Vision-related quality-of-life in pediatric primary brain tumor patients

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, visual dysfunction and impaired vision-related quality-of-life (VR-QOL) are often unrecognized in children. This project investigated VR-QOL in pediatric brain tumor patients.

Methods: We evaluated visual impairment and quality-of-life (QOL) in a quality improvement project at one tertiary care center. Patients ≤ 18, greater than 6 months from diagnosis of brain tumor, excluding intrinsic anterior visual pathway tumors, underwent standardized neuro-ophthalmologic examination. Health-related QOL (HR-QOL) (PedsQL Brain Tumor Module) and VR-QOL questionnaires [CVFQ (Children's Visual Function Questionnaire) in children < 8, and EYE-Q in children 8-18] were obtained from patients and parents.

Results: Among 77 patients, craniopharyngiomas (n = 16, 21%) and astrocytomas (n = 15, 20%) were the most common tumors. Among 44/77 (57%) visually impaired children, 7 (16%) were legally blind. Eye-Q median score was 3.40 (interquartile range 3.00-3.75), worse than average scores for normal children. Eye-Q score decreased 0.12 with every 0.1 increase in logMAR visual acuity (p < 0.001). Patients who were legally blind had a significantly lower Eye-Q score than those who were not [0.70 vs. 3.44 (p < 0.001)]. Cognitive HR-QOL scores decreased 1.3 for every 0.1 increase in logMAR visual acuity (p = 0.02).

Conclusions: Pediatric brain tumor patients' vision, HR-QOL, and VR-QOL were often severely affected even when tumors were considered cured. Visual acuity and legal blindness correlated with VR-QOL. Systematic neuro-ophthalmologic examinations in pediatric primary brain tumor patients are necessary to facilitate early preventative and corrective ophthalmologic interventions.

Keywords: Neuro-ophthalmology; Pediatric; Primary brain tumor; Quality-of-life; Vision.

Fig. 1

logMAR visual acuity vs. Eye-Q Score (points jittered to reduce overlap) – Linear regression showed that Eye-Q score decreased by 0.12 for every 0.1 increase in logMAR visual acuity (worsening vision) [p<0.001]. LogMAR visual acuities = (-log(Snellen)), where logMAR 0 is equivalent to 20/20, logMAR 0.3 is equivalent to 20/40, and logMAR 1.0 is equivalent to 20/200

Fig. 2:

logMAR visual acuity vs. PedsQL Cognitive Problem subscore (patient) (points jittered to reduce overlap) – Linear regression showed that PedsQL Cognitive Problem subscore decreased by 0.13 for every 0.1 increase in logMAR visual acuity [p=0.02]. LogMAR visual acuities (-log(Snellen))

Fig. 3

RNFL vs. Eye-Q score – (points jittered to reduce overlap) – Linear regression showed that Eye-Q score decreased with decreasing retinal nerve fiber layer thickness measured by optical coherence tomography [p=0.03]

Fig. 4

Box plot of Legal blindness status vs. Eye-Q Score with jittered individual observations –- Patients who were legally blind had an Eye-Q score on average of 0.7 compared to 3.43 for those who were not legally blind [p<0.001]. Legal blindness defined as Snellen visual acuity of 20/200 or less in the better seeing eye or remaining visual field in better seeing eye of less than 20 degrees