Achieving a successful visual assessment in children with glaucoma is important, however the difficulty of doing so means some eye care professionals are reluctant to undertake the process.
A new cross-sectional study indicates that a simple static perimetry approach may yield higher-quality results than a combined static/kinetic perimetry approach in children younger than 10 years with glaucoma.
The study1 reported data for 65 children (50.8 per cent girls) with 108 glaucoma affected eyes. Aged five to 15 years, with a median age of 12, they were recruited from two specialist paediatric ophthalmology centres.
The researchers reported that “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, χ2 = 0.33; P = .56), but better-quality tests with Humphrey perimetry were achieved in younger children (McNemar test, χ2 = 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 per cent CI, 0.65-0.93), although 25 of 80 (31 per cent) 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 potentially yields high-quality results in children younger than 10 years. For children older than 10 years, without penalising quality, the addition of kinetic perimetry enabled measurement of far-peripheral sensitivity, which is particularly useful in children with severe visual field restriction.”
Primary congenital glaucoma is a rare disease, which affects approximately one in 20,000 newborns in Western countries but may be higher in certain other populations. Other more common forms of childhood glaucoma can be grouped into uveitic and other secondary forms. Uveitic glaucoma in children is most often associated with juvenile immune arthritis. Other secondary forms are associated with Marfan syndrome, Sturge-Weber syndrome, anterior segment dysgeneses, phacomatoses, retinopathy of prematurity, steroid-induced glaucoma, traumatic glaucoma, and glaucoma after surgery for congenital cataract. Quite often, while the primary disease might not be sight threatening, the secondary glaucoma may cause blindness if inadequately treated.2
The study was published online on December 28 in JAMA Ophthalmology.