Factors associated with visual field testing reliability in children with glaucoma or suspected glaucoma

Purpose To evaluate Humphrey Visual Field (HVF) test reliability and its associated risk factors in children with glaucoma or glaucoma suspect. Design Retrospective cohort study. Methods None Setting Single-center childhood glaucoma clinic. Patient Population 136 patients aged ≤18 years with glaucoma/glaucoma suspect, and least 1 completed 24-2 HVF test between 2018 and 2023. Observation Procedure Demographic and clinical characteristics including age, primary language, visual acuity (VA), and glaucoma diagnosis were extracted from electronic health records. Main Outcome Measures HVF 24-2 testing metrics, including FP, FN, and FL. Tests were defined as reliable using manufacturer guidelines of ≤33% FP, ≤33% FN, and ≤20% FL. For each patient, a reliability score was calculated as the percentage of reliable tests among all tests completed. A multivariable logistic regression model was used to determine factors associated with test-level reliability (yes/no). A multivariable linear regression model was used to determine factors associated with patient-level reliability score. Results Among 634 HVFs from 136 patients (Mean±SD age at first test 12.0±3.2 years, 47.8% female), 51.3% were reliable. Older age, better baseline VA, and English as primary language were associated with greater odds of test-level reliability (p<0.04). Mean±SD patient-level reliability score was 51.7±38.1%. Older age at first clinic visit, better baseline VA, and English as primary language were associated with higher reliability scores (all p<0.02), and number of prior VF tests was not (p=0.56). Conclusions Younger age, worse visual acuity, and non-English as primary language were associated with decreased reliability and should be considered when interpreting VF testing in children. A significant learning effect was not observed with repeated testing.