Visual Field Testing Frequency and Associations in Children With Glaucoma

Abstract

Précis: 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, whereas 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: A retrospective cohort study of 82 children 6–18 years of age with glaucoma seen between August 2018 and 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. Thirty nine percent of patients underwent <1 VF/year, 45.9% ≥1 to <2 VFs/year, and 14.8% ≥2 VF/year. Children who 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 (95% 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, 0.001–0.103, P=0.045) and ED 0.2 (95% CI, 0.1–0.3, P<0.001), respectively]. Conclusions: Most children had between 1 and 2 VF/year, although less than half of all VFs were reliable. Ophthalmologists should consider barriers to care in glaucoma monitoring.