQ-5D-3L+VIS (rs = -0.42) and EQ-5D-5L (Value Set for England rs = -0.31) correlated at least moderately with the Cat-PROM5. Effect sizes of change were consistently largest for the EQ-5D-3L+VIS (range 0.34-0.41), followed by the ICECAP-O (range 0.20-0.34). Results indicated no improvement in responsiveness using the EQ-5D-5L (range 0.13-0.16) compared to the EQ-5D-3L (range 0.17-0.20).

Conclusions: Whilst no PBMs comprehensively demonstrated evidence of construct validity and responsiveness in cataract surgery patients, the ICECAP-O was the most responsive generic PBM to improvements in QOL. Surprisingly the EQ-5D-5L was not more responsive than the EQ-5D-3L in this setting.
Original languageEnglish
Number of pages12
JournalQuality of Life Research
Publication statusPublished - 20 Feb 2020


  • cataract
  • EQ-5D
  • bolt-on
  • responsiveness
  • validity


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