Visual function in children with primary brain tumors

Peragallo, Jason H.

doi:10.1097/wco.0000000000000644

Cited by 18 publications

(16 citation statements)

References 37 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%

“…Damage of the visual pathway commonly manifests as decreased visual acuity (VA), visual field (VF) defects, typically bitemporal hemianopia, and/ or abnormal pupillary reponses [5][6][7][8][9][10][11]. Increased intracranial pressure as a result of obstructive mass effect of the tumour can lead to papilledema with subsequent optic atrophy and permanent vision loss as potential complications [8,12,13]. In addition, therapeutic interventions for CP such as tumour resection or post-surgical radiation therapy can lead to further visual loss.…”

Section: Introductionmentioning

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%

“…As described above, CP and its therapy commonly causes severe and permanent visual impairment, as well as hypothalamic-pituitary dysfunction. 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%

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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“…However, survivors of a brain tumor are at risk for severe late effects of the disease and its treatment [5]. Visual impairment is one of these severe late sequelae of a pediatric brain tumor [6, 7]. It is reported that the harmful influence of the disease and / or its treatment on visual functioning has great impact on the general psychomotor development, school participation and societal participation later in life [7, 8].…”

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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Ophthalmological Findings in Youths With a Newly Diagnosed Brain Tumor

et al. 2022

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ImportanceVisual impairment is an irreversible adverse effect in individuals who experienced a childhood brain tumor. Ophthalmological evaluation at diagnosis enables early detection of vision loss, decision-making about treatment, and when applicable, the timely use of visual interventions. However, awareness of visual impairment in clinical practice is suboptimal, and adherence to ophthalmological evaluation needs to be improved.ObjectiveTo assess the prevalence and types of abnormal ophthalmological findings in youths with a newly diagnosed brain tumor.Design, Setting, and ParticipantsIn this nationwide, prospective cohort study, youths aged 0 to 18 years with a newly diagnosed brain tumor between May 15, 2019, and August 11, 2021, were consecutively enrolled in 4 hospitals in the Netherlands, including the dedicated tertiary referral center for pediatric oncology care.ExposuresA standardized and comprehensive ophthalmological examination, including orthoptic evaluation, visual acuity testing, visual field examination, and ophthalmoscopy, was performed within 4 weeks from brain tumor diagnosis.Main Outcomes and MeasuresThe main outcomes were prevalence and types of visual symptoms and abnormal ophthalmological findings at brain tumor diagnosis.ResultsOf 170 youths included in the study (96 [56.5%] male; median age, 8.3 years [range, 0.2-17.8 years]), 82 (48.2%) had infratentorial tumors; 53 (31.2%), supratentorial midline tumors; and 35 (20.6%), cerebral hemisphere tumors. A total of 161 patients (94.7%) underwent orthoptic evaluation (67 [41.6%] preoperatively; 94 [58.4%] postoperatively); 152 (89.4%), visual acuity testing (63 [41.4%] preoperatively; 89 [58.6%] postoperatively); 121 (71.2%), visual field examination (49 [40.4%] preoperatively; 72 [59.6%] postoperatively); and 164 (96.5%), ophthalmoscopy (82 [50.0%] preoperatively; 82 [50.0%] postoperatively). Overall, 101 youths (59.4%) presented with visual symptoms at diagnosis. Abnormal findings were found in 134 patients (78.8%) during ophthalmological examination. The most common abnormal findings were papilledema in 86 of 164 patients (52.4%) who underwent ophthalmoscopy, gaze deficits in 54 of 161 (33.5%) who underwent orthoptic evaluation, visual field defects in 32 of 114 (28.1%) with reliable visual field examination, nystagmus in 40 (24.8%) and strabismus in 32 (19.9%) of 161 who underwent orthoptic evaluation, and decreased visual acuity in 13 of 152 (8.6%) with reliable visual acuity testing. Forty-five of 69 youths (65.2%) without visual symptoms at diagnosis had ophthalmological abnormalities on examination.Conclusions and RelevanceThe results of this study suggest that there is a high prevalence of abnormal ophthalmological findings in youths at brain tumor diagnosis regardless of the presence of visual symptoms. These findings support the need of standardized ophthalmological examination and the awareness of ophthalmologists and referring oncologists, neurologists, and neurosurgeons for ophthalmological abnormalities in this patient group.

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Visual function in children with primary brain tumors

Cited by 18 publications

References 37 publications

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

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

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

Ophthalmological Findings in Youths With a Newly Diagnosed Brain Tumor

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