Abstract
Recognising a potential visual-field (VF) defect in paediatric patients might be challenging, especially in children before the age of 5 years and those with developmental delay or intellectual disability. Visual electrophysiological testing is an objective and non-invasive technique for evaluation of visual function in paediatric patients, which can characterise the location of dysfunction and differentiate between disorders of the retina, optic nerve and visual pathway. The recording of electroretinography (ERG) and visual-evoked potentials (VEP) is possible from early days of life and requires no subjective input from the patient. As the origins of ERG and VEP tests are known, the pattern of electrophysiological changes can provide information about the VF of a child unable to perform accurate perimetry. This review summarises previously published electrophysiological findings in several common types of VF defects that can be found in paediatric patients (generalised VF defect, peripheral VF loss, central scotoma, bi-temporal hemianopia, altitudinal VF defect, quadrantanopia and homonymous hemianopia). It also shares experience on using electrophysiological testing as additional functional evidence to other tests in the clinical challenge of diagnosing or excluding VF defects in complex paediatric patients. Each type of VF defect is illustrated with one or two clinical cases.
Highlights
Visual-field (VF) testing is an important part of the assessment of children and infants in the paediatric ophthalmology clinic
The tests are performed according to the standards of the International Society for Clinical Electrophysiology of Vision (ISCEV), which has published the guidelines for the following methods
The assessment of the visual field in a child who is not able to undergo formal perimetry is a part of the paediatric ophthalmology clinic and often relies on a multidisciplinary approach to build evidence
Summary
Visual-field (VF) testing is an important part of the assessment of children and infants in the paediatric ophthalmology clinic. Developmental delay, intellectual disability and autistic spectrum disorder are found within an array of visual deficits (both anterior pathway and cortical) that present in the first few years of life [2]. This means there are children that need an assessment of their VF where formal perimetry is not achievable. In clinical practice when formal visual fields cannot be undertaken in a child, visual fields to confrontation are undertaken looking for the child’s behavioural responses This is limited by the child’s attention, cooperation and learnt compensatory eye movements. As a result confrontation visual fields are generally believed to have a low sensitivity [4, 6]
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