Alex R. Bowers, Ph.D.

Harvard Medical School

Associate Professor of Ophthalmology

Schepens Eye Research Institute of Massachusetts Eye and Ear

Associate Scientist

 

Research Summary

Center/Research Area Affiliations

Biography

Dr. Bowers' current research projects encompass three main areas: (1) evaluating the effects of vision impairment on driving skills and behaviors; (2) investigating the relationship between driving performance and novel tests of vision and attention to determine which tests have the greatest potential for identifying at-risk drivers; and (3) evaluating the benefits of optical devices to assist visually impaired people when driving and walking.

Download her CV [PDF] for more information.

Education

Ph.D., Vision Rehabilitation Research, Glasgow Caledonian University, Scotland (1998)

Postgraduate Training

Schepens Eye Research Institute of Mass. Eye and Ear (2002-2005)

Honors

2015: Diplomate, Vision Science Section, American Academy of Optometry
2013: Envision Award in Low Vision Research
2010: Irvin and Beatrice Borish Outstanding Young Researcher Award, American Academy of Optometry
2008: Fellow, American Academy of Optometry

Her Story

Summary

Dr. Bowers is a clinician scientist whose primary focus is vision rehabilitation research. She has made significant contributions to the field as an optometrist in the United Kingdom, as well as an educator and researcher—first at Glasgow Caledonian University and now at Schepens Eye Research Institute of Mass. Eye and Ear. Her achievements were recognized in 2010 when she was awarded the Borish Outstanding Young Researcher Award from the American Academy of Optometry. In 2013, Dr. Bowers received the prestigious Envision Low Vision Research Award.

Currently, Dr. Bowers devotes most of her time to research, which includes the supervision and mentoring of trainees within the research environment.

Assessment Tools in Driving Simulator

A major focus of Dr. Bowers’ research has been the implementation of assessment tools in a high-fidelity driving simulator to enable systematic evaluations of drivers with a range of vision impairments. Her first study of drivers with hemianopia (the loss of half the field of vision on the same side in both eyes) revealed a very wide range in the ability of people with hemianopia to compensate for their hemifield loss by scanning (i.e., making eye and head movements toward the affected side). While some participants scanned well and had detection rates on the side of the field loss that were similar to those of drivers with a full field of vision, others did not scan well and frequently failed to see pedestrian hazards on the side of the field loss. These findings were replicated in subsequent studies. Another series of studies of drivers with central visual field loss (e.g., from age-related macular degeneration) provided the first data to demonstrate the extent to which a blind area in central vision can delay detection of hazards when driving.

Hemianopia Rehabilitation

Dr. Bowers has made major contributions in the field of rehabilitation of patients with hemianopia. She designed and implemented an open-label and then a randomized controlled multi-center clinical trial to evaluate peripheral prism glasses for walking, and also led an on-road, placebo-controlled pilot study of peripheral prism glasses for driving. Through these trials an evidence base has now been established for the utility of the device as a mobility aid. Such evidence-based research is rare in the field of vision rehabilitation.

In addition, Dr. Bowers led a laboratory-based study of peripheral prism glasses and perceptual-motor training for patients with hemianopia. A key aspect that differentiated this study from other studies of rehabilitation interventions for patients with hemianopia was the use of functional outcome measures to evaluate mobility performance in simulated and real world walking and driving tasks.

Projects

Research Interests

  • How vision impairments affect driving
  • Relationship between driving performance and novel tests of vision and attention
  • Evaluation of optical and electronic devices for visually impaired people while driving and walking

Research Methods

The Bowers Laboratory uses the realistic, but controlled environment of a high-fidelity driving simulator to evaluate the impact of central vision loss (e.g., due to age-related macular degeneration), peripheral vision loss (e.g., due to glaucoma or retinitis pigmentosa) and hemianopic visual field loss (loss of half the field of vision e.g., after a stroke). The laboratory is evaluating the effects of these vision impairments on detection of hazards while driving, on steering and lane-keeping skills, and on eye and head movement behaviors.

When evaluating the benefits of optical devices for mobility tasks, we use two main approaches:

1. Laboratory-based studies, including assessments in controlled environments such as the driving simulator

2. Multicenter clinical trials using community-based, low vision clinics where the primary outcome measures are clinical success (whether the devices are still being used six months after being prescribed) and participants’ reports of the benefits of the devices (assessed by questionnaires).

