A New Perimeter Using the Preferential Looking Response to Assess Peripheral Visual Fields in Young and Developmentally Delayed Children

Purpose: To compare the sensitivity, specificity, and interpretability of a newly developed semiautomated static perimeter based on the preferential looking response to the results of confrontation visual field testing in a group of young and/or developmentally delayed children with and without visual field deficit.

Methods: The preferential looking perimeter (PLP) uses observation of the child's natural eye movement response to an appearing target to determine the peripheral visual field. We compared preferential looking perimetry to confrontation testing in 74 children 3-10 years of age (mean, 6.6 years; median, 7 years), including 32 controls and 42 children with neurological and ocular disorders that could cause significant visual field deficit.

Results: Using confrontation testing as the gold standard, the PLP was 100% sensitive and 100% specific (95% CI, 90%-100%), with excellent interobserver agreement. An interpretable result could be achieved in 15 (71%) of the 21 children in whom confrontation testing was unhelpful.

Conclusions: PLP is a useful new technique for assessing significant visual field loss in young or developmentally delayed children, with many advantages over confrontation testing.