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Study of Optimal Perimetric Testing In Children (OPTIC): development and feasibility of the kinetic perimetry
Dipesh E Patel1,2,3,4, Ananth C Viswanathan3, David Garway-Heath3
1Life Course Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, UK.
Insights
A new quantitative measure, the kinetic perimetry reliability measure (KPRM), objectively assesses visual field test reliability in children. This tool, combined with examiner scoring, improves the interpretation of kinetic perimetry results.
Area of Science:
- Ophthalmology
- Visual Science
- Medical Technology
Background:
- Accurate assessment of test reliability is crucial for interpreting perimetric findings in children.
- Currently, no objective measures exist for kinetic perimetry reliability.
- Subjective assessments are standard but lack quantitative data.
Purpose of the Study:
- To develop and assess the feasibility of the kinetic perimetry reliability measure (KPRM).
- To evaluate the association between KPRM and a subjective examiner-based assessment of reliability (EBAR).
- To explore the utility of KPRM in enhancing the interpretation of kinetic perimetry in pediatric populations.
Main Methods:
- Developed and applied the kinetic perimetry reliability measure (KPRM) in 103 children aged 5-15 years undergoing Goldmann perimetry.
- Utilized an examiner-based assessment of reliability (EBAR) scoring system for qualitative assessment.
- Examined the relationship between KPRM and EBAR to evaluate KPRM's effectiveness.
Main Results:
- The KPRM was successfully achieved in all pediatric participants.
- Higher KPRM values correlated with reduced test quality and greater test-retest variability (p=0.005).
- KPRM values decreased with increasing age (p=0.015), and discordance between KPRM and EBAR was minimal (0.97%).
Conclusions:
- KPRM provides a quantitative measure of within-test variability, complementing subjective EBAR scores.
- KPRM and EBAR are distinct yet complementary tools for assessing kinetic perimetry reliability.
- Combining KPRM with EBAR is recommended to improve the interpretation of kinetic perimetry test reliability in children.
Introduction:
Interpretation of perimetric findings, particularly in children, relies on accurate assessment of test reliability, yet no objective measures of reliability exist for kinetic perimetry. We developed the kinetic perimetry reliability measure (KPRM), a quantitative measure of perimetric test reproducibility/reliability and report here its feasibility and association with subjective assessment of reliability.
Methods:
Children aged 5-15 years, without an ophthalmic condition that affects the visual field, were recruited from Moorfields Eye Hospital and underwent Goldmann perimetry as part of a wider research programme on perimetry in children. Subjects were tested with two isopters and the blind spot was plotted, followed by a KPRM. Test reliability was also scored qualitatively using our examiner-based assessment of reliability (EBAR) scoring system, which standardises the conventional clinical approach to assessing test quality. The relationship between KPRM and EBAR was examined to explore the use of KPRM in assessing reliability of kinetic fields.
Results:
A total of 103 children (median age 8.9 years; IQR: 7.1 to 11.8 years) underwent Goldmann perimetry with KPRM and EBAR scoring. A KPRM was achieved by all children. KPRM values increased with reducing test quality (Kruskal-Wallis, p=0.005), indicating greater test-retest variability, and reduced with age (linear regression, p=0.015). One of 103 children (0.97%) demonstrated discordance between EBAR and KPRM.
Conclusion:
KPRM and EBAR are distinct but complementary approaches. Though scores show excellent agreement, KPRM is able to quantify within-test variability, providing data not captured by subjective assessment. Thus, we suggest combining KPRM with EBAR to aid interpretation of kinetic perimetry test reliability in children.
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