Nearly 40% of children with glaucoma do not undergo yearly visual field testing
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Key takeaways:
- Black and multiracial children had significantly lower visual field testing frequency.
- Better visual acuity and more frequent office visits were linked to higher testing frequency.
While most children with glaucoma have at least one visual field test per year, Black and multiracial children were among those with significantly lower testing frequency, according to a single-center study published in Journal of Glaucoma.
“Unlike for adults, there are no formal recommendations for VF testing frequency in children,” Natan Hekmatjah, BS, from the department of ophthalmology at the University of California, San Francisco, School of Medicine, and colleagues wrote. “Although glaucoma in children is uncommon, it is responsible for 5% of pediatric blindness worldwide, and there is little information regarding VF testing frequency in children.”
In a retrospective cohort study, researchers identified 82 children with glaucoma aged 6 to 18 years at UCSF and divided them into two groups: those who had at least one visual field test (n = 61) and those who had never had a test (n = 21).
In addition to assessing frequency of visual field testing, researchers examined patient characteristics associated with testing frequency, including age, self-reported race and ethnicity, sex, primary language, glaucoma diagnosis, distance to provider, office visit frequency, follow-up compliance, insurance type and best-corrected visual acuity.
Of those who had at least one test, the mean age at first testing was 11.8 years, 57.4% were girls, 75.4% spoke primarily English and 62.3% had public insurance. In addition, mean logMAR acuity was 0.3 in the better eye, and most patients identified as white (18%), followed by Asian (13.1%), Black (8.2%), multiracial (4.9%) or other/declined to state (55.7%).
Among those with no history of testing, the mean age at first office visit was 9.8 years, 38.1% were girls, 66.7% spoke primarily English, and 71.4% had public insurance. Mean logMAR acuity was 0.7 in the better eye. Conversely, most patients in this group identified as Black (19%) or Asian (14.3%), while just 4.8% self-reported as white.
Results also showed that 45.9% of patients had one to two visual field tests per year, 14.8% had at least two and 39% had fewer than one test per year. Less than half of all tests (44.9%) were reliable, researchers reported.
Overall, patients who identified as Black or multiracial had significantly lower visual field testing frequency, while better visual acuity and more frequent office visits were significantly associated with higher testing frequency.
“Although no formal guidelines exist regarding recommended VF testing frequency in children with glaucoma, providers should consider barriers to care, and future guidelines may require special considerations for children with low vision or different types of glaucoma,” Hekmatjah and colleagues wrote. “Future studies should consider additional sociodemographic and socioeconomic factors as potential barriers to care of VF testing frequency.”
Perspective
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Functional testing is an integral part of classifying glaucoma severity and tracking its progression. Real-world data on adults with glaucoma show that the average number of annual VF testing performed is suboptimal and much less than recommended by practice patterns. Although glaucoma is responsible for 5% of pediatric blindness worldwide, there is limited information and no guidelines for VF use and frequency in pediatric patients with glaucoma.
This single center, retrospective study of 82 children with glaucoma showed an average number of annual visual fields performed similar to that in adult studies. Interestingly, of 82 patients, 21 did not undergo a single visual field test. This group was considerably younger (median age, 8.1 years) than those who received visual fields (median age, 11.8 years) and also had lower visual acuity. Notably, 47 patients in this study declined to state their race, which the authors acknowledged may bias any race analysis provided.
The overall VF frequency employed in this study is similar to that found in adult data with a glaring difference in field utilization in younger children with lower vision compared with older children with better vision. The abilities of the individual child with glaucoma should dictate the best individual strategy to detect glaucomatous change. Hopefully as field technologies expand, they provide more adaptive capabilities in children with glaucoma.
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