Binocular Summation in Strabismus

斜视的双眼求和

• 批准号: 8166016
• 负责人: Stacy Pineles
• 金额: $ 21.63万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8166016
• 关键词: Adult; Affect; Age; Age of Onset; Amblyopia; Award; Binocular Vision; Biometry; Blindness; Child; Childhood; Clinical; Clinical Research Curriculum Award; Clinical Trials; Clinical Trials Design; Contrast Sensitivity; Data; Depth Perception; Development; Development Plans; Diagnosis; Disease; Epidemiologic Studies; Epidemiology; Etiology; Eye diseases; Foundations; Future; Goals; Individual; Institution; K-Series Research Career Programs; Knowledge; Lead; Measurement; Measures; Mentors; Mentorship; Monocular Vision; Multi-Institutional Clinical Trial; Operative Surgical Procedures; Ophthalmologist; Outcome; Outcome Measure; Patient Care; Patient Self-Report; Patients; Population; Positioning Attribute; Principal Investigator; Proxy; Psychophysics; Psychophysiology; Quality of life; Questionnaires; Randomized Clinical Trials; Randomized Controlled Trials; Request for Applications; Research; Research Personnel; Series; Stimulus; Strabismus; Structure; Supervision; Surveys; Testing; Time; Training; Treatment outcome; Vision; Visual; Visual Acuity; Visual evoked cortical potential; Work; career; career development; design; early onset; evidence based guidelines; experience; functional outcomes; health related quality of life; improved; interest; monocular; novel; programs; randomized trial; responsible research conduct; skills; standard measure; success

DESCRIPTION (provided by applicant): This application requests a career development award for a dually trained pediatric and neuro- ophthalmologist with a scientific interest in developing large-scale randomized clinical trials evaluating strabismus surgery (the most commonly performed pediatric ophthalmic surgery) using a comprehensive battery of psychophysical and electrophysiological tests. This will allow the candidate to create an individual research program that evaluates binocular summation, a novel measure of binocular function not currently evaluated by strabismus researchers, using functional measures. Through the completion of this research, the candidate will establish preliminary data for further independent research, and she will also define novel objective measures by which to measure binocular function in larger clinical trials of strabismus treatments (surgical and non-surgical). In addition, by completing the proposed didactic program leading to a M.S. degree in Epidemiology and involvement in the multi-center Pediatric Eye Disease Investigators Group (PEDIG), the candidate will by the end of the award period, gain the valuable hands-on experience, knowledge, and mentorship required to design, propose and implement randomized clinical trials related to strabismus surgery. The candidate's long-term goal is to lead clinical trials that will improve evidence based recommendations for strabismus treatments. This project will be under the supervision of senior investigators who will jointly provide guidance in strabismus research, epidemiology, and psychophysics The candidate will have the following objectives during the award period: 1) Development of an individual research program in strabismus outcomes; 2) Completion of coursework in epidemiology, biostatistics, clinical trial design, and the responsible conduct of research through participation in an M.S. degree program in Epidemiology and the UCLA K30 program; 3) Develop expertise in psychophysics and the use of the sweep visual evoked responses; 4) Gain experience in multi-center clinical trial design and implementation with PEDIG. Presently, strabismus treatment outcomes are evaluated by subjective and insensitive tests, such as clinical examination and stereopsis that often do not adequately assess the binocular function. The development of objective outcome measures for strabismus surgery research is essential in order to provide meaningful evidence-based recommendations. The overall goal of the research component of this proposal is to evaluate binocular summation, which is defined as the improvement in binocular vision compared to monocular vision, in patients with strabismus using a comprehensive battery of functional psychophysical and electrophysiological tests. This goal will be accomplished with 3 specific aims: 1. Determine the effect of ocular misalignment on binocular summation. In a large population of strabismic individuals, we will test the hypothesis that ocular misalignment impairs binocular summation by comparing subjects with various forms of strabismus to control subjects. Our hypothesis is that binocular summation in strabismic subjects will be lower than non-strabismic controls, and that binocular summation scores can distinguish between these two populations. We will also test the effect of contrast level, strabismus sub-type, and onset age on binocular summation. 2. Determine the impact of surgical realignment on binocular summation. We will test the hypothesis that ocular realignment surgery improves binocular summation in most strabismic subjects. We will also evaluate the influence of age of strabismus onset, timing of ocular realignment, interocular differences in acuity, and strabismus type on improvement in binocular summation. 3. Evaluate binocular summation as a surrogate measure for other outcomes used in clinical trials, including ocular alignment before and after surgery, strabismus control, and quality of life. Together, this project will characterize a novel outcome that describes functional binocular visual status in strabismic subjects that can be used in future clinical trials. Beyond the development of this individual research program, the experienced gained by the candidate in the proposed interactions with expert mentors and collaborators will provide training in clinical trial design, psychophysical outcomes, and sweep visual evoked responses. The institution, mentors, and collaborators outlined in this proposal are dedicated to research and cultivating the careers of early investigators. This structured career development plan will to position the candidate for independent investigator status at the end of the award period. PUBLIC HEALTH RELEVANCE: Strabismus or ocular misalignment is a common ocular disorder, affecting 3-5% of the population. Untreated strabismus can lead to permanent loss of vision from amblyopia or loss of binocular function and depth perception. Strabismus surgery is the most commonly performed ocular surgery in children; however, currently there are very few randomized, controlled trials to evaluate strabismus with functional measures. This work will aim to further define objective and functional measures to characterize strabismus surgery outcomes and to further define the binocular experience of patients with strabismus. The career development goals of the principal investigator include developing the skills to propose, implement, and analyze large randomized trials to improve evidence-based recommendations for strabismus treatments, which will improve the care of patients with strabismus.

