Objective To further refine the Chinese Adult Strabismus-20 （CAS-20） health-related quality of life（HRQOL） questionnaire using Rasch analysis. Methods In this cross-sectional study， the CAS-20 questionnaire was independently completed by 246 adult strabismus patients. Based on the score for each item， Rasch analysis was performed on the original CAS-20 using the following aspects： dimensionality， response order， local dependence， infit and outfit analysis， differential item function， subject targeting and confirmatory dimensionality. Results The original CAS-20 was divided into 4 subscales， which were labeled ″self-perception″， ″interaction″， ″reading function″， and ″general function″. Response ordering was appropriate for all of the 4 subscales. As a result of infit and outfit analysis， 3 items were removed， one each from ″self-perception″， ″reading function″， and ″general function″. No significant differential item function was found for sex or age. Compared with the ability of the patients and item difficulty， the 3 subscales matched well except for ″reading function″. Conclusion The original CAS-20 was reduced to 17 items， and divided into 4 subscales， which were ″self-perception″， ″interaction″， ″reading function″， and ″general function″. Subject response choices saved 5 test options. The refined CAS-20 may prove to be more responsive to HRQOL changes in adult strabismus patients.
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