Joshua Ehrlich

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

Research Project Description
Joshua Ehrlich, Paul Lee, Noelle E. Carlozzi, John W. Creswell, David C. Musch, Joshua D. Stein, Donna M. Wicker, Sherry H. Day, Kanishka Thiran Jayasundera, Sayoko E. Moroi, Stephen Gerard Schilling

The burden of blindness and visual impairment in the United States is expected to double between 2015 and 2050, yet there has not been adequate research in the field of low vision rehabilitation (LVR) to improve the functioning of patients with limited vision. Most prior research in low vision has focused on patients with central vision loss. 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 LVR interventions for this population, it is necessary to have a valid and patient-centered measure of functioning that is relevant to patients with severe PFL. The proposed project aims to develop and validate a patient-reported outcome measure, the Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Assessment. In Aim 1, focus groups with patients, caretakers and vision providers will be used to identify the impairments and LVR goals associated with severe PFL. Since PFL often exists in combination with central vision loss, this project will include patients with various levels of visual acuity to address the impairments and LVR goals common to PFL. 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 visually guided motor behavior. In Aim 2, focus group data will guide the selection of 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. This project addresses the National Eye Institute's 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 functional abilities of patients with chronic visual impairment. He will achieve this through coursework, mentorship and patient-centered research to improve the measurement of functional impairment and to evaluate and identify 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 rehabilitation, mixed-methods analysis and clinical trials. Dr. Ehrlich has devised a plan consisting of pertinent coursework, individualized mentorship, and directed self-study to achieve his career development and research goals. Dr. Ehrlich's career development will benefit from the vast resources of the University of Michigan and the support of his research mentors, including Dr. Noelle Carlozzi, Dr. Paul Lee, Dr. Robert Massof and Dr. 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.

Funding:
National Eye Institute
(1 K23 EY 027848 01)

Funding Period: 7/1/2017 to 8/31/2022