Referral for Ophthalmology Evaluation and Visual Sequelae in Children With Primary Brain Tumors

Liu, Yin Allison; Abongwa, Chenue; Ashwal, Stephen; Deming, Douglas; Winter, Timothy W.

doi:10.1001/jamanetworkopen.2019.8273

Cited by 19 publications

(34 citation statements)

References 18 publications

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“…Visual problems may be reversible in early stages of visual impairment. Therefore, timely monitoring of visual function and early detection of visual impairment in children with CP is of major importance to preserve visual function and provide adequate treatment [12,13,17,18,20]. In children with irreversible visual impairment, timely referral for visual rehabilitation may reduce the adverse effects of visual impairment on health and/or vision related quality of life [115,116].…”

Section: Discussionmentioning

confidence: 99%

“…Early detection of visual abnormalities requires timely referral to an ophthalmologist for ophthalmological examination. Previous studies have already demonstrated the importance of ophthalmological examination in children with a brain tumour at time of diagnosis and during follow-up [12,13,17,18,20].…”

Section: Introductionmentioning

confidence: 99%

“…These tumour sequelae have a major impact on a child’s health and quality of life [ 12 , 13 , 17 – 19 ]. Therefore, early detection of visual impairment together with adequate treatment and support is of major relevance as it may reduce irreversible visual sequelae and improve long-term visual outcome and quality of life [ 12 , 13 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Visual functions in children with craniopharyngioma at diagnosis: A systematic review

et al. 2020

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Childhood craniopharyngioma is a rare and slow growing brain tumour, often located in the sellar and suprasellar region. It commonly manifests with visual impairment, increased intracranial pressure and hypothalamic and/or pituitary deficiencies. Visual impairment in childhood adversely affects a child's daily functioning and quality of life. We systematically reviewed the literature to provide an extensive overview of the visual function in children with craniopharyngioma at diagnosis in order to estimate the diversity, magnitude and relevance of the problem of visual impairment. Of the 543 potentially relevant articles, 84 studies met our inclusion criteria. Visual impairment at diagnosis was reported in 1041 of 2071 children (50.3%), decreased visual acuity was reported in 546 of 1321 children (41.3%) and visual field defects were reported in 426 of 1111 children (38.3%). Other ophthalmological findings described were fundoscopic (32.5%) and orthoptic abnormalities (12.5%). Variations in ophthalmological testing methods and ophthalmological definitions precluded a meta-analysis. The results of this review confirm the importance of ophthalmological examination in children with craniopharyngioma at diagnosis in order to detect visual impairment and provide adequate support. Future studies should focus on long-term visual follow-up of childhood craniopharyngioma in response to different treatment strategies to provide insight in risks and ways to prevent further loss of vision.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Visual functions in children with craniopharyngioma at diagnosis: A systematic review

et al. 2020

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“…Visual manifestations of brain tumours in children include blurring of vision, diplopia, ocular nerve palsy, papilledema, optic atrophy, ptosis, nystagmus, strabismus, proptosis, and photophobia. [ 5 ] As the visual system in children is still developing, brain tumours and their surgical management can alter the normal neuroanatomical structures of the visual system and cause permanent visual impairment [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Neuroophthalmic Manifestations of Intracranial Tumours in Children

Kotecha

Gotecha

Chugh

et al. 2021

Case Reports in Ophthalmological Medicine

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Background. All children between 0 and 16 years presenting with brain tumours confirmed by Magnetic Resonance Imaging (MRI) and treated surgically in our institute were included in this study. Objective. The aim of this study is to evaluate the neuroophthalmic and clinical characteristics of intracranial space occupying lesions in children. Methods. Neuroophthalmic manifestations along with location of the tumour by contrast-enhanced MRI, type of surgical intervention, and postoperative histopathological diagnosis were evaluated. Results. In pediatric brain tumours, male preponderance was seen and supratentorial location was more common in general, while in older children, infratentorial tumours were more common than supratentorial tumours. Headache, vomiting, and cerebellar signs were the commonest neurological features. Diminution of vision, diplopia, and strabismus were the commonest ophthalmic symptoms. Papilledema, ophthalmoparesis, and nystagmus were the most frequent ophthalmological signs. Neurological manifestations of seizures, altered sensorium and motor deficits were more frequently seen in supratentorial tumours, while cranial nerve involvement and ataxia were seen in infratentorial tumours. Ophthalmological manifestations including diplopia, strabismus, ophthalmoparesis, and nystagmus were more frequently seen in infratentorial tumours. Astrocytoma was the most frequent histopathological diagnosis followed by medulloblastoma. Conclusion. Diagnosis of pediatric intracranial tumours is complex and requires a multidisciplinary approach for prompt management. An ophthalmologist should have a high index of suspicion for brain tumours especially in patients presenting with common ocular symptoms like diminution of vision, diplopia, and strabismus without any neurological symptoms.

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“…Currently, each center uses its own schedule for checkups since there is no international standardization of vision testing for this patient group. Standardization of diagnostic testing methods will optimize earlier detection of changes in visual function, initiation of early treatment to preserve visual function and provide timely referral to visual rehabilitation centers to improve coping with aspects of development in daily life [22].…”

Section: Introductionmentioning

confidence: 99%

Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study)

et al. 2019

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BackgroundChildren with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers.Methods/designThe CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment.DiscussionThe CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor.Trial registrationThe CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.

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Referral for Ophthalmology Evaluation and Visual Sequelae in Children With Primary Brain Tumors

Cited by 19 publications

References 18 publications

Visual functions in children with craniopharyngioma at diagnosis: A systematic review

Visual functions in children with craniopharyngioma at diagnosis: A systematic review

Neuroophthalmic Manifestations of Intracranial Tumours in Children

Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study)

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