Zara Saleem,Bo Wang,Rizul Naithani,Samuel Alvarez,Sharon F Freedman,Mays El-Dairi
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A neuro-ophthalmologist predicted expected visual field (VF) abnormalities based on history, examination, magnetic resonance imaging, and optical coherence tomography of the retina and optic nerve. A masked ophthalmologist graded HVFs and VRFs with respect to global indices and VF abnormalities.\r\n\r\nMAIN OUTCOME MEASURES\r\nComparison between clinically-predicted and observed visual field defects and visual field global indices between virtual reality fields (VRF) and Humphrey visual fields (HVF).\r\n\r\nRESULTS\r\n129 children (253 eyes) were included, mean age 11.1±3.9 years. Fewer children successfully completed HVF than VRF (191 vs. 240 eyes, p<0.0001). Comparing HVF to VRF, average mean deviation (MD) was similar (-5.0±6.3 vs -5.3±6.2 dB, respectively, p=0.782). When comparing global indices between HVF and VRF, moderate correlation was observed for both MD and pattern standard deviation (PSD). Sensitivity of HVF vs. VRF to detect any clinically-predicted VF defect was 86.5% vs. 88.6%, respectively, p=0.861; specificity was 30.8% vs 33.5%, respectively, p=0.725. HVF vs. VRF concordance for presence/absence of any clinically-predicted VF defect was 52.0% vs 53.0%, respectively (p=0.849).\r\n\r\nCONCLUSION\r\nHVF and VRF were comparable, with relatively high sensitivity and low specificity for the detection of clinically-predicted VF defects in children with known or suspected neuro-ophthalmic disease. 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引用次数: 0
摘要
目的虚拟现实视场测试(VRF)在成人和儿童的正常眼和青光眼中是可行和可靠的,但其在儿童神经眼科疾病中的作用尚不清楚。目的评价VRF与标准自动视距(HVF)在儿童神经眼病中的可行性。设计诊断方法的前瞻性信度和效度比较。已知或怀疑有神经眼疾病的儿童(< 18岁)。方法招募2022年7月至2023年3月期间在杜克眼科中心(Duke Eye Center)就诊的儿童。参与者尝试了HVF和VRF。神经眼科医生根据病史、检查、磁共振成像和视网膜和视神经的光学相干断层扫描预测预期的视野(VF)异常。一位蒙面眼科医生对hvf和vrf的整体指数和VF异常进行了分级。主要观察指标:虚拟现实视场(VRF)和汉弗莱视场(HVF)临床预测和观察到的视野缺损及视野整体指数的比较。结果纳入儿童129例(253眼),平均年龄11.1±3.9岁。成功完成HVF的儿童少于VRF(191对240眼,p<0.0001)。HVF与VRF比较,平均偏差(MD)相似(分别为-5.0±6.3 dB vs -5.3±6.2 dB, p=0.782)。当比较HVF和VRF的整体指标时,MD和模式标准差(PSD)均有中度相关性。HVF和VRF检测临床预测VF缺损的敏感性分别为86.5%和88.6%,p=0.861;特异性分别为30.8% vs 33.5%, p=0.725。HVF和VRF在存在或不存在任何临床预测的VF缺陷方面的一致性分别为52.0%和53.0% (p=0.849)。结论hvf和VRF具有可比性,对已知或疑似神经眼科疾病患儿临床预测的VF缺陷检测具有较高的敏感性和较低的特异性。然而,更多的儿童能够成功地进行VRF而不是HVF,这表明VRF可能在这一具有挑战性的人群中提供有价值的临床评估。
Evaluating the role of virtual reality visual fields (VRF) in the diagnosis and management of pediatric neuro-ophthalmic conditions.
OBJECTIVE
Virtual reality field testing (VRF) is feasible and reliable in adults and in children with normal and glaucomatous eyes, but its role in pediatric neuro-ophthalmic conditions remains unexplored.
PURPOSE
to evaluate the feasibility of using VRF vs. standard automated perimetry (HVF) in children with neuro-ophthalmic conditions.
DESIGN
Prospective reliability and validity comparison of diagnostic approaches.
PARTICIPANTS
Children (< 18 years of age) with a known or suspected neuro-ophthalmic condition.
METHODS
Children presenting to one pediatric neuro-ophthalmologist at Duke Eye Center between 07/2022-03/2023 were recruited. Participants attempted both HVF and VRF. A neuro-ophthalmologist predicted expected visual field (VF) abnormalities based on history, examination, magnetic resonance imaging, and optical coherence tomography of the retina and optic nerve. A masked ophthalmologist graded HVFs and VRFs with respect to global indices and VF abnormalities.
MAIN OUTCOME MEASURES
Comparison between clinically-predicted and observed visual field defects and visual field global indices between virtual reality fields (VRF) and Humphrey visual fields (HVF).
RESULTS
129 children (253 eyes) were included, mean age 11.1±3.9 years. Fewer children successfully completed HVF than VRF (191 vs. 240 eyes, p<0.0001). Comparing HVF to VRF, average mean deviation (MD) was similar (-5.0±6.3 vs -5.3±6.2 dB, respectively, p=0.782). When comparing global indices between HVF and VRF, moderate correlation was observed for both MD and pattern standard deviation (PSD). Sensitivity of HVF vs. VRF to detect any clinically-predicted VF defect was 86.5% vs. 88.6%, respectively, p=0.861; specificity was 30.8% vs 33.5%, respectively, p=0.725. HVF vs. VRF concordance for presence/absence of any clinically-predicted VF defect was 52.0% vs 53.0%, respectively (p=0.849).
CONCLUSION
HVF and VRF were comparable, with relatively high sensitivity and low specificity for the detection of clinically-predicted VF defects in children with known or suspected neuro-ophthalmic disease. However, more children were able to successfully perform VRF than HVF, suggesting VRF may provide valuable clinical assessment in this challenging population.
期刊介绍:
The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect.
The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports.
Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.