Skip to main content

  • Eye Evaluation Needed in Children With Brain Tumors

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
    Add to My Bookmarks

    Journal Highlights

    JAMA Network Open
    Published online August 2, 2019

    Download PDF

    Visual impairment in children with brain tumors has received limited attention. Ophthalmologic evaluation is not required for most neuro-oncol­ogy clinical trials, and visual function is rarely monitored during or after treatment of the tumor. In a study of children with primary brain tumors, Liu et al. looked at patterns of refer­ral to ophthalmology and found that more than half of the children were not referred. The authors emphasized that ophthalmologic evaluation of these patients is needed to ensure that visual function deficits are identified and managed.

    For this retrospective study, the researchers included 141 children with a primary brain tumor treated at Loma Linda University Children’s Hospital and Eye Institute during a five-year period. Outcomes of interest were the incidence of ophthalmic evaluation, the prevalence of abnormal ophthalmic findings, and the association of such findings with tumor characteristics.

    The median age of the children was 7 years (range, 0-18 years); 52% were male. Findings showed that 73 patients (52%) did not have any formal ophthalmologic evaluation. The other 68 patients received assessment by one of four pediatric ophthalmologists and/or neuro-ophthalmologists; the total number of eye care visits for these patients was 222.

    The mean five-year survival rates for patients with and without eye exams did not differ substantially (78.3% vs. 84.9%, respectively). The median time from tumor diagnosis to initial ophthalmologic evaluation was nine months (range, 0-94 months). Among the 68 examined children, 10 (15%) had visual symptoms at the time of tumor diagnosis, and 61 (90%) had abnormal findings when examined, including strabismus (60%), impaired visual acuity (54%), amblyopia (38%), papilledema (35%), visual field defects (19%), optic atrophy (18%), and ker­atopathy (15%). Strabismus was more common with posterior fossa tumors. Radiation therapy correlated signifi­cantly with amblyopia.

    In light of these findings, the authors recommend ophthalmologic referral of children with brain tumors so that visual sequelae can be detected and vision preserved.

    The original article can be found here.