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

摘要 美国的失明和视力障碍负担预计将在2015年至2010年期间翻一番 2050年到896万人。黑人、西班牙裔和老年人将受到不成比例的影响，进一步 突出了视力障碍的不同影响。尽管低视力康复(LVR)已被证明 为了改善患者的功能，仍有相当多的机会更好地理解和克服 视力低下造成的功能限制。具体地说，LVR对周围视野患者的有效性 Lost(PFL)还没有得到很好的研究，尽管15%-20%的LVR患者有青光眼或视网膜 退行性变是PFL的两个重要原因。为了评估和比较针对这一人群的干预措施， 需要一种高度相关的功能衡量标准。拟议的项目将通过 开发和验证患者报告的结果测量，低视力严重收缩 周边视力(LV-Scope)评估。在本提案的目标1中，与患者、照顾者组成的焦点小组 视力提供者将确定与严重PFL相关的损害和LVR目标。因为PFL经常 存在合并视力下降，PFL患者和一系列视力将被包括在内。 我们预计PFL将优先影响背侧视觉处理流的已知功能，因为这 路径依赖于周围视觉的空间意识和运动行为。在目标2中，焦点小组数据 将指导结果衡量的调查项目的选择。在目标3中，心理测评将测试 LV-Scope的效度、可靠性和精确度。一旦经过验证，LV-Scope可能是最理想的 评估和确定针对PFL患者的有针对性的LVR策略的结果衡量标准相当大 未被充分研究的人群。该项目直接针对国家眼科研究所的低视力优先研究 创建和验证与日常生活任务相关的视力测试。埃尔利希博士的长期职业目标 是为了改善低视力患者的视觉依赖功能。他将通过以下方式实现这一点 课程、指导和研究，以改善功能障碍的测量并促进 评估有针对性的LVR战略。申请者的培训计划是他的培训计划的自然发展 眼科、临床研究和公共卫生方面的背景。他将在以下方面获得知识和专业知识 结果测量发展和心理测量学，低视力和康复，混合方法分析和 临床试验。埃尔利希博士设计了一项有针对性的课程计划，个性化的指导和指导 自学以达到他的培训和研究目标。埃尔利希博士的职业发展将受益于 密歇根大学的资源和他的导师的支持，包括Noelle Carlozzi博士，Paul 李，罗伯特·马索夫和琼·斯特尔马克。这项建议表明了埃尔利希博士致力于获得 具备成为独立调查员和解决紧迫的公共卫生需求所需的技能。

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.