{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T04:53:33Z","timestamp":1776488013160,"version":"3.51.2"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012068","name":"HCRW","doi-asserted-by":"publisher","award":["2023\/2024(ER)-ER-23-07-Dr Francis William Barwise Sanders"],"award-info":[{"award-number":["2023\/2024(ER)-ER-23-07-Dr Francis William Barwise Sanders"]}],"id":[{"id":"10.13039\/100012068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The metamorphopsia questionnaire (MeMoQ) is an established patient-reported outcome measure (PROM) in the context of macular disease. However, its performance has not been proved in those being treated for various macular conditions with intravitreal anti-vascular endothelial growth factor (Anti-VEGF). The objective was to eliminate misfitting items, enhance measurement precision, and ensure optimal response categorisation. Methods: Rasch analysis was performed iteratively on 2286 responses from patients with macular diseases being treated with Anti-VEGF to optimise the MeMoQ. Fit statistics, reliability indices, person and item separation measures, and principal component analysis (PCA) of residuals were assessed to determine the optimal model. This study was conducted in an outpatient clinic specialising in retinal diseases in Hywel Dda University Health Board. Results: Misfitting items were removed in successive iterations, leading to optimised category probability curves and stable fit statistics for the MeMoQ. The resulting model for all responses included two final items, with person separation remaining inadequate reducing from 1.23 to 1.12 and reliability from 0.60 to 0.56. Category probability curves demonstrated good ordering of response variables with Andrich thresholds separated by &gt;1.2 logits. In the subgroups of neovascular age-related macular degeneration and diabetic macular oedema person separation remained below two and reliability remained low. Conclusions: Rasch analysis demonstrated that the MeMoQ was not a valid or reliable PROM in this patient population. Therefore, the MeMoQ may not provide a reliable index of patient\u2019s perception and visual experience when undergoing Anti-VEGF treatment.<\/jats:p>","DOI":"10.3390\/jcm15082867","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:55:12Z","timestamp":1775807712000},"page":"2867","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychometric Assessment of the Metamorphopsia Questionnaire in Patients with Macular Diseases Receiving Anti-Vascular Endothelial Growth Factor Treatment"],"prefix":"10.3390","volume":"15","author":[{"given":"Francis W. B.","family":"Sanders","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Prince Philip Hospital, Hywel Dda University Health Board, Llanelli SA14 8QF, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0347-7651","authenticated-orcid":false,"given":"Jennifer H.","family":"Acton","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3722-8757","authenticated-orcid":false,"given":"Barbara","family":"Ryan","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4517-4616","authenticated-orcid":false,"given":"Colm","family":"McAlinden","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK"},{"name":"Department of Ophthalmology, Princess of Wales Hospital, Bridgend CF31 1RQ, UK"},{"name":"Wenzhou Medical University, Wenzhou 325015, China"},{"name":"Eye and Ear Nose & Throat Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000441033","article-title":"Metamorphopsia: An Overlooked Visual Symptom","volume":"55","author":"Midena","year":"2015","journal-title":"Ophthalmic Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1136\/bjophthalmol-2014-306544","article-title":"Patient-Reported Outcomes in Randomised Controlled Trials on Age-Related Macular Degeneration","volume":"99","author":"Krezel","year":"2015","journal-title":"Br. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1038\/eye.2015.170","article-title":"The Design and Implementation of a Study to Investigate the Effectiveness of Community vs. Hospital Eye Service Follow-up for Patients with Neovascular Age-Related Macular Degeneration with Quiescent Disease","volume":"30","author":"Taylor","year":"2016","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cct.2015.04.004","article-title":"Inclusion of Patient-Reported Outcome Measures in Registered Clinical Trials: Evidence from ClinicalTrials.Gov (2007\u20132013)","volume":"43","author":"Vodicka","year":"2015","journal-title":"Contemp. Clin. Trials"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1136\/bjophthalmol-2014-305550","article-title":"Biomarkers and Surrogate Endpoints in Glaucoma Clinical Trials","volume":"99","author":"Medeiros","year":"2015","journal-title":"Br. J. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lane, J., Rohan, E.M.F., Sabeti, F., Essex, R.W., Maddess, T., Dawel, A., Robbins, R.A., Barnes, N., He, X., and McKone, E. (2018). Impacts of Impaired Face Perception on Social Interactions and Quality of Life in Age-Related Macular Degeneration: A Qualitative Study and New Community Resources. