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.

Public Health Relevance

The permanent loss of vision has been shown to adversely affect day-to-day functioning, and quality of life. Vision rehabilitation may improve patients' functional abilities through the use of assistive devices and educational strategies. However, the effectiveness of rehabilitation options for patients with peripheral vision loss is poorly known since most prior research has focused on patients with central vision loss. In order to evaluate and compare the effectiveness of low vision rehabilitation strategies for patients with peripheral vision loss, a valid and reliable method for measuring vision-dependent functioning is needed. The proposed research will use the insights of patients, their caregivers and their vision care providers to develop a patient- reported outcome measure that assesses functioning in patients with low vision due to severe peripheral vision loss and can be used in future clinical trials of low vision interventions for this population. This project is relevant to the mission of the National Eye Institute, as it aims to address visual impairment and improve quality of life.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23EY027848-03
Application #
9770881
Study Section
Special Emphasis Panel (ZEY1)
Program Officer
Agarwal, Neeraj
Project Start
2017-09-01
Project End
2022-08-31
Budget Start
2019-09-01
Budget End
2020-08-31
Support Year
3
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Ehrlich, Joshua R; Hassan, Shirin E; Stagg, Brian C (2018) Prevalence of Falls and Fall-Related Outcomes in Older Adults with Self-Reported Vision Impairment. J Am Geriatr Soc :
Stagg, Brian C; Choi, HwaJung; Woodward, Maria A et al. (2018) Association of Social Support Network Size With Receipt of Cataract Surgery in Older Adults. JAMA Ophthalmol 136:423-427
Ehrlich, Joshua R (2018) What Is the Value of Preference Values for Patient-Centered Eye Care? JAMA Ophthalmol 136:664-665
Lee, Yoon H; Chen, Andrew X; Varadaraj, Varshini et al. (2018) Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance. JAMA Ophthalmol 136:622-629
Ehrlich, Joshua R; Frank, Charlie; Smiley, Josiah et al. (2018) Development of a rapid point-of-care patient reported outcome measure for cataract surgery in India. Health Qual Life Outcomes 16:25
Ganesh, Sandra C; Narendran, Kalpana; Nirmal, Jeyanthi et al. (2018) The key informant strategy to determine the prevalence and causes of functional low vision among children in South India. Ophthalmic Epidemiol 25:358-364