Myrthe A Nuijts1, Inge Stegeman1,2,3,4, Tom van Seeters5, Marloes D Borst6, Carlien A M Bennebroek7, Dennis R Buis8, Nicole C Naus9, Giorgio L Porro1, Michelle B van Egmond-Ebbeling1, Elisabeth S M Voskuil-Kerkhof1, JanWillem R Pott10, Niels E Franke11, Evelien de Vos-Kerkhof11, Eelco W Hoving11, Antoinette Y N Schouten-van Meeteren11, Saskia M Imhof1. 1. Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Department of Otorhinolaryngology and Head & Neck Surgery University, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands. 4. Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 5. Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands. 6. Faculty of Medicine, Utrecht University, Utrecht, the Netherlands. 7. Department of Ophthalmology, location AMC of Amsterdam University Medical Center, Amsterdam, the Netherlands. 8. Department of Pediatric Neurosurgery, location AMC of Amsterdam University Medical Center, Amsterdam, the Netherlands. 9. Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands. 10. Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 11. Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Abstract
Importance: Visual 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. Objective: To assess the prevalence and types of abnormal ophthalmological findings in youths with a newly diagnosed brain tumor. Design, Setting, and Participants: In 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. Exposures: A 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 Measures: The main outcomes were prevalence and types of visual symptoms and abnormal ophthalmological findings at brain tumor diagnosis. Results: Of 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 Relevance: The 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.
Importance: Visual 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. Objective: To assess the prevalence and types of abnormal ophthalmological findings in youths with a newly diagnosed brain tumor. Design, Setting, and Participants: In 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. Exposures: A 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 Measures: The main outcomes were prevalence and types of visual symptoms and abnormal ophthalmological findings at brain tumor diagnosis. Results: Of 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 Relevance: The 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.
Authors: Sophie Wilne; Jacqueline Collier; Colin Kennedy; Karin Koller; Richard Grundy; David Walker Journal: Lancet Oncol Date: 2007-08 Impact factor: 41.316
Authors: Myrthe A Nuijts; Inge Stegeman; Giorgio L Porro; Josje C Duvekot; Michelle B van Egmond-Ebbeling; Denise C P van der Linden; Eelco W Hoving; Antoinette Y N Schouten-van Meeteren; Saskia M Imhof Journal: J Neuroophthalmol Date: 2021-10-29 Impact factor: 4.415
Authors: Gregory T Armstrong; Qi Liu; Yutaka Yasui; Sujuan Huang; Kirsten K Ness; Wendy Leisenring; Melissa M Hudson; Sarah S Donaldson; Allison A King; Marilyn Stovall; Kevin R Krull; Leslie L Robison; Roger J Packer Journal: J Natl Cancer Inst Date: 2009-06-17 Impact factor: 11.816