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

解决因严重周边视野丧失导致的低视力问题：以患者为中心的结果测量的开发和验证

• 批准号: 9294683
• 负责人: Joshua Robert Ehrlich
• 金额: $ 22.45万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9294683
• 关键词: Activities of Daily Living; Address; Affect; Area; Attenuated; Awareness; Behavior; Blindness; Caregivers; Caring; Chronic; Clinical; Clinical Research; Clinical Trials; Cognitive; Consensus; Data; Development; Dorsal; Effectiveness; Ensure; Evaluation; Focus Groups; Future; Glaucoma; Goals; Hispanics; Impairment; Individual; Institutes; Intervention; Interview; Journals; Knowledge; Life; Measurement; Measures; Mentors; Mentorship; Methodology; Methods; Michigan; Mission; Modeling; Motion Perception; Motor; National Eye Institute; Ophthalmologist; Ophthalmology; Outcome; Outcome Measure; Outcomes Research; Pathway interactions; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Peripheral; Population; Population Intervention; Prevalence; Principal Component Analysis; Provider; Psychometrics; Public Health; Quality of life; Randomized Controlled Trials; Rehabilitation therapy; Research; Research Design; Research Personnel; Research Priority; Retinal Degeneration; Review Literature; Self-Direction; Self-Help Devices; Stream; Surveys; Testing; Training; United States; University resources; Validation; Validity and Reliability; Vision; Vision Disorders; Vision Tests; Visual Acuity; Visual Fields; Visual impairment; Work; blind; career; career development; compare effectiveness; design; functional disability; improved; improved functioning; information processing; insight; instrument; patient oriented; programs; rehabilitation strategy; response; skills; spatial vision; systematic review; theories; vision rehabilitation; visual processing

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.

抽象的 2015 年至 2015 年期间，美国失明和视力障碍的负担预计将翻一番 到 2050 年，黑人、西班牙裔和老年人将受到更大程度的影响。 尽管低视力康复（LVR）已被证明，但仍强调了视力障碍的不同影响。 为了改善患者的功能，仍有大量机会更好地理解和克服 具体而言，LVR 对于周边视野患者的功能限制。 尽管 15-20% 接受 LVR 的患者患有青光眼或视网膜病变，但 PFL 损失 (PFL) 尚未得到充分研究 退化是 PFL 的两个重要原因 为了评估和比较针对该人群的干预措施， 拟议的项目将通过以下方式解决这一问题： 开发和验证患者报告的结果测量，低视力严重受限 周边视力 (LV-SCOPE) 评估 在本提案的目标 1 中，与患者、护理人员进行焦点小组讨论。 视力提供者将确定与严重 PFL 相关的损伤和 LVR 目标，因为 PFL 经常发生。 由于 PFL 与视力丧失同时存在，因此将包括患有 PFL 和一系列视力的患者。 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 路径取决于空间意识和运动行为的周边视觉。在目标 2 中，焦点小组数据。 将指导结果测量的调查项目的选择。在目标 3 中，将测试心理测量评估。 LV-SCOPE 的有效性、可靠性和精确度一旦经过验证，LV-SCOPE 可能是最佳选择。 评估和确定针对 PFL 患者的针对性 LVR 策略的结果测量，相当大的 该项目直接针对国家眼科研究所的低视力优先研究。 领域“创建和验证与日常生活任务相关的视力测试。”Ehrlich 博士的长期职业目标。 他将通过改善低视力患者的视力依赖功能来实现这一目标。 课程作业、指导和研究，以改进功能障碍的测量并促进 对有针对性的 LVR 策略的评估是申请人的培训计划的自然进展。 他将获得眼科、临床研究和公共卫生方面的知识和专业知识。 结果测量发展和心理测量、低视力和康复、混合方法分析和 埃利希博士制定了相关课程、个性化指导和指导计划。 自学实现他的培训和研究目标将使埃利希博士的职业发展受益匪浅。 密歇根大学的资源以及他的导师的支持，包括Noelle Carlozzi博士。 Lee、Robert Massof 和 Joan Stelmack 这一提案表明了 Ehrlich 博士对获得该奖项的承诺。 成为独立调查员和解决紧迫的公共卫生需求的必要技能。