Perimetry in young and neurologically impaired children: The Behavioral Visual Field (BEFIE) Screening Test revisited

Abstract

IMPORTANCE: Visual field examination in young or neurologically impaired children is a challenge. As a result, the Behavioral Visual Field (BEFIE) Screening Test was developed in 1995. OBJECTIVES: To evaluate the applicability of the BEFIE test in a large population of young or neurologically impaired children, its reliability and consistency of findings across time, and its potential diagnostic value compared with standard conventional perimetry. DESIGN, SETTING, AND PARTICIPANTS: The BEFIE tests were performed at an academic tertiary center and measured the peripheral visual field extension in degrees by observing an individual's response to a stimulus on a graded arc that moved from the periphery to the center of the visual field along different meridians. Patient files from all children who underwent this test were retrospectively analyzed. In total, 1788 BEFIE tests were performed in 835 children (median age, 3.4 years). MAIN OUTCOMES AND MEASURES: Reliability and results of all tests were longitudinally evaluated. The diagnostic value of the BEFIE test was assessed by comparing monocular BEFIE test results with those of standard conventional perimetry in children who underwent both. RESULTS: Of 1788 tests, 74% (95% CI, 72%-76%) were considered reliable from the age of 4 months and older, with increasing success with higher ages; 56% reliable in children younger than 1 year; 71% reliable in children between 1 and 2 years; and more than 75% reliable in children 2 years and older (Spearman r = 0.506; P = .11). Peripheral visual field defects were found in 28% (95% CI, 25%-31%) of all first reliable tests. In 75% of children who underwent serial testing, results were consistent and there were good explanations in the case of discrepancies. Comparison of monocular BEFIE tests with standard conventional perimetry results in 147 eyes yielded a positive predictive value of 98% (95% CI, 94%-100%), negative predictive value of 66% (95% CI, 56%-75%), specificity of 98% (95% CI, 95%-100%), sensitivity of 60% (95% CI, 50%-71%), and superior sensitivity of 80% (95% CI, 70%-91%) when only absolute peripheral visual field defects at standard conventional perimetry were accounted for. CONCLUSIONS AND RELEVANCE: These data suggest that the BEFIE test is a valuable tool to detect peripheral visual field defects when standard conventional perimetry cannot be performed in young or neurologically impaired children.