title: Perimetry in young and neurologically impaired children: the Behavioral Visual Field (BEFIE) Screening Test revisited.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Koenraads
authors.affiliation: Brain Center Rudolf Magnus, Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
authors.affiliation: Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Denise C P
authors.initials: DC
authors.lastname: van der Linden
authors.affiliation: Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Saskia M
authors.initials: SM
authors.lastname: Imhof
authors.affiliation: Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Giorgio L
authors.initials: GL
authors.lastname: Porro
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012607:Scotoma / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult