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Study of Optimal Perimetric Testing In Children (OPTIC): development and feasibility of the kinetic perimetry reliability measure (KPRM)
  1. Dipesh E Patel1,2,3,4,
  2. Ananth C Viswanathan3,
  3. David Garway-Heath3,
  4. Phillippa M Cumberland1,2,
  5. Bronwen C Walters4,2,
  6. Isabelle Russell-Eggitt2,
  7. Mario Cortina-Borja5,
  8. Jugnoo S Rahi1,2,3,4
  9. OPTIC Study Group
    1. 1Life Course Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, UK
    2. 2Ulverscroft Vision Research Group, London, UK
    3. 3NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
    4. 4Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
    5. 5Clinical Epidemiology, Nutrition and Biostatistics Section, UCL Institute of Child Health, London, UK
    1. Correspondence to Professor Jugnoo S Rahi, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; j.rahi{at}ucl.ac.uk

    Abstract

    Introduction Interpretation of perimetric findings, particularly in children, relies on accurate assessment of test reliability, yet no objective measures of reliability exist for kinetic perimetry. We developed the kinetic perimetry reliability measure (KPRM), a quantitative measure of perimetric test reproducibility/reliability and report here its feasibility and association with subjective assessment of reliability.

    Methods Children aged 5–15 years, without an ophthalmic condition that affects the visual field, were recruited from Moorfields Eye Hospital and underwent Goldmann perimetry as part of a wider research programme on perimetry in children. Subjects were tested with two isopters and the blind spot was plotted, followed by a KPRM. Test reliability was also scored qualitatively using our examiner-based assessment of reliability (EBAR) scoring system, which standardises the conventional clinical approach to assessing test quality. The relationship between KPRM and EBAR was examined to explore the use of KPRM in assessing reliability of kinetic fields.

    Results A total of 103 children (median age 8.9 years; IQR: 7.1 to 11.8 years) underwent Goldmann perimetry with KPRM and EBAR scoring. A KPRM was achieved by all children. KPRM values increased with reducing test quality (Kruskal-Wallis, p=0.005), indicating greater test-retest variability, and reduced with age (linear regression, p=0.015). One of 103 children (0.97%) demonstrated discordance between EBAR and KPRM.

    Conclusion KPRM and EBAR are distinct but complementary approaches. Though scores show excellent agreement, KPRM is able to quantify within-test variability, providing data not captured by subjective assessment. Thus, we suggest combining KPRM with EBAR to aid interpretation of kinetic perimetry test reliability in children.

    • Field of vision
    • Diagnostic tests/Investigation
    • Child health (paediatrics)

    https://doi.org/10.1136/bjophthalmol-2016-309402

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      Footnotes

      • Collaborators OPTIC Study Group members: Peng Tee Khaw, Bronwen Walters, Phillippa Cumberland, Isabelle Russell-Eggitt, Chris Timms, John Brookes, Anthony Moore, Maria Papadopoulos, David Garway-Heath, Ananth Viswanathan, Alki Liasis, David Crabb, Mario Cortina-Borja, Dipesh Patel, and Jugnoo Rahi.

      • Contributors Conception and design: DEP, ACV, DFG-H, PMC, BCW, IRE, JSR. Data collection: DEP. Analysis: DEP, PMC, MCB. Manuscript preparation, revision and final approval: DEP, ACV, DFG-H, PMC, BCW, IRE, MCB, JSR.

      • Funding This study was funded by the Guide Dogs for the Blind Association (GBDA) (grant no. OR2009-04e). The 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 Institute of Child Health/Great Ormond Street Hospital NHS Foundation Trust.

      • Disclaimer 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.

      • Ethics approval London—Bloomsbury.

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

      • Data sharing statement Due to ethical restrictions on data sharing related to participant consent, aggregated data are available on request to Professor Jugnoo Rahi (j.rahi@ucl.ac.uk).