Youth diagnosed with brain tumors often present with abnormal ophthalmological findings, according to study findings published in JAMA Ophthalmology.
Visual impairment is a well-established adverse effect of childhood brain tumors. Impaired vison has substantial impacts on health and quality of life. Many previous studies on visual impairment in childhood brain tumors have not included a complete ophthalmologic evaluation.
This cohort study was part of a large prospective, longitudinal, multicenter, cohort study conducted in the Netherlands. Youth (N=170) with a newly diagnosed brain tumor underwent a clinical examination, magnetic resonance imaging (MRI), and complete ophthalmologic assessment between 2019 and 2021. Trends in visual abnormalities were evaluated.
Patients were aged median 8.3 (range, 0.2-17.8) years at diagnosis, 56.5% were boys, the most common tumors were low-grade (44.7%) or high-grade (11.8%) gliomas, 51.8% of tumors were located in the supratentorial region, and 30.0% of tumors affected optic pathways.
The most common symptoms at presentation included:
- Headache (65.3%)
- Nausea or vomiting (62.9%)
- Abnormal gait or coordination (32.9%)
- Lethargy (31.7%)
- Weight loss (24.1%)
- Behavioral changes or school difficulties (21.8%)
- Auditory symptoms or vertigo (18.2%)
Visual symptoms were common, with only 40.6% reporting no vision-related symptoms. The most common visual symptoms were:
- Decreased vision (24.7%)
- Diplopia (24.7%)
- Eye movement disorder (18.8%)
- Visual field loss (13.5%)
Half of patients (51.2%) underwent neurosurgery alone and nearly a quarter (23.5%) underwent neurosurgery and received chemotherapy and radiotherapy.
During ophthalmologic examination, 65.2% had abnormal findings. Abnormalities were most common among patients with infratentorial tumors (76.5%) and hydrocephalus (75.6%) compared with supratentorial midline tumors (55.0%) or cerebral hemisphere tumors (53.3%).
During the orthoptic evaluation, common abnormalities included gaze deficits (33.5%), nystagmus (24.8%), and strabismus (19.9%).
Stratified by tumor location, median monocular best-corrected visual acuity was:
- 20/200 before surgery and 20/20 after surgery for the patients with cerebral hemisphere tumors (n=70)
- 20/20 before and 20/25 after surgery for the patients with midline tumors (n=106)
- 20/20 before and after surgery for the patients with infratentorial tumors (n=164)
Patients were given occlusion therapy (4.7%), eye drops (2.9%), and referral to a visual rehabilitation center (2.4%).
This study may have included selection bias as not all eligible patients were approached.
The researchers concluded that “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.”
Nuijts MA, Stegeman I, van Seeters T, et al. Ophthalmological findings in youths with a newly diagnosed brain tumor. JAMA Ophthalmol. Published online September 15, 2022. doi:10.1001/jamaophthalmol.2022.3628