Comparing the Vitreous Floaters Functional Questionnaire to the VFQ-25 in Vision Degrading Myodesopsia from Vitreous Floaters.

Abstract

To compare the Vitreous Floater Functional Questionnaire (VFFQ-23) to the NEI Visual Function Questionnaire (VFQ-25) in patients with vision degrading myodesopsia (VDM) from vitreous floaters. Composite scores for each questionnaire were compared in asymptomatic controls, patients who chose observation (OBS), and those electing vitrectomy. The impact of limited refractive vitrectomy (LRV) on the composite scores of each questionnaire was determined. A retrospective study comparing questionnaire correlations with management choice (OBS or LRV), and a prospective, non-randomized, interventional case series. 74 subjects were asymptomatic controls; 193 subjects had bilateral floaters: 139 chose OBS, 54 elected LRV surgery. Patients complaining of bilateral "floaters" completed the VFFQ-23 and VFQ-25 questionnaires and composite scores were correlated with visual acuity (VA), contrast sensitivity (CS), quantitative ultrasonography (QUS), and management choice (OBS or LRV). LRV was performed in 54 patients, and all tests were repeated at 6, 12, 24, and 36 months post-operatively. VFFQ-23 (0 to 100), NEI VFQ-25 (0 to 100), VA (Snellen), CS (Freiburg Acuity Contrast Test), QUS (AU), predictive value, Receiver Operator Characteristic areas under the curve (AUC), decision curve analysis (DCA). VFFQ-23 correlated with CS (R = -.619; P < .0001) and QUS (R = -.632; P < .0001). VFFQ-23 correctly identified 89% of patients who chose LRV with a positive predictive value of 73.8% for LRV and 95.3% for OBS, while VFQ-25 had a positive predictive value of only 60%; VFFQ-23 AUC = 0.923, VFQ-25 AUC = 0.570. DCA demonstrated a higher net benefit for VFFQ-23 than both "Treat All" and "Treat None" strategies. After LRV, VFFQ-23 improved 72.2% ± 3.2% (P < .001), while VFQ-25 only improved 7.4% ± 1.8%, (P < .001). The difference-in-differences before and after surgery between VFFQ-23 and VFQ-25 was 31.9 ± 12.0 (P < .001). In patients with vitreous floaters, the VFFQ-23 correlated with CS and QUS. VFFQ-23 was a better predictor of patient management choice (OBS or LRV) and was more sensitive to post-operative improvement than VFQ-25. VFFQ-23 superiority to VFQ-25 was confirmed by DCA. Thus, VFFQ-23 may be more useful in assessing the subjective impact of floaters on visual quality-of-life, in screening/triage, and as an outcome measure of current and future therapies for VDM.