Addressing Low Vision due to Severe Peripheral Field Loss: Development and Validation of a Patient-Centered Outcome Measure

摘要

Abstract The burden of blindness and visual impairment in the United States is expected to double between 2015 and 2050 to 8.96 million people. Blacks, Hispanics and older individuals will be disproportionally affected, further accentuating the disparate impact of vision disorders. Although low vision rehabilitation (LVR) has been shown to improve the functioning of patients, considerable opportunities remain to better understand and overcome functional limitations due to low vision. Specifically, the effectiveness of LVR for patients with peripheral field loss (PFL) has not been well-studied, though 15-20% of patients presenting for LVR have glaucoma or a retinal degeneration, two important causes of PFL. In order to evaluate and compare interventions for this population, a highly relevant measure of functioning is needed. The proposed project will address this through the development and validation of a patient-reported outcome measure, the Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Assessment. In Aim 1 of this proposal, focus groups with patients, caretakers and vision providers will identify the impairments and LVR goals associated with severe PFL. Since PFL often exists in combination with visual acuity loss, patients with PFL and a range of visual acuities will be included. We anticipate that PFL will preferentially impact known functions of the dorsal visual processing stream, as this pathway depends on peripheral vision for spatial awareness and motor behavior. In Aim 2, focus group data will guide the selection of survey items for the outcome measure. In Aim 3, psychometric evaluations will test the validity, reliability and precision of the LV-SCOPE. Once validated, the LV-SCOPE may be an optimal outcome measure to evaluate and identify targeted LVR strategies for patients with PFL, a sizable understudied population. This project directly addresses the National Eye Institute's low vision priority research area “to create and validate vision tests relevant for the tasks of daily living.” Dr. Ehrlich's long-term career goal is to improve the vision-dependent functioning of patients with low vision. He will achieve this through coursework, mentorship and research to improve the measurement of functional impairment and facilitate the evaluation of targeted LVR strategies. The applicant's training plan is a natural progression from his background in ophthalmology, clinical research and public health. He will acquire knowledge and expertise in outcome measure development and psychometrics, low vision and rehabilitation, mixed-methods analyses and clinical trials. Dr. Ehrlich has devised a plan of pertinent coursework, individualized mentorship, and directed self-study to achieve his training and research goals. Dr. Ehrlich's career development will benefit from the vast resources of the University of Michigan and the support of his mentors, including Drs. Noelle Carlozzi, Paul Lee, Robert Massof and Joan Stelmack. This proposal demonstrates Dr. Ehrlich's commitment to gaining the necessary skills to become an independent investigator and to addressing a pressing public health need.