Assessment of an Effective Visual Field Testing Strategy for a Normal Pediatric Population

Abstract

Aim: To investigate which visual field testing strategy yields more reliable and tolerable field analysis in a normal pediatric population. Material and Methods: 68 healthy children aged 6–13 years with no ocular or systemic diseases were included in the study. One randomly selected eye of each child underwent standard achromatic visual field analysis using a Model 750 Humphrey Field Analyzer II (Carl Zeiss Meditec, Dublin, Calif., USA). We evaluated the reliability criteria (false negative, false positive and fixation loss scores) and the duration of the visual field tests performed by Fastpac (with stimulus sizes III and V, respectively) and SITA Fast with stimulus size III. Moreover, subjects underwent Goldmann perimetry testing with stimulus V. Ability to complete the perimetry tests was also scored. Perimetric analysis was stopped before the end if signs of fatigue appeared. Mean sensitivity, mean defect and pattern standard deviation were recorded for automated tests. Results: All subjects but 8 successfully completed each of four tests. The mean duration of the tests was 4.23, 5.46, 6.35 and 11.06 min for SITA Fast with stimulus size III, Fastpac with stimulus size V, Size III and Goldmann perimetry, respectively (p < 0.001). Both false-negative and false-positive test scores were found to be significantly lower for SITA Fast with stimulus size III compared to the other automated tests (p < 0.01). Children older than 8 years (n = 35) achieved significantly higher test reliability scores (p < 0.01). Conclusion: As early detection of structural and functional visual abnormalities may be of utmost importance in the pediatric population considering many potentially serious neurological and ocular problems met with, accurate and reproducible visual field testing is vital. To achieve this goal, visual field testing with SITA Fast algorithm seemed to be a promising strategy for a pediatric population in a typical clinical setting.

Study of Optimal Perimetric Testing In Children (OPTIC)

“…It is difficult to compare directly our kinetic data with the extant literature reporting VF size in children, because prior research involved assessments along fewer meridians, using large stimuli (V4e) only, 5,6 or had a small sample and analyzed with parametric methods. 20 However, visual inspection does show that our results in the oldest children are similar to the results of Egge 1 in 14-to 15-year-olds (n ¼ 68, Goldmann perimetry), albeit with a slightly smaller nasal field in our study, but similar confidence estimates.…”

“…5,6 The Goldmann perimeter is no longer available commercially, and only 1 study 7 has produced normative isopter area values in children using a kinetic perimeter with similar specifications, namely, the Octopus 900 (n ¼ 82; aged 5e15 years). Furthermore, the development of normative isopter models should account for the nonparametric distribution of points, yet current normative values (in adults and children) have failed to do this.…”

“…14 There is some evidence to suggest children without ocular pathology do not reach adult-level sensitivities with the SITA strategy, but reference values are not known. 6 We report a systematic investigation of fields using Goldmann and Octopus kinetic, and Humphrey static perimetry (SITA 24-2 FAST), in children aged 5 to 15 years, attained using test protocols suitable for a clinical setting.…”

A new perimeter using the preferential looking response to assess peripheral visual fields in young and developmentally delayed children

“…[2][3][4] Aslam and colleagues 5 have recently described a computer game-based, child-friendly, flat-screen perimeter. 5 This system may be useful for detecting relative field deficit and scotomata in children but requires a learned and conscious response, which limits its use in younger and developmentally delayed children.…”

Feasibility and outcome of automated kinetic perimetry in children

“…Akar et al [30] evaluated 68 6-to 13-year-old healthy children using Goldmann perimetry (V4 stimulus on 8 meridians at 3°/second). The testing took on average 11.06 minutes (11.06 ± 3.9 minutes), which was longer than in other comparable studies (shown in Table 1).…”