Perimetry in Children: Survey of Current Practices in the United Kingdom and Ireland

Abstract

Purpose: Visual fields are key functional outcome measures in children with a variety of ophthalmologic disorders. However, reliably assessing fields in children is challenging. We report the findings of a survey of current practices of perimetry in children in the United Kingdom and Ireland.

Methods: An electronic questionnaire was sent to Orthoptic Service Heads in July 2008.

Respondents were asked for comments regarding visual field testing in children as well as details of the volume and type of perimetry performed in their units, over a 1-year period.

Results: Of the 98 (62%) completed questionnaires, 16 departments reported not testing visual fields in children. In total 3675 subjects under 16 years of age were reported to have undergone perimetry in 1 year, most in units with a ≥ 50% pediatric caseload for orthoptics. A total of 42% of units used static perimetry alone, 11% kinetic, and 47% used a combination of both.

Conclusion: High numbers of visual field tests are carried out in children in the UK and Ireland annually. Automated perimetry is used predominantly, despite the underlying algorithms having been developed for adult populations. Thus there is a clear need for more research, to ensure that evolving management practices are informed by understanding of the diagnostic accuracy and value of perimetry in children.

KEYWORDS::

• Kinetic perimetry
• Static perimetry
• Visual fields
• Children
• Orthoptists

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. This work was undertaken at Great Ormond Street Hospital/UCL Institute of Child Health which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme. The Centre for Paediatric Epidemiology and Biostatistics at ICH also benefits from funding support from the Medical Research Council in its capacity as the MRC Centre of Epidemiology for Child Health. Jugnoo Rahi is also supported in part by the Moorfields Eye Hospital/UCL Institute of Ophthalmology, which receives a proportion of funding from the NIHR Moorfields Biomedical Research Centre and Phillippa Cumberland is supported by the Ulverscroft Foundation.

APPENDIX

Visual Field Testing in Children

(1) What proportion of the total workload of your department is paediatric (under 16 years)?

100%  □

75–100% □

50–75%  □

25–50%  □

0–25%  □

(2) Are visual fields tested in patients’ under16 years old in your department?

Yes    □

No □

If No, please return the questionnaire without completing further questions

(3) How many children under 16 years undergo visual field testing in your department each year (approx.)

Number

(4) Who undertakes visual fields in patients under 16 years? (tick all that apply)

Orthoptists

Nurses  □

Doctors □

Visual field technicians  □

Health care assistants □

Optometrists  □

Others (please specify)  □

(5) Who refers children for visual field testing in your department? (tick all that apply)

Ophthalmologist – same hospital   □

Ophthalmologist – other hospital   □

Neurologist □

Endocrinologist  □

Paediatrician  □

GP  □

Other (please specify)  □

(6) Do you test visual fields in children with:

Yes No

Glaucoma □ □

Visual pathway tumor     □ □

Other intra-cranial tumor  □ □

Benign intracranial hypertension  □ □

Systemic medication  □ □

(as baseline/follow-up –

please specify drug)  □ □

Other – please specify  □ □

(7) How do you test visual fields in patients 16 years old and under (tick all that apply)

Goldmann Perimeter       □

Humphrey Visual Field Analyser  □

Confrontational Fields  □

Other – please specify  □

(8) If you use the Humphrey, which programme do you use? (tick all that apply)

SITA  □

Threshold Testing  □

Supra threshold testing  □

Other (please specify)  □

Please add any comments you have regarding visual field testing in children in the box below

Name of person completing questionnaire:

Department Address:

Thank you for your help – your contribution is much appreciated

Please return this questionnaire via e-mail to [email protected]

Bronwen Walters, Head Orthoptist,

Great Ormond Street Hospital