The Houston Vision Assessment Test (HVAT): An assessment of validity

Thomas C. Prager, Alice Z. Chuang, Carl H. Slater, Jay H. Glasser, Richard S. Ruiz

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


PURPOSE. Cataract surgery is one of the most successful procedures in medicine, and outcome is typically measured by a single factor - improvement in visual acuity. Health-related functional outcome testing, which quantifies the patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. METHOD. A functional outcome test (the Houston Vision Assessment Test - HVAT) was evaluated in a cataract population of 149 patients from seven study centers. Test results were correlated with objective ophthalmic endpoints. The HVAT divides an estimated total impairment into subcomponents of Visual Impairment (correctable by cataract surgery) and non-visual Physical Impairments (co-morbidities not affected by cataract surgery). RESULTS. In this prospective study, the average Visual Impairment score improved by 19 points (65%) following cataract extraction (the mean HVAT Visual Impairment score was 29 points before surgery and 10 points at 5 months post-surgery, a change of 65%). Physical Impairment remained unchanged by surgery. Visual acuity was a poor predictor of Visual Impairment. CONCLUSIONS. The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

Original languageEnglish (US)
Pages (from-to)87-102
Number of pages16
JournalOphthalmic Epidemiology
Issue number2
StatePublished - 2000


  • Cataract
  • Functional outcome
  • Houston Visual Assessment Test
  • Quality of life
  • Questionnaire study
  • Visual assessment

ASJC Scopus subject areas

  • Ophthalmology
  • Epidemiology


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