Ophthalmological Findings in Youths With a Newly Diagnosed Brain Tumor

Abstract

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.

Ophthalmological Findings in Youths With a Newly Diagnosed Brain Tumor

“…These questionnaires were completed by the patient, except for in the youngest patients (ages 3 to 4 years), who had their questionnaires completed by a proxy. A total of 57% were visually impaired and 9% were legally blind, in contrast with the authors finding of 8.6% visually impaired and 1.8% legally blind …”

“…It is unclear what factors led to worse initial examination findings in this previously reported cohort, although that cohort did not include optic pathway gliomas and the definition of visual impairment differed from the authors’ criteria. In the previous report, visual impairment was defined as best-corrected visual acuity 20/40 or worse in the better-seeing eye (or 3 lines worse than vision appropriate for age), complete loss of vision in 1 eye, or a bitemporal or homonymous hemianopia.…”

“…Nuijts et al defined visual impairment as best-corrected visual acuity more than 0.5 LogMAR (approximate Snellen equivalent of 20/70 or worse) in the better-seeing eye. Additionally, 53% of patients had visual field defects, in contrast with Nuijts et colleagues’ finding of 28.1% of patients with visual field defects among those able to complete testing . Sensitivities for detecting visual field defects may have been different between the 2 studies, as Nuijts et al included semiautomatic-static peritests and Behavioral Visual Field Screening Tests, while the Peragallo et al study did not.…”

“…To the Editor I read with interest the article by Nuijts et al on symptoms and ophthalmological findings in pediatric patients presenting with brain tumors. This a prospective national cohort study in the Netherlands of all children presenting with a brain tumor over a more than 2-year period that included defined ophthalmologic examinations performed or attempted on every child who presented with a brain tumor.…”

“…The study by Nuijts et al did not include information regarding the vision-related quality of life in children with brain tumors. In a previous report by Peragallo et al on 77 pediatric patients with primary brain tumors who underwent standardized neuro-ophthalmic evaluations in a prospective cohort study at a single tertiary care center, 2 vision-related quality-of-life questionnaires validated for use in children with vision problems were used.…”