Driving with Hemianopia

This project continues Dr. Bowers’ prior research on driving with hemianopia. The current study is investigating the ability of people with hemianopia to compensate for the hemifield loss by scanning (eye and head movements) in realistic scenarios involving a range of different hazards within the safe environment of the driving simulator. We are interested in the question of why some people with hemianopia compensate well by scanning yet others do not. In later stages of the project we will evaluate a novel intervention aimed at improving the scanning of drivers with hemianopia.

Why do Drivers Fail to See Hazards at Intersections?

The aim of this project is to understand more about the factors that may contribute to the finding that older drivers are more likely to be involved in intersection crashes than middle-age drivers. Interestingly, people sometimes report that they looked but failed to see the vehicle with which they crashed. We are using novel laboratory tests of visual attention and peripheral vision, complemented by more real-world tests in the driving simulator to investigate this observation. Using eye and head tracking we are recording whether older drivers actually fail to look in the direction of a hazard and do not see it, or whether they look directly at the hazard but do not consciously see it.

Driving with Bioptic Telescopes

People with reduced visual acuity are permitted to drive in 45 states with the aid of a small telescope, called a bioptic telescope, mounted at the top of their spectacle lens. The aim of the project is to investigate when and how bioptic telescopes are used and the safety of driving with bioptic telescopes. Using an in-car recording system and computerized analysis programs, we will record participants' daily driving activities for several months and then automatically process the vast amount of data to select segments of interest for analysis. This naturalistic driving evaluation will be complemented by lab-based tests and driving simulator evaluations. This project is being conducted in collaboration with Dr. Gang Luo.

Collision-Warning Device for People with Blindness or Severe Vision Loss

People with total blindness or severe vision loss often use a long cane when walking to warn them of potential obstacles in their path. However, the traditional long cane only detects objects at ground level. Dr. Gang Luo and colleagues have developed a collision warning device to provide long-cane users with warnings of potential collisions from objects above ground level (e.g., over-hanging tree branches). The goal of this project is to establish a strong evidence base for the functional efficacy of the device by conducting a randomized controlled clinical trial of the device in which participants use the device in their daily activities for one or two months.

Current Research Funding

2012-2017
National Institutes of Health: Co-Investigator
Bioptic driving by visually impaired
2015-2019
U.S. Department of Defense: Co-Principal Investigator
Development of a vision-assistive device for veterans with TBI-associated visual dysfunctions
2015-2020 National Institutes of Health: Principal Investigator
Scanning and detection at intersections
2017-2018 New England College of Optometry
The effects of age, simulated vision impairment and distraction on hazard detection when driving

Publications

H-index

21 (Google Scholar, as of September 2017)

Selected Publications

Dr. Bowers has published more than 60 peer-reviewed articles. Below is a list of selected publications. View her publications on PubMed.

  1. Alberti C, Goldstein RB, Peli E, and Bowers AR. Driving with hemianopia, V: Do individuals with hemianopia spontaneously adapt their gaze scanning to differing hazard detection demands? Transl. Vis. Sci. Technol. In press
  2. Bowers AR. Driving with homonymous visual field loss: a review of the literature. Clin Exp Optom. 2016;99(5):402-18.
  3. Bowers AR, Sheldon SS, DeCarlo DK, Peli E. Bioptic Telescope Use and Driving Patterns of Drivers with Age-Related Macular Degeneration. Transl Vis Sci Technol. 2016;5(5):5.
  4. Houston KE, Woods RL, Goldstein RB, Peli E, Luo G and Bowers AR. Asymmetry in the collision judgments of people with homonymous field defects and left hemispatial neglect. Invest. Ophthalmol. Vis. Sci. 2015;56:4135–4142
  5. Bowers AR, Keeney K, Peli E. Randomized, placebo-controlled clinical trial of peripheral prism glasses for hemianopia. JAMA Ophthalmol. 2014;132(2):214-222.

Laboratory

Current Members of Dr. Alex Bowers’ Laboratory

Postdoctoral Fellows
Steven Savage, PhD
Garrett Swan, PhD

Research Assistant
Lily Zhang, MS

Graduate Student
Christine Zhang, BS

Visiting Research Scholar
Maha Shahin, MD, MS

Visiting PhD Students
Ilja Feldstein, MSc
Christian Lehsing, MSc

Alumni

More than 20 trainees have worked in Dr. Bowers’ laboratory. To view the complete list of alumni, download her CV [PDF].