Study of Optimal Perimetric Testing in Children (OPTIC): Feasibility, Reliability and Repeatability of Perimetry in Children

Abstract

PurposeTo investigate feasibility, reliability and repeatability of perimetry in children.MethodsA 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.ResultsOverall 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.ConclusionsFeasibility 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.

Feasibility of Macular Integrity Assessment (MAIA) Microperimetry in Children: Sensitivity, Reliability, and Fixation Stability in Healthy Observers

“…28 Although more children (five) than adults (one) failed to complete all three MP assessments, only two of these failures were due to fatigue or fussiness. The individuals (two children, one adult) excluded due to poor eye tracking could likely have been tested after administering mydriatics, and this was confirmed post hoc in the one adult participant (0.5% tropicamide).…”

Semi‐automated kinetic perimetry: Comparison of the Octopus 900 and Humphrey visual field analyzer 3 versus Goldmann perimetry

“…In this study, the reliability and repeatability of the three perimeters was not assessed. The recently published studies of optimal perimetric testing in children (OPTIC) tested reliability and repeatability of Goldmann and Octopus 900 kinetic perimetry in children (Patel et al 2015). They developed an examiner based assessment of reliability (EBAR) scoring system and a kinetic perimetry reliability measure (KPRM) that can be used in quantifying within-test variability (Patel et al 2017).…”

Study of Optimal Perimetric Testing In Children (OPTIC): development and feasibility of the kinetic perimetry reliability measure (KPRM)

“…Test quality was rated qualitatively using our previously reported examiner-based assessment of reliability (EBAR) score, with ratings of either ‘good’, ‘fair’ or ‘poor’ quality, with a good-quality test being one that is expected to represent true VF sensitivity. EBAR scores are derived from matching observed behaviours to predefined criterion, and take into account key components that affect test reliability such as fatigue, loss of fixation, poor concentration and behaviour 6. It was developed to standardise conventional qualitative examiner assessments and is judged independently to the test outcome.…”

“…Interpretation of results relies on an understanding of the variability of responses in normal subjects,2 normative (reference) values3–5 and accurate assessment of test reliability 6. Modern static algorithms incorporate measures of false-positive/false-negative responses and fixation losses to assess reliability.…”