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0209218"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Schuster, A.K., Wolfram, C., Hudde, T., Klatt, A., Schnegelsberg, B., Midani-Oezkan, H., Ross, M., Ziemssen, F., and Pfeiffer, N. (2023). Impact of Routinely Performed Optical Coherence Tomography Examinations on Quality of Life in Patients with Retinal Diseases-Results from the ALBATROS Data Collection. J. Clin. Med., 12.","DOI":"10.3390\/jcm12123881"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1097\/IAE.0000000000001316","article-title":"Responsiveness of the National Eye Institute Visual Function Questionnaire-25 to Visual Acuity Gains in Patients with Diabetic Macular Edema: Evidence from the RIDE and RISE Trials","volume":"37","author":"Bressler","year":"2017","journal-title":"Retina"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1185\/03007995.2015.1081880","article-title":"Three-Year Patient-Reported Visual Function Outcomes in Diabetic Macular Edema Managed with Ranibizumab: The RESTORE Extension Study","volume":"31","author":"Mitchell","year":"2015","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.ophtha.2011.01.031","article-title":"The RESTORE Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema","volume":"118","author":"Mitchell","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jdiacomp.2015.03.009","article-title":"Changes in Vision Related Quality of Life in Patients with Diabetic Macular Edema: Ranibizumab or Laser Treatment?","volume":"29","author":"Turkoglu","year":"2015","journal-title":"J. Diabetes Complicat."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1016\/j.ophtha.2014.07.008","article-title":"RIDE and RISE Research Groups Vision-Related Function after Ranibizumab Treatment for Diabetic Macular Edema: Results from RIDE and RISE","volume":"121","author":"Bressler","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1167\/iovs.09-3535","article-title":"Correlations between M-CHARTS and PHP Findings and Subjective Perception of Metamorphopsia in Patients with Macular Diseases","volume":"52","author":"Arimura","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1038\/s41433-018-0230-0","article-title":"Patient-Reported Prevalence of Metamorphopsia and Predictors of Vision-Related Quality of Life in Vitreomacular Traction: A Prospective, Multi-Centre Study","volume":"33","author":"Patel","year":"2019","journal-title":"Eye"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1097\/IAE.0000000000004071","article-title":"Validation of M-Charts for Quantitative Assessment of Metamorphopsia Following Rhegmatogenous Retinal Detachment Repair","volume":"44","author":"Oquendo","year":"2024","journal-title":"Retina"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e649","DOI":"10.1111\/aos.12735","article-title":"Quantifying Metamorphopsia in Patients with Diabetic Macular Oedema and Other Macular Abnormalities","volume":"93","author":"Achiron","year":"2015","journal-title":"Acta Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mori, K., Ishikawa, K., Wada, I., Kubo, Y., Kobayashi, Y., Nakama, T., Haruta, M., Akiyama, M., Nakao, S., and Yoshida, S. (2020). Changes in Metamorphopsia after the Treat-and-Extend Regimen of Anti-VEGF Therapy for Macular Edema Associated with Branch Retinal Vein Occlusion. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0241343"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"17356","DOI":"10.1038\/s41598-022-22401-y","article-title":"Changes in Metamorphopsia Following Intravitreal Aflibercept Injection for Diabetic Macular Edema","volume":"12","author":"Murakami","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Osaka, R., Manabe, K., Manabe, S., Nakano, Y., Takasago, Y., Shiragami, C., Hirooka, K., Muraoka, Y., and Tsujikawa, A. (2018). Persistent Metamorphopsia Associated with Branch Retinal Vein Occlusion. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204015"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Nowomiejska, K., Oleszczuk, A., Brzozowska, A., Grzybowski, A., Ksiazek, K., Maciejewski, R., Ksiazek, P., Juenemann, A., and Rejdak, R. (2013). M-Charts as a Tool for Quantifying Metamorphopsia in Age-Related Macular Degeneration Treated with the Bevacizumab Injections. BMC Ophthalmol., 13.","DOI":"10.1186\/1471-2415-13-13"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1001\/jamaophthalmol.2019.1519","article-title":"Study of Comparative Treatments for Retinal Vein Occlusion 2 Investigator Group Patient-Reported Visual Function Outcomes After Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal or Hemiretinal Vein Occlusion: Preplanned Secondary Analysis of a Randomized Clinical Trial","volume":"137","author":"Scott","year":"2019","journal-title":"JAMA Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1016\/S2214-109X(13)70145-1","article-title":"Global Prevalence of Age-Related Macular Degeneration and Disease Burden Projection for 2020 and 2040: A Systematic Review and Meta-Analysis","volume":"2","author":"Wong","year":"2014","journal-title":"Lancet Glob. