Academic journal article Journal of Visual Impairment & Blindness

Development and Validation of a Short-Form Adaptation of the Age-Related Vision Loss Scale: The AVL12

Academic journal article Journal of Visual Impairment & Blindness

Development and Validation of a Short-Form Adaptation of the Age-Related Vision Loss Scale: The AVL12

Article excerpt

Abstract: This article describes the development and evaluation of a short form of the 24-item Adaptation to Age-Related Vision Loss (AVL) scale. The evaluation provided evidence of the reliability and validity of the short form (the AVL12), for significant interindividual differences at the baseline and for individual-level change in AVL scores over time. Thus, the AVL12 maintains strong psychometric properties and is a shorter, more efficient measure for assessing adaptation to age-related vision loss in both research and clinical settings.


The Adaptation to Age-Related Vision Loss (AVL) scale (Horowitz & Reinhardt, 1998) was developed to provide a psychosocial measure of adjustment specifically for older adults who are adapting to late-life vision loss. The major impetus for developing the AVL was the absence of instruments in the field that specifically focused on older adults with visual impairments (both those who are blind and those with low vision) and on their psychosocial, rather than functional, adaptation to vision loss. Horowitz and Reinhardt (1998) argued that it was not that older adults adapted differently to visual impairment than did younger people, but that the indicators of adaptation would be different in later life. For example, references to braille, school, and work in the few scales that focused on psychological issues related to vision loss would not be appropriate for older adults who lost vision later in life.

Furthermore, in lieu of a specific measure of adaptation to late-life vision loss, most researchers relied on global measures of well-being, such as measures of life satisfaction, morale, and depression. Global measures of well-being, however, focus on the older person's current emotional state and on the congruence between desired and achieved lifetime goals. Adaptation to a specific late-life stressor, such as visual impairment, is not synonymous with adaptation to aging, but may be a contributor to overall subjective well-being in later life. Thus, both global and domain-specific measures are relevant to understanding the quality of life of older adults with visual impairments. In a review of the literature, common themes were identified that contributed to the definition of adaptation to age-related vision loss, namely, themes of acceptance, a realistic approach to both limitations and remaining capabilities, and a balance between independence and the appropriate use of assistance (Horowitz & Reinhardt, 1998).

The original AVL scale had 24 items and a dichotomous response set (agree or disagree). A factor analysis of the original 24-item scale indicated that while the different aspects of adaptation just noted are reflected in the items, the scale was more consistent with, and best used as, a uni-dimensional measure. Furthermore, analyses gave support for the reliability and validity of the scale. The internal consistency of the scale was high (alpha = .84), and convergent validity was indicated by significant correlations with commonly used scales of life satisfaction (correlations ranged from .49 to .63) and depression (correlations ranged from -.55 to -.74) and a single-item self-rating of adaptation (correlations ranged from .37 to .45; see Horowitz & Reinhardt, 1998).

Given the increasing number of older adults with age-related vision loss (Campbell, Crews, Moriarty, Zack, & Blackman, 1999; Horowitz, Brennan, & Reinhardt, 2005), as well as the increasing need to document the effectiveness and outcomes of vision rehabilitation services (Agency for Healthcare Research and Quality, 2002), it is not surprising that research on the psychosocial consequences of age-related vision loss and psychosocial outcomes of vision rehabilitation services for older adults has been increasing in recent years. However, the research tools that are available focus primarily on assessing vision-related function. These tools include questionnaires that were available at the time that the AVL scale was developed, such as the Visual Function Self-report (Steinberg et al. …

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