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Dipesh E Patel, Bronwen C Walters, Isabelle Russell-Eggitt, Jugnoo S Rahi, Phillippa Cumberland; OPTIC study: Feasibility and reliability of perimetry in children with glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3935. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Although World Glaucoma Association guidance advocates the use of perimetry in childhood glaucoma from 7-8 years of age, there is a dearth of research into optimal perimetric approaches. We investigated the feasibility and reliability of common perimetric tests in children with glaucoma, to inform the development of clinical protocols.
Children aged 5-15 years, with visual acuity better than 1.0 LogMAR (6/60) in at least one eye with glaucoma, were recruited from Moorfields and Great Ormond Street Hospitals. Children underwent perimetry, using the Humphrey SITA 24-2 FAST algorithm and a combined static/kinetic test (G-TOP with a far-periphery kinetic isopter) using the Octopus perimeter, performed under clinical conditions. Test completion and duration were recorded. Test quality was assessed with our previously reported Examiner Based Assessment of Reliability (EBAR) scoring system with ratings of ‘good’, ‘fair’ or ‘poor’ quality (developed and reported previously), and automated reliability indices (false positives/negatives and fixation losses) were documented.
All subjects (n=65) completed the Humphrey assessment and 98.4% the Octopus. The combined static/kinetic test (mean=14.8 minutes) took significantly longer than static perimetry alone (mean=11.7 minutes) (p<0.001).For Humphrey perimetry, there was a significant reduction with age in the number of false positives (p=0.011) and fixation losses (p=0.003). Similarly, for Octopus perimetry, there was a significant reduction with age in the number of false positives (p<0.001), and no change with age for false negative values (p=0.251).Test quality (measured by EBAR) improved with age with both Humphrey (regression, p=0.002) and Octopus perimeters (p<0.001) (Figure 1). Over half of subjects performed reliably from 8 (Humphrey) or 9 years (Octopus). Over 10 years, 87/90 (96.7%) assessments were reliable, with equivalence in degree of reliability (χ2, p=0.827). In younger children, reliability was better for Humphrey static perimetry (χ2, p=0.005).
Perimetry in children with glaucoma is both potentially feasible and reliable from 5 years but both aspects improve with age. We suggest static perimetry alone should be undertaken in children under 10 years of age whilst a combined static/kinetic technique is more appropriate with older children.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Fig 1. Proportion of EBAR ratings (good, fair or poor quality) per perimeter, by age groups
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