Computerized adaptive tests: Efficient and precise assessment of the patient-centered impact of diabetic retinopathy

Eva K. Fenwick, John Barnard, Alfred Gan, Bao Sheng Loe, Jyoti Khadka, Konrad Pesudovs, Ryan Man, Shu Yen Lee, Gavin Tan, Tien Y. Wong, Ecosse L. Lamoureux

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
3 Downloads (Pure)


Purpose: Evaluate efficiency, precision, and validity of RetCAT, which comprises ten diabetic retinopathy (DR) quality of life (QoL) computerized adaptive tests (CATs). Methods: In this cross-sectional clinical study, 183 English and/or Mandarin-speaking participants with DR (mean age ± standard deviation [SD] 56.4 ± 11.9 years; 38% proliferative DR [worse eye]) were recruited from retinal clinics in Singapore. Participants answered the RetCAT tests (Symptoms, Activity Limitation, Mobility, Emotional, Health Concerns, Social, Convenience, Economic, Driving, and Lighting), which were capped at seven items each, and other questionnaires, and underwent eye tests. Our primary evaluation focused on RetCAT efficiency (i.e. standard error of measurement [SEM] ± SD achieved and time needed to complete each CAT). Secondary evaluations included an assessment of RetCAT’s test precision and validity. Results: Mean SEM across all RetCAT tests was 0.351, ranging from 0.272 ± 0.130 for Economic to 0.484 ± 0.130 for Emotional. Four tests (Mobility, Social, Convenience, and Driving) had a high level of measurement error. The median time to take each RetCAT test was 1.79 minutes, ranging from 1.12 (IQR [interquartile range] 1.63) for Driving to 3.28 (IQR 2.52) for Activity Limitation. Test precision was highest for participants at the most impaired end of the spectrum. Most RetCAT tests displayed expected correlations with other scales (convergent/divergent validity) and were sensitive to DR and/or vision impairment severity levels (criterion validity). Conclusions: RetCAT can provide efficient, precise, and valid measurement of DRrelated QoL impact. Future application of RetCAT will employ a stopping rule based on SE rather than number of items to ensure that all tests can detect meaningful differences in person abilities. Responsiveness of RetCAT to treatment interventions must also be determined. Translational Relevance: RetCAT may be useful for measuring the patient-centered impact of DR severity and disease progression and evaluating the effectiveness of new therapies.

Original languageEnglish
Article number3
Number of pages12
JournalTranslational Vision Science and Technology
Issue number7
Publication statusPublished - Jun 2020

Bibliographical note

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


  • Computerized adaptive testing
  • Diabetic retinopathy
  • Item banks
  • Quality of life
  • Vision impairment


Dive into the research topics of 'Computerized adaptive tests: Efficient and precise assessment of the patient-centered impact of diabetic retinopathy'. Together they form a unique fingerprint.

Cite this