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1097\/OPX.0000000000000001","article-title":"Quality Assessment of Ophthalmic Questionnaires: Review and Recommendations","volume":"90","author":"Khadka","year":"2013","journal-title":"Optom. Vis. Sci. Off. Publ. Am. Acad. Optom."},{"key":"ref_24","unstructured":"Rasch, G. (1993). Probabilistic Models for Some Intelligence and Attainment Tests, MESA Press."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jtos.2017.01.005","article-title":"Rasch Analysis of Three Dry Eye Questionnaires and Correlates with Objective Clinical Tests","volume":"15","author":"McAlinden","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/BF02293814","article-title":"A Rating Formulation for Ordered Response Categories","volume":"43","author":"Andrich","year":"1978","journal-title":"Psychometrika"},{"key":"ref_27","first-page":"1228","article-title":"More about Critical Eigenvalue Sizes (Variances) in Standardized-Residual Principal Components Analysis (PCA)","volume":"23","author":"Linacre","year":"2009","journal-title":"Rasch Meas. Trans."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1001\/archopht.119.7.1050","article-title":"National Eye Institute Visual Function Questionnaire Field Test Investigators Development of the 25-Item National Eye Institute Visual Function Questionnaire","volume":"119","author":"Mangione","year":"2001","journal-title":"Arch. Ophthalmol."},{"key":"ref_29","first-page":"41","article-title":"The Impact of Surgery on Self-Reported Metamorphopsia and Vision-Related Quality of Life in Patients with an Idiopathic Full-Thickness Macular Hole","volume":"6","author":"Bhatti","year":"2022","journal-title":"Br. Stud. Dr. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jcjo.2017.08.006","article-title":"Metamorphopsia and Vision-Related Quality of Life among Patients with Age-Related Macular Degeneration","volume":"53","author":"Xu","year":"2018","journal-title":"Can. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000486164","article-title":"Impact of Metamorphopsia on Quality of Life after Successful Retinal Detachment Surgery","volume":"240","author":"Saleh","year":"2018","journal-title":"Ophthalmologica"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e318","DOI":"10.1111\/aos.12559","article-title":"Metamorphopsia and Interocular Suppression in Monocular and Binocular Maculopathy","volume":"93","author":"Wiecek","year":"2015","journal-title":"Acta Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"010427","DOI":"10.7189\/jogh.09.010427","article-title":"Global Epidemiology of Retinal Vein Occlusion: A Systematic Review and Meta-Analysis of Prevalence, Incidence, and Risk Factors","volume":"9","author":"Song","year":"2019","journal-title":"J. Glob. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-Analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_35","unstructured":"Gibbons, E., Black, N., Fallowfield, L., Newhouse, R., and Fitzpatrick, R. (2016). Patient-Reported Outcome Measures and the Evaluation of Services. Challenges, Solutions and Future Directions in the Evaluation of Service Innovations in Health Care and Public Health, NIHR Journals Library."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Fenwick, E.K., Gupta, P., and Man, R.E.K. (2022). Assessment of Vision-Related Quality of Life. Ophthalmic Epidemiology, CRC Press.","DOI":"10.1201\/9781315146737-22"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.ophtha.2023.07.001","article-title":"Patient-Reported Outcome Measure Use in Guidelines Published by the American Academy of Ophthalmology: A Review","volume":"130","author":"Yu","year":"2023","journal-title":"Ophthalmology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1080\/02713683.2021.1912779","article-title":"Clinical Update on Metamorphopsia: Epidemiology, Diagnosis and Imaging","volume":"46","author":"Hanumunthadu","year":"2021","journal-title":"Curr. Eye Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"542357","DOI":"10.2147\/OPTH.S542357","article-title":"The Amsler Grid in Everyday Practice: A Review of Its Role and Limitations in Primary Care","volume":"20","author":"Estreicher","year":"2026","journal-title":"Clin. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1097\/IAE.0000000000000581","article-title":"Metamorphopsia and Its Quantification","volume":"35","author":"Simunovic","year":"2015","journal-title":"Retina"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1097\/IAE.0b013e3181d1a75e","article-title":"Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration: Multicenter Evaluation of a Preferential Hyperacuity Perimeter Designed as a Home Device","volume":"30","author":"Loewenstein","year":"2010","journal-title":"Retina"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2867\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T04:18:27Z","timestamp":1776485907000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15082867"],"URL":"https:\/\/doi.org\/10.3390\/jcm15082867","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}