Abstract
Purpose :
It is well established that tumors such as optic pathway gliomas and suprasellar tumors have high rates of associated visual impairment and are often symptomatic. The potential visual sequelae associated with tumors in other areas of the brain, however, have received little attention to date. The purpose of this study was to better understand current referral patterns among patients with newly diagnosed brain tumors and further categorize any associated visual impairment. This will serve as a baseline as we initiate a new ophthalmic screening protocol for these patients at our institution.
Methods :
This was a retrospective cohort study of all children with primary brain tumors diagnosed at our tertiary care facility from January - December 2019. Charts were reviewed for oncologic data as well as ophthalmic data if an evaluation was performed in either the inpatient or outpatient setting. Patients who were initially diagnosed at our institution but received their oncologic care elsewhere were excluded.
Results :
Seventy-one patients were diagnosed with a new primary brain tumor and received at least some portion of their oncologic care within the study period. The mean age at diagnosis was 9.24 years. The distribution of pathologic diagnosis is illustrated in Figure 1. An ophthalmology referral was sent for 45 of these patients (63%), and 41 of these were evaluated by an ophthalmologist [11 inpatient only (27%) vs 15 outpatient only (36%) vs inpatient + outpatient (36%)]. Thirty of the 41 patients had some form of visual impairment (73%), including optic nerve abnormalities (41%), decreased visual acuity to <20/40 (10%), abnormal eye movements (strabismus/nystagmus/motility disorders, 48%), decreased color vision (5%), visual field deficits (15%), abnormal pupils (12%), and eyelid/anterior segment abnormalities (17%). One patient underwent strabismus surgery during the study period. Only one patient was referred to low vision services.
Conclusions :
The prevalence of visual impairment among patients with primary brain tumors is high, however, referral rates for ophthalmology evaluation remain low. We plan to address this gap in care by instituting a formal ophthalmology referral and screening protocol at our institution.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.