The study compared different static and combined static / kinetic perimetry approaches in children with glaucoma . The study data suggest that monitoring visual fields in childhood glaucoma should consider age, disease severity, and different strengths of static vs.. kinetic tests.
Cross-sectional, observational study recruiting children prospectively between May 2013 and June 2015 at 2 tertiary specialist pediatric ophthalmology centers in London, England (Moorfields Eye Hospital and Great Ormond Street Hospital). The study included 65 children aged 5 to 15 years with glaucoma (108 affected eyes).
A comparison of test quality and outcomes for static and combined static / kinetic techniques, with respect to ability to quantify glaucomatous loss. Children performed perimetric assessments using Humphrey static and Octopus combined static tendency-oriented perimetry / kinetic perimetry in a single sitting, using standardized clinical protocols, administered by a single examiner.
Information is collected about test duration, completion, and quality (using automated reliability indices and our qualitative Examiner-Based Assessment of Reliability score). Perimetry outputs were scored using the Aulhorn and Karmeyer classification. One affected eye in 19 participants was retested with Swedish Interactive Thresholding Algorithm 24-2 FAST and 24-2 standard algorithms.
Sixty-five children (33 girls [50.8%]), with a middle age of 12 years (interquartile range, 9-14 years), were tested. Test quality (Examiner-Based Assessment of Reliability score) improved with increasing age for both Humphrey and Octopus strategies and were equivalent in children older than 10 years (McNemar test, χ 2 = 0.33; P = .56), but better-quality tests with Humphrey perimetry were achieved in younger children (McNemar test, χ 2 = 4.0, P = .05).
Octopus and Humphrey static MD values ??worse than or equal to -6 dB showed disagreement (Bland-Altman, mean difference, -0.70; limit of agreement, -7.74 to 6.35) but were comparable when greater than this threshold (mean difference, -0.03, limit of agreement, -2.33 to 2.27).
Visual field classification scores for static perimetry tests showed substantial agreement (linearly weighted κ, 0.79; 95% CI, 0.65-0.93), although 25 of 80 (31%) were graded with a more severe defect for Octopus static perimetry. Of the 7 severe cases of visual field loss (grade 5), 5 had lower kinetic than static classification scores.
A simple static perimetry approach potential yields high-quality results in children younger than 10 years. For children older than 10 years, without criminalizing quality, the addition of kinetic perimetry enabled measurement of far-sensitivity, which is particularly useful in children with severe visual field restriction.