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Study of Optimal Perimetric Testing in Children (OPTIC): Feasibility, Reliability and Repeatability of Perimetry in
Dipesh E Patel1, Phillippa M Cumberland2, Bronwen C Walters3
1Life Course Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom; Ulverscroft Vision Research Group, London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Insights
Perimetry testing is feasible and reliable in children, improving with age. Goldmann perimetry is best for younger children, but alternatives are needed as it is discontinued.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Visual Field Testing
Background:
- Assessing visual field function in children is crucial for diagnosing and managing various ophthalmic conditions.
- Traditional perimetry methods may present challenges in pediatric populations due to cooperation and attention span limitations.
Purpose of the Study:
- To evaluate the feasibility, reliability, and repeatability of different perimetry techniques in children aged 5-15 years.
- To determine the most suitable perimetry strategy for different age groups within the pediatric population.
Main Methods:
- A prospective observational study involving 154 children (5-15 years) without ophthalmic conditions affecting visual fields.
- Standardized protocols using Humphrey static (SITA 24-2 FAST), Goldmann, and Octopus kinetic perimeters were employed.
- Data on test duration, subjective experience, and examiner-rated quality were collected to assess feasibility and reliability, with repeat testing for repeatability.
Main Results:
- High overall feasibility was observed across all methods (Goldmann 96.1%, Octopus 89%, Humphrey 100%).
- Examiner-rated reliability was generally good, particularly for Goldmann perimetry in children under 9 years.
- Reliability significantly improved with increasing age (p<0.001), and test repeatability was good across all strategies.
Conclusions:
- Formal perimetry is feasible and reliable in children, with performance improving with age.
- By age 9, all tested perimetry strategies are highly feasible and reliable for clinical visual field assessment.
- While Goldmann perimetry is effective for younger children (5-8 years), its discontinuation necessitates research into suitable alternatives for this age group.
Purpose:
To investigate feasibility, reliability and repeatability of perimetry in children.
Methods:
A prospective, observational study recruiting 154 children aged 5-15 years, without an ophthalmic condition that affects the visual field (controls), identified consecutively between May 2012 and November 2013 from hospital eye clinics. Perimetry was undertaken in a single sitting, with standardised protocols, in a randomised order using the Humphrey static (SITA 24-2 FAST), Goldmann and Octopus kinetic perimeters. Data collected included test duration, subjective experience and test quality (incorporating examiner ratings on comprehension of instructions, fatigue, response to visual and auditory stimuli, concentration and co-operation) to assess feasibility and reliability. Testing was repeated within 6 months to assess repeatability.
Results:
Overall feasibility was very high (Goldmann=96.1%, Octopus=89% and Humphrey=100% completed the tests). Examiner rated reliability was 'good' in 125 (81.2%) children for Goldmann, 100 (64.9%) for Octopus and 98 (63.6%) for Humphrey perimetry. Goldmann perimetry was the most reliable method in children under 9 years of age. Reliability improved with increasing age (multinomial logistic regression (Goldmann, Octopus and Humphrey), p<0.001). No significant differences were found for any of the three test strategies when examining initial and follow-up data outputs (Bland-Altman plots, n=43), suggesting good test repeatability, although the sample size may preclude detection of a small learning effect.
Conclusions:
Feasibility and reliability of formal perimetry in children improves with age. By the age of 9 years, all the strategies used here were highly feasible and reliable. Clinical assessment of the visual field is achievable in children as young as 5 years, and should be considered where visual field loss is suspected. Since Goldmann perimetry is the most effective strategy in children aged 5-8 years and this perimeter is no longer available, further research is required on a suitable alternative for this age group.
