Life Course Epidemiology and Biostatistics Section, University College London Great Ormond Street Institute of Child Health, London, England.
Ulverscroft Vision Research Group, London, England.
JAMA Ophthalmol. 2018 Feb 1;136(2):155-161. doi: 10.1001/jamaophthalmol.2017.5898.
There is limited evidence to support the development of guidance for visual field testing in children with glaucoma.
To compare different static and combined static/kinetic perimetry approaches in children with glaucoma.
DESIGN, SETTING, AND PARTICIPANTS: 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 (Swedish Interactive Thresholding Algorithm 24-2 FAST) and Octopus combined static tendency-oriented perimetry/kinetic perimetry (isopter V4e, III4e, or I4e) in a single sitting, using standardized clinical protocols, administered by a single examiner. Information was 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 median 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, 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% 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 potentially yields high-quality results in children younger than 10 years. For children older than 10 years, without penalizing quality, the addition of kinetic perimetry enabled measurement of far-peripheral sensitivity, which is particularly useful in children with severe visual field restriction.
目前仅有有限的证据支持为青光眼患儿制定视野检查指南。
比较青光眼患儿不同的静态和静态/动态联合视野检查方法。
设计、地点和参与者：这是一项横断面、观察性研究，于 2013 年 5 月至 2015 年 6 月在英国伦敦的 2 家三级专科儿科眼科中心（莫尔菲尔德眼科医院和大奥蒙德街儿童医院）前瞻性招募患儿。研究纳入了 65 名年龄 5 至 15 岁的青光眼患儿（108 只患眼）。
比较静态和静态/动态联合技术的测试质量和结果，重点是评估定量青光眼损失的能力。患儿在单次就诊时使用 Humphrey 静态（瑞典交互阈值算法 24-2 FAST）和 Octopus 联合静态倾向导向视野检查/动态视野检查（等视线 V4e、III4e 或 I4e）进行视野检查，使用标准化的临床方案，由同一位检查者进行检查。记录了测试持续时间、完成情况和质量（使用自动可靠性指数和我们的定性检查者评估可靠性评分）。视野检查结果采用 Aulhorn 和 Karmeyer 分类法进行评分。19 名参与者中的 1 只患眼接受了瑞典交互阈值算法 24-2 FAST 和 24-2 标准算法的重复检查。
共有 65 名患儿（33 名女孩[50.8%]）参与研究，中位年龄为 12 岁（四分位间距，9-14 岁）。测试质量（检查者评估可靠性评分）随年龄增长而提高，对于 Humphrey 和 Octopus 两种策略均如此，且在年龄大于 10 岁的患儿中相当（McNemar 检验，χ2=0.33；P=0.56），但在年龄较小的患儿中，Humphrey 视野检查可获得更好的测试质量（McNemar 检验，χ2=4.0；P=0.05）。静态视野检查的 Octopus 和 Humphrey MD 值等于或大于-6 dB 时，存在不一致（Bland-Altman，平均差异，-0.70；一致性界限，-7.74 至 6.35），但当超过该阈值时，结果具有可比性（平均差异，-0.03；一致性界限，-2.33 至 2.27）。静态视野检查的视野分类评分显示具有较高的一致性（线性加权κ，0.79；95%CI，0.65-0.93），尽管 80 个评分中有 25 个（31%）被评为 Octopus 静态视野检查结果更严重。7 例严重视野缺损（5 级）中，5 例的动态分类评分低于静态分类评分。
对于 10 岁以下的儿童，简单的静态视野检查方法可能会产生高质量的结果。对于 10 岁以上的儿童，如果不降低质量，增加动态视野检查可以测量远周边敏感性，这在视野严重受限的儿童中特别有用。
