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

Nuijts, Myrthe A.; Degeling, M. H.; Stegeman, Inge; Meeteren, Antoinette Y. N. Schouten–van; Imhof, Saskia M.

doi:10.1186/s12886-019-1225-8

Cited by 10 publications

(10 citation statements)

References 50 publications

(58 reference statements)

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“…OCT is a noninvasive imaging modality that provides cross-sectional images of the optic nerve and retinal structures ( 49 ). Our currently ongoing CCISS study investigates ophthalmological outcomes at diagnosis and in follow-up to define the value of OCT in children with any type of brain tumor ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

Ophthalmological Evaluation in Children Presenting With a Primary Brain Tumor

Nuijts

Stegeman²,

Porro³

et al. 2021

Journal of Neuro-Ophthalmology

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Background: Children with a brain tumor are prone to develop visual impairment, which to date is often underestimated and unrecognized. Our aim was to assess the prevalence of ophthalmological evaluation and abnormal ophthalmological findings, and investigate whether demographic and tumor-related characteristics are associated with abnormal ophthalmological findings in children presenting with a primary brain tumor. Methods: Medical records of all 90 children diagnosed with a primary brain tumor between June 2018 and May 2019 and treated at the Princess Máxima Center for Pediatric Oncology, a tertiary referral center in the Netherlands, were retrospectively reviewed. Univariate regression analysis was used to investigate associations between demographic, tumor-related and clinical characteristics, and abnormal ophthalmological findings. Results: Sixty children (34 male [56.7%]; median [range] age, 9.3 [0–16.9] years) underwent ophthalmological evaluation within 6 weeks before or after diagnosis, 11 children (5 male [45.5%]; median [range] age, 5.7 [0.1–17.2] years) were seen more than 6 weeks before or after diagnosis, and 19 children (7 male [36.8%]; median [range] age, 7.2 [1.9–16.6] years) did not receive ophthalmological evaluation within at least 6 months from diagnosis. A total of 19 children (21.1%) presented with visual symptoms as first sign leading to the diagnosis of a brain tumor. Children who presented with visual symptoms (odds ratio [OR], 22.52; 95% confidence interval [CI], 4.90–103.60) and/or hydrocephalus (OR, 3.60; 95% CI, 1.38–9.36) at diagnosis were more often seen for ophthalmological evaluation. The most common abnormal ophthalmological findings were eye movement disorders (66.0%), papilledema (44.1%), and visual field defects (58.1%). Eye movement disorders occurred more frequently in patients with an infratentorial tumor (OR, 4.71; 95% CI, 1.03–21.65). The risk of papilledema was associated with older age (OR, 1.19; 95% CI, 1.05–1.34), hydrocephalus (OR, 9.63; 95% CI, 2.68–34.61), and infratentorial (OR, 9.11; 95% CI, 1.77–46.78) and supratentorial (OR, 13.13; 95% CI, 1.92–89.52) tumors. Conclusions: In this study, most children with a primary brain tumor underwent ophthalmological evaluation around diagnosis, 21% of the children were not evaluated. The high prevalence of abnormal ophthalmological findings stresses the importance of early standardized ophthalmological evaluation to detect visual impairment and provide timely treatment to potentially prevent permanent visual loss.

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Section: Discussionmentioning

confidence: 99%

Ophthalmological Evaluation in Children Presenting With a Primary Brain Tumor

Nuijts

Stegeman²,

Porro³

et al. 2021

Journal of Neuro-Ophthalmology

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show abstract

“…This cohort study was performed as part of a larger prospective, longitudinal, multicenter, cohort study investigating visual impairment in youths newly diagnosed with a brain tumor in the Netherlands . The study was approved by the Medical Ethical Committee Utrecht as part of that study and adhered to the principles of the Declaration of Helsinki .…”

Section: Methodsmentioning

confidence: 99%

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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“…In recent years, optical coherence tomography has become a powerful, non-invasive, diagnostic tool in optic neuropathies and brain tumours with optic pathways involvement [7][8][9] thanks to the detection of change in peripapillary retinal nerve fiber layer thickness and ganglion cell complex-inner plexiform layer, 10 in the paediatric age too. Since the peripapillary nerve fiber layer is strictly related to intracranial pathologies directly or indirectly involving optic pathways, 7 the structural data obtained with this technology and the anatomic quantification of peripapillary retinal nerve fiber layer thickness can make the difference in difficult decision-making procedures.…”

Section: Case Descriptionmentioning

confidence: 99%