No / PURPOSE. To develop and validate a questionnaire for the measurement of the impact of contact lenses on quality of life (QoL): The Contact Lens Impact on Quality of Life (CLIQ) Questionnaire. METHODS. The questionnaire was developed and validated using conventional methods and Rasch analysis to assure content validity, repeatability, construct validity, and low respondent burden. Item identification and selection (647 items) were performed with an extensive literature review, professional advice, and lay focus groups. Item reduction used focus groups and data obtained from 161 subjects completing a 90-item pilot questionnaire. Validity and reliability, from data of 128 additional subjects, were assessed using Rasch analysis, intraclass correlation coefficient, and Bland-Altman limits of agreement. RESULTS. A 28-item CLIQ Questionnaire was developed and shown to have good validity and reliability by Rasch analysis statistics: real person separation, 2.02; model person separation, 2.17; reliability, 0.80; root mean square measurement error, 2.73; mean square ± SD infit, 1.01 ± 0.18; outfit, 1.01 ± 0.19. The items (mean score, 49.8 ± 4.9) were well targeted to the subjects (mean score, 51.2 ± 6.2) with a mean difference of 1.35 (scale range, 0-100) units. Test-retest intraclass correlation coefficient (0.86) and coefficient of repeatability (±8.00 units) demonstrated good repeatability. CONCLUSIONS. Rasch analysis and standard psychometric analyses demonstrated that the 28-item CLIQ Questionnaire is a valid and reliable measure of QoL in contact lens wearers. A scoring algorithm is provided for CLIQ Questionnaire users to convert raw scores into the Rasch analysis-derived linear person measures.

No / PURPOSE. Epidemiologic studies have indicated that elderly people who wear multifocal spectacles have an increased risk of tripping, particularly on stairs. Yet no studies have experimentally examined how wearing multifocal spectacles affects stair and step negotiation. The purpose of this study was to determine the effects of wearing multifocal compared with single-distance vision spectacles on minimum toe clearance and risk of tripping during step negotiation in the elderly. METHODS. Nineteen healthy subjects (mean age, 71.4 years) performed a single step up to a new level (heights, 7.5, 15, and 22 cm) while wearing multifocal (bifocals and progressive addition lenses) or single-distance vision spectacles. Minimum horizontal and vertical toe clearance were assessed by analyzing data collected with a five-camera, three-dimensional motion-analysis system. RESULTS. There was no difference in mean minimum toe clearance in subjects when wearing multifocal compared with single-distance vision spectacles. However, there was greater within-subject variability in vertical toe clearance when wearing multifocal spectacles (variance ratio, 1.53; P = 0.0004). Subjects were also significantly more likely to trip when wearing multifocal compared with single-vision spectacles (one-sided Fisher's exact test P = 0.025). CONCLUSIONS. Because of increased within-subject variability in vertical toe clearance when wearing multifocal spectacles, elderly individuals may be at greater risk of falling when negotiating steps and stairs if they do not also consistently increase margins of safety (mean vertical toe clearance). This suggests that some elderly who are at high risk of falling may benefit from wearing single-distance vision rather than multifocal spectacles when walking.