Lessons Learned from 23 Years of Experience in Testing Visual Field of Neurologically Impaired Children

Abstract

Background: Despite general difficulty to measure visual field (VF) in Neurologically Impaired (NI) children, the timely finding of a VF impairment may contribute to finding the right diagnosis and treatment as well as to explaining their visual behaviour to parents and caregivers. We describe the Standard Conventional Perimetry (SCP) and a potential gain in time to diagnosis of a visual field defect (VFD) when using a behavioural visual field (BVF) test. Methods: NI children who underwent SCP at the University Medical Center Utrecht were retrospectively analysed and scored with the examiner-based assessment of reliability (EBAR) scoring system. The difference in time to diagnosis between the BVF and SCP tests was calculated. Results: In this cohort of 115 NI children (69 boys and 46 girls), the majority suffered from neoplasms (36%) and stroke/haemorrhage (34%). The mean age at which they were able to complete an SCP test was 8.3 years (range 4.5 17.4). 44% were tested with the Full Field Peritest (FFP), 23% with the Goldmann VF test, 29% with the Central Peritest (CP) and 4% with the Humphrey Field Analyzer. Among the FFP 44% had “good” reliability versus 22% in Goldmann tests and 17% in CP (p < 0.001). The mean age of NI children performing SCP was 8.3 years versus 4.6 years with BV F (p < 0.001). Conclusion: The Full Field Peritest is the most reliable VF test in this cohort of NI children. Use of the BVF test significantly reduces (average 3.7 years) the time to diagnosis of a peripheral VFD.