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Applying Theories and Interventions from Behavioral Medicine to Understand and Reduce Visual Field Variability in Patients with Vision Loss

机译：应用行为医学的理论和干预措施来了解和减少视力丧失患者的视野变异性

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Visual field (VF) test results are often unreliable in visually impaired patients, but continue to be a cornerstone of clinical trials and play a vital role in clinical decision making since they are the primary method to determine patients’ functional vision loss or progression. Currently, patients are typically asked to perform VF tasks with minimal instruction or consideration of their psychological experience during the test. The gradual loss of vision due to retinal diseases, such as retinitis pigmentosa (RP), age-related macular degeneration (AMD), or glaucoma can contribute to the experience of negative psychosocial states, such as anxiety, stress, and depression, as well as diminished quality of life. We hypothesize that VF testing elicits test performance anxiety and perception of functional losses of vision, which induces distracting negative thoughts that result in increased VF test variability. Resources for processing and responding to vision-related information may be diverted from task-relevant VF stimuli to task-irrelevant ones, such as internal worry and test anxiety, thereby resulting in VF test performance decrements. We present a theoretical model to support the hypothesis that VF variability is linked to patients’ negative thoughts during VF testing. This conceptual framework provides a basis for the development of coping strategies and mindfulness-based interventions to be evaluated in future research aimed at improving psychosocial states and VF reliability in visually-impaired patients. It would be highly significant to intervene by modifying negative thoughts during VF testing to reduce test variability in glaucoma patients who are progressively losing vision to a blinding eye disease, but whose vision loss has not been accurately identified and treated early enough due to variable VF results. In clinical trials of potential interventions for RP and non-neovascular AMD, reducing VF variability would effectively increase the precision for detecting treatment effects and allow a reduction in the number of VF tests needed to estimate the treatment responses, thus reducing burden on investigators and patients, as well as saving time and money.
机译：视力（VF）测试结果在视力障碍患者中通常不可靠，但仍是临床试验的基石，并且在临床决策中起着至关重要的作用，因为它们是确定患者功能性视力丧失或进展的主要方法。当前，通常要求患者在测试期间以最少的指导或考虑其心理经验来执行VF任务。由于视网膜疾病（例如色素性视网膜炎（RP），年龄相关性黄斑变性（AMD）或青光眼）而导致的视力逐渐丧失，也可能导致不良的社会心理状态，例如焦虑，压力和抑郁生活质量下降。我们假设VF测试会引起测试性能焦虑和对视力丧失的感知，从而引起分散注意力的负面想法，从而导致VF测试变异性增加。用于处理和响应与视觉有关的信息的资源可能从与任务相关的VF刺激转移到与任务无关的刺激，例如内部担忧和测试焦虑，从而导致VF测试性能下降。我们提供一种理论模型来支持VF变异性与VF测试期间患者的负面想法有关的假设。该概念框架为应对策略和基于正念的干预措施的开发提供了基础，这些干预措施将在未来的研究中进行评估，旨在改善视力障碍患者的心理状态和VF可靠性。对于在逐渐丧失视力的视力疾病而视力下降的青光眼患者中进行干预，通过在VF测试过程中修改消极想法来减少测试变异性，以进行干预是非常重要的，但由于VF结果不佳，其视力下降尚未得到足够的准确识别和治疗。在针对RP和非血管性AMD的潜在干预措施的临床试验中，降低VF变异性将有效提高检测治疗效果的准确性，并减少估计治疗反应所需的VF测试次数，从而减轻研究者和患者的负担，以及节省时间和金钱。

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