Comparison of visual field indices between normal adults and children
Reviewed by Lauren Hepworth

The authors present a prospective observational study which aimed to compare visual field indices with retinal nerve fibre layer (RNFL) thickness using optical coherence tomography (OCT) in normal adults and children. Children aged 6–18 years were recruited from a single centre. Exclusion criteria were family history of glaucoma, ophthalmic pathology, refractive error >3 dioptres, attention deficit disorder and other conditions which are known to effect visual fields. Ophthalmic conditions which were not excluded were nasolacrimal duct obstruction, ptosis, strabismus and amblyopia. All children had an ophthalmic examination including visual acuity, intraocular pressure (IOP) and fundus and media evaluation. Only children completing all tests and meeting set criteria (visual acuity >20/40, clear media, IOP <22mHg and no suspicion of glaucoma) were included in the analysis. The children then underwent a 24-2 SITA-standard visual field assessment, fundus photography, and RNFL measurement on OCT. Adults were identified from a database of OCT and visual field parameters from participation in previous studies, using the same inclusion / exclusion criteria as the children. For each child recruited, an adult with normal visual fields was matched based in RNFL thickness. The children were stratified into two groups by age, 6–11 years and 12–18 years. The number of recruited children totalled 59, with a mean age of 12 years old. The comparison of visual field indices between adults and children with the same RNFL thickness revealed the mean deviation to be significantly lower in children, with a greater difference with children ≤11 years old. Younger children also took significantly longer to complete perimetry and all children were significantly less reliable. The authors conclude that for children ≤11 years old perimetry findings are subnormal speculating that retinal sensitivity develops with age. An alternative theory relating to attention span and cognitive ability could be factors. This study highlights the need for normative databases of perimetry for children <12 years old to enable more meaningful visual field assessment for paediatric glaucoma and neuro-ophthalmology.

Visual field indices in children and adults with comparable retinal nerve fiber layer thickness.
Thakur U, Thattaruthody F, Gupta G, et al.
JOURNAL OF THE AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2023;27:203.