Visual Field Testing Frequency and Associations in Children with Glaucoma

J Glaucoma. 2024 Apr 23. doi: 10.1097/IJG.0000000000002406. Online ahead of print.

Abstract

Prcis: Children with glaucoma had an average of 1.3 visual field tests per year. Self-reported black and multiracial patients had lower visual field testing rates, while older children with better visual acuity had more frequent testing.

Purpose: To evaluate frequency of visual field (VF) testing in children with glaucoma and identify characteristics associated with VF frequency.

Methods: Retrospective cohort study of 82 children aged 6-18 years with glaucoma seen between August 2018-May 2023. Patients were divided into those who had ≥1 VF test (303 VF tests of 61 children) and 0 VFs (21 children). Eyes were excluded if best corrected visual acuity (BCVA) was counting fingers or worse. Characteristics obtained included age, self-reported race and ethnicity, sex, primary language, glaucoma diagnosis, distance to provider, office visit frequency, follow-up compliance, insurance type, and BCVA. The main outcome measure was VF testing frequency.

Results: Among children with ≥1 VF test, mean age at first VF was 11.8±2.8 years, mean number of VF/year was 1.3±0.8, and 44.9% of all VFs were reliable. 39.3% of patients underwent <1 VF/year, 45.9% ≥1 to <2 VFs/year, and 14.8% ≥2 VF/year. Children that were Black or multiracial had significantly lower VF testing frequency (estimated difference (ED) -1.2 [95% CI -2.0 to -0.4, P=0.002] and ED -1.3 [CI -2.2 to -0.3, P=0.008], respectively). Better visual acuity and greater office visit frequency were significantly associated with higher VF testing frequency (ED 0.052 [95% CI 0.001 to 0.103, P=0.045] and ED 0.2 [95% CI 0.1 to 0.3, P<0.001], respectively).

Conclusions: Most children had between 1-2 VF/year, though less than half of all VFs were reliable. Ophthalmologists should consider barriers to care in glaucoma monitoring.