NEW YORK (Reuters Health) – Static perimetry is feasible for visual field testing in children with glaucoma as young as age 5 years, and kinetic perimetry provides complementary results in older children, according to findings from the Optimal Perimetric Testing in Children (OPTIC) study.
Visual field testing is commonly used to manage adult glaucoma, but it can be challenging in young children, and its role in managing childhood glaucoma remains unclear.
Dr. Jugnoo S. Rahi from UCL GOS Institute of Child Health, London, England, and colleagues investigated the feasibility and quality of perimetry in 65 children with glaucoma (median age, 12 years; range, 5-15). They compared static and combined static/kinetic techniques and tested affected and unaffected eyes.
The researchers performed assessments using an Octopus 900 and a Humphrey Visual Field Analyzer 740/750i – and used the qualitative Examiner-Based Assessment of Reliability (EBAR) as a measure of test quality. The findings were published online December 28 in JAMA Ophthalmology.
The proportion of good-quality tests, by EBAR, increased with increasing age for both the Humphrey (from 2/6 for children ages 5-7 to 33/33 for those ages 12-15) and the Octopus (from 1/6 for children ages 5-7 to 32/33 for those ages 12-15) perimeters.
Among children younger than 10, Humphrey perimetry had better EBAR ratings than Octopus perimetry.
In eyes with glaucoma, the number of false-positive results and fixation losses decreased with increasing age, whereas false-negative results were similar across age groups.
Visual field classification scores for static perimetry tests showed substantial agreement between the methods, although 25 of 80 eyes (31%) were graded with a more severe defect for Octopus static perimetry.
Of the seven severe cases of visual field loss, five had lower kinetic than static classification scores.
“Static perimetry (either using Humphrey or Octopus) is most likely to detect mild glaucomatous visual field loss and is most likely to be feasible in younger children,” the researchers conclude. “The value of assessing the far-peripheral field using kinetic perimetry lies in the assessment of children with moderate/severe visual field loss in whom assessment of the full extent of the field, i.e., sensitivity outside 30-degree eccentricity, may enable detection of residual islands of sensitivity, which is not possible with conventional static perimetry alone.”
“We believe a gap remains in our understanding of the role of perimetry in identifying progressive visual field loss in young children with glaucoma, and our cross-sectional study may inform such future research,” they add. “Our findings may offer guidance to clinicians about optimal perimetric approaches and interpretation of findings to improve clinical management now.”
“Although the study evaluated children aged 5 to 15 years, it is my experience that some younger children can be successfully tested, even as young as 3 years,” writes Dr. Joseph Caprioli from University of California-Los Angeles in a related editorial.
“The OPTIC study is an important contribution to our published evidence that supports the use of visual field measurements in children with glaucoma,” the editorial concludes. “Perhaps more importantly, it highlights the possibility of obtaining useful visual field measurements even in young children and that this should more frequently and assiduously be attempted. Successful perimetric evaluations undoubtedly enhance the ability to recognize insufficiently treated glaucoma and render the dangers of pediatric glaucoma less harmful.”
Dr. Robert N. Weinreb, director of Shiley Eye Institute’s Hamilton Glaucoma Center, University of California, San Diego, told Reuters Health by email, “Although it is recognized that assessment of the visual field in children can be useful, but challenging, this study provides validation for the feasibility of obtaining reliable static perimetric testing in children as young as 5 years of age.”
“Kinetic perimetry can enable reliable measurement of the far-peripheral sensitivity for children older than 10 years, and may be particularly useful with severe visual field restriction,” he said.
“Reliable visual field testing with widely available instrumentation is feasible in many children and should be performed when diagnosing glaucoma or monitoring existing glaucoma,” Dr. Weinreb concluded.
Dr. Rahi was unable to respond to a request for comment in time for publication.
SOURCES: http://bit.ly/2lq3QDg and http://bit.ly/2BSKWvQ
JAMA Ophthalmol 2017.
Tidak ada komentar:
Posting Komentar