THE CLINICAL PRESENTATION OF CHILDREN WITH TUMORS AFFECTING THE ANTERIOR VISUAL PATHWAYS

Purpose: To review the ways in which children with tumours affecting t he anterior visual pathways present and to determine the extent of vis ual loss at presentation and the visual prognosis after treatment, Met hods: A retrospective review of the 17 children (age 1-13 years at pre sentation) referred to a specialist paediatric oncology unit, Ten chil dren had extrinsic tumours affecting the chiasmal area whilst 7 had in trinsic gliomas affecting the optic nerve and/or chiasm. Patients were followed up for up to 13 years (median 2 years), Results: The childre n studied presented with a variety of symptoms including headaches, le thargy and growth failure. Despite the clinical finding of marked visu al loss in several cases, visual failure was not prominent amongst the presenting symptoms, After surgical intervention and other treatment vision stabilised or improved; eyes with no perception of light for sh ort periods could regain substantial vision. Conclusion: Children with progressive visual deterioration due to tumours do not readily verbal ise their difficulty and may have profound loss at presentation, Stand ard clinical tests of vision will identify the extent of damage. Visua l prognosis depends on the underlying pathology and length of history but prompt treatment may lead to substantial improvement in vision.