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Study of Optimal Perimetric Testing In Children (OPTIC): developing consensus and setting research priorities for
Dipesh E Patel1,2,3, Phillippa M Cumberland1,2, Bronwen C Walters2,4
1Life Course Epidemiology and Biostatistics Section, UCL GOS Institute of Child Health, London, UK.
Insights
Expert consensus recommends starting visual field testing (perimetry) around age 7 for children with glaucoma. Guidance also emphasizes assessing test quality using qualitative methods and reliability indices, with further research needed on defining progressive visual field loss.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma Management
- Visual Field Testing
Background:
- Perimetry is crucial for managing pediatric glaucoma but lacks evidence-based guidelines.
- This study aimed to update clinical guidance through expert consensus.
Purpose of the Study:
- To establish expert consensus on perimetry use in children with glaucoma.
- To identify research gaps in pediatric glaucoma visual field assessment.
Main Methods:
- Modified Delphi consensus process with UK-based pediatric glaucoma experts.
- Electronic questionnaires and iterative analysis to achieve agreement.
- Panel selection based on clinical experience and training.
Main Results:
- Consensus reached on 80.8% of items in two rounds.
- Recommendations include initiating perimetry around age 7.
- Consensus on using qualitative methods and reliability indices for test quality assessment.
- Disagreement noted on defining progressive visual field loss and longitudinal perimetry implementation.
Conclusions:
- Expert consensus exists on perimetry implementation and quality assessment in pediatric glaucoma.
- Further research is required to define progressive visual field loss and long-term perimetry strategies.
- Individual patient factors are critical for test selection, interpretation, and testing frequency.
Background:
Perimetry is important in the management of children with glaucoma, but there is limited evidence-based guidance on its use. We report an expert consensus-based study to update guidance and identify areas requiring further research.
Methods:
Experts were invited to participate in a modified Delphi consensus process. Panel selection was based on clinical experience of managing children with glaucoma and UK-based training to minimise diversity of view due to healthcare setting. Questionnaires were delivered electronically, and analysed to establish 'agreement'. Divergence of opinions was investigated and resolved where possible through further iterations.
Results:
7/9 experts invited agreed to participate. Consensus (≥5/7 (71%) in agreement) was achieved for 21/26 (80.8%) items in 2 rounds, generating recommendations to start perimetry from approximately 7 years of age (IQR: 6.75-7.25), and use qualitative methods in conjunction with automated reliability indices to assess test quality. There was a lack of agreement about defining progressive visual field (VF) loss and methods for implementing perimetry longitudinally. Panel members highlighted the importance of informing decisions based upon individual circumstances-from gauging maturity/capability when selecting tests and interpreting outcomes, to accounting for specific clinical features (e.g. poor IOP control and/or suspected progressive VF loss) when making decisions about frequency of testing.
Conclusions:
There is commonality of expert views in relation to implementing perimetry and interpreting test quality in the management of children with glaucoma. However, there remains a lack of agreement about defining progressive VF loss, and utilising perimetry over an individuals' lifetime, highlighting the need for further research.
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