描述（由申请人提供）：本申请要求为接受过双重培训的儿科和神经眼科医生提供职业发展奖，该医生对开发大规模随机临床试验评估斜视手术（最常进行的儿科眼科手术）使用综合评估方法具有科学兴趣。一系列心理物理和电生理测试。这将使候选人能够创建一个评估双眼总和的个人研究计划，这是一种使用功能测量方法目前尚未由斜视研究人员评估的双眼功能的新颖测量方法。通过完成这项研究，候选人将为进一步的独立研究建立初步数据，她还将确定新的客观措施，用于在斜视治疗（手术和非手术）的大型临床试验中测量双眼功能。此外，通过完成拟议的教学计划，可以获得硕士学位。流行病学学位并参与多中心儿科眼病调查组 (PEDIG)，候选人将在奖励期结束时获得设计、提出和实施随机化所需的宝贵实践经验、知识和指导与斜视手术相关的临床试验。候选人的长期目标是领导临床试验，以改善斜视治疗的循证建议。该项目将在高级研究人员的监督下，他们将共同为斜视研究、流行病学和心理物理学提供指导。候选人在获奖期间将实现以下目标：1）制定斜视结果的个人研究计划； 2) 通过参加硕士学位，完成流行病学、生物统计学、临床试验设计和负责任的研究行为等课程。流行病学学位课程和加州大学洛杉矶分校 K30 课程； 3）发展心理物理学和扫视视觉诱发反应的使用方面的专业知识； 4) 获得PEDIG多中心临床试验设计和实施的经验。 目前，斜视治疗结果是通过主观和不敏感的测试来评估的，例如临床检查和立体视觉，这些测试通常不能充分评估双眼功能。为了提供有意义的基于证据的建议，制定斜视手术研究的客观结果测量至关重要。该提案研究部分的总体目标是使用一系列功能性心理物理和电生理学测试来评估斜视患者的双眼总和，即双眼视力相对于单眼视力的改善。这一目标将通过 3 个具体目标来实现： 1. 确定眼部未对准对双眼求和的影响。在大量斜视个体中，我们将通过将具有各种形式斜视的受试者与对照受试者进行比较来检验眼部错位损害双眼总和的假设。我们的假设是，斜视受试者的双眼总和将低于非斜视对照，并且双眼总和分数可以区分这两个人群。我们还将测试对比度水平、斜视亚型和发病年龄对双眼总和的影响。 2. 确定手术重新对准对双眼总和的影响。我们将检验这样的假设：眼部矫正手术可以改善大多数斜视受试者的双眼总和。我们还将评估斜视发病年龄、眼球矫正时间、眼间视力差异以及斜视类型对双眼总和改善的影响。 3. 评估双眼总和作为临床试验中使用的其他结果的替代指标，包括手术前后的眼位对准、斜视控制和生活质量。总之，该项目将描述一个新的结果，描述斜视受试者的功能性双眼视觉状态，可用于未来的临床试验。除了这个个人研究项目的开发之外，候选人在与专家导师和合作者的拟议互动中获得的经验将提供临床试验设计、心理物理结果和全面视觉诱发反应方面的培训。本提案中概述的机构、导师和合作者致力于研究和培养早期研究人员的职业生涯。这一结构化的职业发展计划将使候选人在奖励期结束时获得独立研究员的地位。 公众健康相关性：斜视或眼部错位是一种常见的眼部疾病，影响 3-5% 的人口。未经治疗的斜视可导致弱视造成的视力永久性丧失或双眼功能和深度知觉丧失。斜视手术是儿童最常进行的眼科手术；然而，目前很少有随机对照试验通过功能测量来评估斜视。这项工作旨在进一步定义客观和功能性的测量来表征斜视手术的结果，并进一步定义斜视患者的双眼体验。主要研究者的职业发展目标包括培养提出、实施和分析大型随机试验的技能，以改进斜视治疗的循证建议，这将改善斜视患者的护理。