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Study of Optimal Perimetric Testing in Children (OPTIC): evaluation of kinetic approaches in childhood neuro-ophthalmic disease
  1. Dipesh E Patel1,2,3,4,
  2. Phillippa M Cumberland1,2,
  3. Bronwen C Walters2,4,
  4. Mario Cortina-Borja5,
  5. Jugnoo S Rahi1,2,3,4
  6. For the OPTIC study group
    1. 1 Life Course Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
    2. 2 Ulverscroft Vision Research Group, London, UK
    3. 3 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
    4. 4 Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
    5. 5 Clinical Epidemiology, Nutrition and Biostatistics Section, UCL GOS Institute of Child Health, London, UK
    1. Correspondence to Professor Jugnoo S Rahi, UCL GOS Institute of Child Health, London WC1N 1EH, UK; j.rahi{at}


    Aims We compared feasibility, quality and outcomes of visual field (VF) testing in children with neuro-ophthalmic disease between the discontinued ‘gold-standard’ Goldmann and Octopus perimeters.

    Methods Children with neuro-ophthalmic disease, attending Great Ormond Street Hospital, London, were assessed using standardised protocols by one examiner in a single sitting, using Goldmann and Octopus kinetic perimetry. Outputs were classified to compare severity of loss and defect type. Test quality was assessed using both qualitative and quantitative methods.

    Results Thirty children (40% female) aged 5–15 years participated. Goldmann perimetry was completed in full by 90.0% vs 72.4% for Octopus. Inability to plot the blind spot was the most common reason for not completing testing. Over 75% completed a test in ≤20 min. Duration was similar between perimeters (paired t-test, mean difference: 0.48min (−1.2, 2.2), p=0.559). The lowest quality tests were for Octopus perimetry in children <8 years, without significant differences between perimeters in older children (McNemar’s test, χ2=1.0, p=0.317). There was broad agreement between Goldmann and Octopus outputs (good quality, n=21, Bland-Altman, mean difference for isopters I4e (−514.3 deg2 (−817.4, –211.2), p=0.814), I2e (−575.5 deg2 (−900.1, –250.9), p=0.450) and blind spot (20.8 deg2 (5.7, 35.8), p=0.451)). However, VF severity grades and defect type matched in only 57% and 69% of tests, respectively. Octopus perimetry underestimated severe VF defects.

    Conclusions Informative perimetry is feasible in children ≥8 years with neuro-ophthalmic conditions, with either Goldmann or Octopus perimeters. However, meaningful differences exist between the two approaches with implications for consistency in longitudinal assessments.

    • field of vision
    • child health (paediatrics)
    • diagnostic tests/investigation
    • visual pathway


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    • Collaborators OPTIC study group members: Peng Tee Khaw, PhD, FRCOphth (NIHR BRC MEH/UCL IOO); Bronwen Walters, BMedSci (GOSH); Phillippa M Cumberland, BA, MSc (UCL GOS ICH, UVRG); Isabelle Russell-Eggitt, FRCOphth (UVRG); Chris Timms, DBO(T) (MEH); John Brookes, BSc, FRCOphth (MEH, GOSH); Anthony Moore, FRCOphth, FMedSci (UCL IOO/MEH, University of California); Maria Papadopoulos, FRCOphth (MEH); David Garway-Heath, MD, FRCOphth (NIHR BRC MEH/UCL IOO); Ananth Viswanathan, PhD, FRCOphth (MEH); Alki Liasis, PhD (GOSH); David Crabb, MSc, PhD (City University); Mario Cortina-Borja, MSc, PhD (UCL GOS ICH); Dipesh E Patel, BMedSci, PhD (UCL GOS ICH/GOSH, MEH); and Jugnoo S Rahi, PhD, FRCOphth (UCL GOS ICH/GOSH, UCL IOO/MEH).

    • Contributors Concept and design: DEP, PMC, BCW, JSR. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: DEP. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: DEP, PMC, MCB. Obtained funding: BCW, PMC, JSR. Administrative, technical or material support: DEP, JSR. Supervision: PMC, BCW, MCB, JSR. Final approval of the article: all authors.

    • Funding This work was supported by The Guide Dogs for the Blind Association (GBDA) (grant number OR2009-04e). This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust/UCL Institute of Ophthalmology and UCL GOS Institute of Child Health/Great Ormond Street Hospital NHS Foundation Trust. JSR is part funded by the National Institute for Health Research, Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. JSR is a National Institute for Health Research (NIHR) senior investigator. PMC is funded by the Ulverscroft Foundation.

    • Disclaimer The sponsor and funding organisation had no role in the design and conduct of the study; collection, management, analysis and interpretation of data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The National Health Service Research Ethics Committee for London–Bloomsbury approved the study which followed the tenets of the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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