Vision-related quality-of-life in pediatric primary brain tumor patients

Abstract

Purpose: Brain tumors are the leading cause of death from childhood cancer. Although overall survival has improved due to earlier detection, better therapies, and improved surveillance, visual dysfunction and impaired vision-related quality-of-life (VR-QOL) are often unrecognized in children. This project investigated VR-QOL in pediatric brain tumor patients. Methods: We evaluated visual impairment and quality-of-life (QOL) in a quality improvement project at one tertiary care center. Patients ≤18, greater than 6 months from diagnosis of brain tumor, excluding intrinsic anterior visual pathway tumors, underwent standardized neuro-ophthalmologic examination. Health-related QOL (HR-QOL) [PedsQL Brain Tumor Module] and VR-QOL questionnaires [CVFQ (Children’s Visual Function Questionnaire) in children ˂8, and EYE-Q in children 8–18] were obtained from patients and parents. Results: Among 77 patients, craniopharyngiomas (n=16, 21%) and astrocytomas (n=15, 20%) were the most common tumors. Among 44/77 (57%) visually impaired children, 7 (16%) were legally blind. Eye-Q median score was 3.40 (interquartile range 3.00–3.75), worse than average scores for normal children. Eye-Q score decreased 0.12 with every 0.1 increase in logMAR visual acuity [p<0.001]. Patients who were legally blind had a significantly lower Eye-Q score than those who were not (0.70 vs. 3.44 [p<0.001]). Cognitive HR-QOL scores decreased 1.3 for every 0.1 increase in logMAR visual acuity [p=0.02]. Conclusions: Pediatric brain tumor patients’ vision, HR-QOL, and VR-QOL were often severely affected even when tumors were considered cured. Visual acuity and legal blindness correlated with VR-QOL. Systematic neuro-ophthalmologic examinations in pediatric primary brain tumor patients are necessary to facilitate early preventative and corrective ophthalmologic interventions.

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 …”

“…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. 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.…”

“…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.…”

Neurosurgery for eloquent lesions in children: state-of-the-art rationale and technical implications of perioperative neurophysiology

“…However, sufficient data exist on functional impairments, such as vision, and consecutive negative effects on quality of life (QOL) in children. 45 Long-term data in rather small cohorts of pediatric brain tumor patients have demonstrated the aggravating effects of treatment-related morbidity on QOL during long-term follow-up. 46…”

Long-term postoperative quality of life in childhood survivors with cerebellar mutism syndrome

“…The inventory includes self-report and parent-proxy report versions, both of which are highly reliable. Several studies on the QoL of children with brain tumors have been conducted, where PedsQL 4.0 were widely used (Eaton et al, 2020;Li et al, 2021;Peragallo et al, 2021). However, similar studies on CMS are scarce.…”