Patel, D; (2016) Study of Optimal Perimetric Testing In Children (OPTIC). Doctoral thesis , UCL (University College London).

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Abstract

Assessment of the visual field (VF) using perimetry provides valuable information for the diagnosis and management of ophthalmic and neurological disorders. It is estimated that over 3500 children under 16 years of age undergo formal perimetry in the UK per year, without any consensus on approaches to testing in children. There is also a paucity of robust data on the correct interpretation of test reliability, which is necessary to inform understanding of the usefulness of perimetry in monitoring children. Interpretation of findings relies on an understanding of the normal VF (i.e. reference values), its natural development/progression throughout the life-course and the variability of responses in normal subjects. However there is limited literature in all these areas with respect to children. To address this, a prospective, clinico-epidemiological, observational study was undertaken, collecting perimetric data on 249 children aged 5-15 years; 154 without an ophthalmic condition affecting the visual field (controls), 65 with glaucoma and 30 with neurological disease. Common adult perimetric tests were used and data on fixation, concentration, behaviour, response to auditory stimuli and fatigue were also collected, to report test reliability. In a ‘normal’ population, feasibility and reliability of perimetry improved with age, and by 9 years of age, there were no differences in reliability between tests. ‘Good quality’ assessments were reproducible on repeat testing. Visual field size/sensitivity increased with age, and reference values were defined for each perimetric test used. Comparisons between perimeters and test groups highlight differences in test feasibility, reliability and output. Thus, guidance for perimetric testing has been suggested here, including methods for assessing test reliability and appropriate test protocols, dependent on the clinical condition and age of subject. Follow-up studies are needed to generate the evidence required to understand the role of perimetry in the long-term management of ophthalmic diseases in childhood.

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