Abstract
BackgroundPerimetry is important in the management of children with glaucoma, but there is limited evidence-based guidance on its use. We report an expert consensus-based study to update guidance and identify areas requiring further research.MethodsExperts were invited to participate in a modified Delphi consensus process. Panel selection was based on clinical experience of managing children with glaucoma and UK-based training to minimise diversity of view due to healthcare setting. Questionnaires were delivered electronically, and analysed to establish ‘agreement’. Divergence of opinions was investigated and resolved where possible through further iterations.Results7/9 experts invited agreed to participate. Consensus (≥5/7 (71%) in agreement) was achieved for 21/26 (80.8%) items in 2 rounds, generating recommendations to start perimetry from approximately 7 years of age (IQR: 6.75–7.25), and use qualitative methods in conjunction with automated reliability indices to assess test quality. There was a lack of agreement about defining progressive visual field (VF) loss and methods for implementing perimetry longitudinally.Panel members highlighted the importance of informing decisions based upon individual circumstances—from gauging maturity/capability when selecting tests and interpreting outcomes, to accounting for specific clinical features (e.g. poor IOP control and/or suspected progressive VF loss) when making decisions about frequency of testing.ConclusionsThere is commonality of expert views in relation to implementing perimetry and interpreting test quality in the management of children with glaucoma. However, there remains a lack of agreement about defining progressive VF loss, and utilising perimetry over an individuals’ lifetime, highlighting the need for further research.
Highlights
Childhood glaucoma is a rare, potentially blinding optic neuropathy characterised by raised intraocular pressure
We have previously investigated the relative strengths of static, kinetic, and combined static and kinetic techniques in children with glaucoma [9], adding information about the use of optimised static perimetry algorithms such as the Humphrey SITA 24-2 FAST (Swedish Interactive Thresholding Algorithm, Carl Zeiss Meditec AG, Jena, Germany) and Octopus G-TOP (Tendency-Oriented Perimetry, HaagStreit Holding AG, Koeniz, Switzerland) to existing data on rarebit [10], supra-threshold [11] and game-based techniques [12]
Our research demonstrated the utility of combined static/kinetic perimetry for monitoring visual field (VF) defects in children with severe glaucoma [9]
Summary
Childhood glaucoma is a rare, potentially blinding optic neuropathy characterised by raised intraocular pressure (IOP) and optic nerve damage [1]. Five in 100,000 children born in Great Britain each year are diagnosed with the most frequent form of childhood glaucoma, primary congenital glaucoma [2, 3], which is usually primarily managed surgically, with further surgery and/or topical treatment required to mitigate disease progression [4]. Monitoring children with glaucoma presents different challenges to the management of adults in whom measurement of IOP, assessment of optic disc morphology and visual field (VF) assessment together form a core triad of the clinical assessment of progression [5, 6], with an emerging role for imaging techniques [7, 8]. IOP measurement and direct visualisation of the optic disc are both more challenging but achievable with appropriate approaches in children [1]. Perimetry is important in the management of children with glaucoma, but there is limited evidence-based guidance on its use. We report an expert consensus-based study to update guidance and identify areas requiring further research
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
