The Relationship of Vision and Quality of Life (QOL) in Patients with Pediatric Primary Brain Tumors (PBT).

Abstract

Purpose : Brain tumors are the leading cause of death from childhood cancer, although overall survival has improved due to earlier detection, better therapies, and improved surveillance. Permanent sequelae of the tumor and its treatment may cause severe visual deficits and decreased QOL.¹ Visual dysfunction and impaired vision related QOL (VR-QOL) are often not recognized in children because of examination difficulty and lack of awareness. As part of an ongoing quality improvement project we performed a cross-sectional analysis to evaluate visual impairment and its effects on QOL.

Methods : We included patients 18 years old and younger, more than 6 months from diagnosis of primary brain tumor, excluding primary intrinsic anterior visual pathway tumors. All patients underwent neuro-ophthalmologic examination. Health-related QOL (HR-QOL) questionnaires, using PedsQL Brain Tumor Module ² were obtained from patients and parents. VR-QOL questionnaires, using CVFQ (Children’s visual function questionnaire) ³ in children under 8 years old, and EYE-Q ⁴ in children from 8 to 18 years old, were obtained. Demographic data, driving status, schooling, and use of low-vision aids were recorded.

Results : 43 patients were evaluated. Astrocytomas (9/43) and craniopharyngiomas (9/43) were the most common tumors. Diagnosis was made at 6.6 years (range 0.2-17). Mean age at examination was 11.7 years (IQ range 8.8-15.6). 3/43 patients (7%) were legally blind; 12/43 (28%) were visually impaired. Eye-Q median score was 4.275 (IQ range 3.925-4.750). Eye-Q score decreased 0.14 with every 0.1 increase in logMAR visual acuity [p<0.001]. Average Eye-Q score for legally blind patients was 1.4; for non-legally blind patients 4.35 [p=0.003]. Cognitive HR-QOL scores decreased 1.2 for every 0.1 increase in logMAR visual acuity [p=0.06].

Conclusions : At our institution, pediatric PBT patients’ vision, HR-QOL, and VR-QOL are often severely affected, even when the PBT is considered "cured". Visual acuity is correlated with VR-QOL. Systematic neuro-ophthalmologic examinations in pediatric PBT patients may improve long-term visual outcomes and QOL through earlier interventions.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.