روانسنجی
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Index of Functional Impairment in Patients With Cataract (VF-14)
Steinberg et al‚ 1991

1.    Do you have any difficulty‚ even with glasses‚ reading small print‚ such as labels on medicine bottles‚ a telephone book‚ food labels? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
2.    Do you have any difficulty‚ even with glasses‚ reading a newspaper or a book? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have?
1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
3.    Do you have any difficulty‚ even with glasses‚ reading a large-print book or large-print newspaper or numbers on a telephone? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
4.    Do you have any difficulty‚ even with glasses‚ recognizing people when they are close to you? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
5.    Do you have any difficulty‚ even with glasses‚ seeing steps‚ stairs‚ or curbs? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
6.    Do you have any difficulty‚ even with glasses‚ reading traffic signs‚ street signs‚ or store signs? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
7.    Do you have any difficulty‚ even with glasses‚ doing fine handwork like sewing‚ knitting‚ crocheting‚ carpentry? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
8.    Do you have any difficulty‚ even with glasses‚ writing checks or filling out forms? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
9.    Do you have any difficulty‚ even with glasses‚ playing games such as bingo‚ dominos‚ card games‚ mahjong? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
10.    Do you have any difficulty‚ even with glasses‚ taking part in sports like bowling‚ handball‚ tennis‚ golf? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
11.    Do you have any difficulty‚ even with glasses‚ cooking? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
12.    Do you have any difficulty‚ even with glasses‚ watching television? _ Yes _ No _ Not applicable
If yes‚ how much difficulty do you currently have? 1. A little‚ 2. A moderate amount‚ 3. A great deal‚ 4. Are you unable to do the activity?
13.    Do you currently drive a car? _ Yes (go to 14) _ No (go to 16)
14.    How much difficulty do you have driving during the day because of your vision? Do you have: 1. No difficulty‚ 2. A little difficulty‚ 3. A moderate amount of difficulty‚ 4. A great deal of difficulty?
15.    How much difficulty do you have driving at night because of your vision? Do you have: 1. No difficulty‚ 2. A little difficulty‚ 3. A moderate amount of difficulty‚ 4. A great deal of difficulty?
16.    Have you ever driven a car? _ Yes (go to 17) _ No (stop)
17.    When did you stop driving? _ Less than 6 months ago _ 6-12 months ago _ More than 12 months ago
18.    Why did you stop driving? _ Vision _ Other illness _ Other reason

****نسخه دیگر

4= No‚ 3= A little difficulty‚ 2=Moderate difficulty‚ 1= A great deal of difficulty‚ 0= Unable to do this activity
•    Do you have any difficulty‚ even with glasses‚ reading small print‚ such as labels on medicine bottles‚ a telephone book‚ or food labels?
•    Do you have any difficulty‚ even with glasses‚ reading a newspaper or a book?
•    Do you have any difficulty‚ even with glasses‚ reading a large- print book or‚ newspaper or numbers on a telephone?
•    Do you have any difficulty‚ even with glasses‚ recognizing people when they are close to you?
•    Do you have any difficulty‚ even with glasses‚ seeing steps‚ stairs or curbs?
•    Do you have any difficulty‚ even with glasses‚ reading traffic signs‚ street signs‚ or store signs?
•    Do you have any difficulty‚ even with glasses‚ doing fine handwork like sewing‚ knitting‚ crocheting‚ or carpentry?
•    Do you have any difficulty‚ even with glasses‚ writing checks or filling out forms?
•    Do you have any difficulty‚ even with glasses‚ playing games such as bingo‚ dominos‚ card games‚ and mahjong?
•    Do you have any difficulty‚ even with glasses‚ taking part in sports like bowling‚ handball‚ tennis‚ golf?
•    Do you have any difficulty‚ even with glasses‚ cooking?
•    Do you have any difficulty‚ even with glasses‚ watching television?
•    Do you currently drive a car? Yes/No
•    How much difficulty do you have driving during the day because of your vision? 4= None‚ 3= A little‚ 2= Moderate amount‚ 1= A great deal
•    How much difficulty do you have driving at night because of your vision? 4= None‚ 3= A little‚ 2= Moderate amount‚ 1= A great deal
•    Have you previously driven a car but since stopped? Yes/No
•    When did you stop driving? _ Less than 6 months ago _ 6-12 months ago _ More than 12 months ago
•    Why did you stop driving? _ Poor Vision _ Other illness _ Other reason

*** Sum of Points/ Degree of Visual Impairment/ VF score
0 to 5 very/ severe impairment/ 0 to 9
6 to 16/ severe impairment/ 10 to 29
17 to 41/ moderate impairment/ 30 to 74
42 to 51/ mild impairment/ 75 to 92
52 to 54/ minimal impairment/ 93 to 98
55 to 56/ no visual impairment/ 99 to 100

This instrument can be found at: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/640668 & https://yorkeyeinstitute.com/sites/default/files/VF-14%20Questionnaire.pdf & https://www.ncbi.nlm.nih.gov/books/NBK259054/bin/appd-m4.pdf

Steinberg‚ E.P.‚ Tielsch‚ J.M.‚ Schein‚ O.D.‚ Javitt‚ J.C.‚ Sharkey‚ P.‚ Cassard‚ S.D.‚ Legro‚ M.W.‚ Diener-West M.‚ Bass‚ E.B.‚ Damiano‚ A.M.‚ et al. (1994).The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol;112(5):630-8
Parrish RK II. (1996). Visual impairment‚ visual functioning‚ and quality of life assessments in patients with glaucoma. Trans Am Ophth Soc; 94: 919-1028 (page 924).