Key points What are the prevalence and types of visual symptoms and abnormal ophthalmological findings in young people at the time of brain tumor diagnosis? Findings In this cohort study of 170 Dutch youth aged 0 to 18 years with a newly diagnosed brain tumor, abnormal ophthalmologic findings were found in 78.8%, and 65.2% without visual symptoms at diagnosis had ophthalmologic abnormalities. in the exam. Meaning These findings suggest that standardized ophthalmologic examination should be considered in youth with a newly diagnosed brain tumor to enable early detection of vision loss, treatment decision-making, and, when appropriate, timely referral for visual rehabilitation. . |
Importance
Visual impairment is an irreversible adverse effect in people who experienced a childhood brain tumor. Ophthalmological evaluation at diagnosis allows early detection of vision loss, decision-making about treatment and, where appropriate, the timely use of visual interventions. However, awareness of visual impairment in clinical practice is suboptimal and compliance with ophthalmological evaluation needs to be improved.
Aim
To evaluate the prevalence and types of abnormal ophthalmologic findings in young people with a newly diagnosed brain tumor.
Design, environment and participants
In this nationwide prospective cohort study, young people aged 0 to 18 years with a newly diagnosed brain tumor between May 15, 2019 and August 11, 2021 were consecutively enrolled at 4 hospitals in the Netherlands, including the center tertiary reference center dedicated to pediatric oncology care.
Exhibitions
A comprehensive, standardized ophthalmologic examination, including orthoptic evaluation, visual acuity testing, visual field examination, and ophthalmoscopy, was performed within 4 weeks of brain tumor diagnosis.
Main results and measures
The main outcomes were the prevalence and types of visual symptoms and abnormal ophthalmological findings at the time of brain tumor diagnosis.
Results
Of 170 youth included in the study (96 [56.5%] men; 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%), tumors of the cerebral hemisphere.
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 youth (59.4%) presented with visual symptoms at the time of 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 tests.
Forty-five of 69 youth (65.2%) without visual symptoms at diagnosis had ophthalmologic abnormalities on examination. and decreased visual acuity in 13 of 152 (8.6%) with reliable visual acuity testing.
Forty-five of 69 youth (65.2%) without visual symptoms at diagnosis had ophthalmologic abnormalities on examination. and decreased visual acuity in 13 of 152 (8.6%) with reliable visual acuity testing.
Forty-five of 69 youth (65.2%) without visual symptoms at diagnosis had ophthalmologic abnormalities on examination.
Conclusions and relevance
- The results of this study suggest that there is a high prevalence of abnormal ophthalmological findings in young people at the time of brain tumor diagnosis, regardless of the presence of visual symptoms.
- These findings support the need for standardized ophthalmologic examination and awareness of ophthalmologists and oncologists, neurologists, and neurosurgeons regarding ophthalmologic abnormalities in this patient group.
