Goldmann perimetry in acromegaly - A survey of 307 cases from 1951 through1996

Objective: Because Visual pathway lesions are a common complication of pitu itary tumors, visual field examinations in patients with acromegaly were st udied. Proportion and outcome of visual field defects in patients with acro megaly were evaluated. Design: Large, retrospective case series. Participants: We reviewed 307 cases of acromegaly seen from 1951 through 19 96 at a single referral center. Methods: Kinetic visual field testing had been performed with the Goldmann perimeter, and the frequency of visual field defects and their correlation with other clinical manifestations and characteristics of the adenoma were examined. Main Outcome Measures: Repeat visual field examinations. Results: Of the 307 patients included in the analysis, a visual field defec t that could be attributed to the pituitary adenoma was observed in 62 (20. 2%) during follow-up. Visual field defects were bilateral in 38 (61.3%) of these cases. Patients with visual field abnormalities were significantly yo unger (P = 0.04), had larger tumors (P < 0.001), had more suprasellar exten sions (P ( 0.001), and had higher levels of growth hormone in their serum ( P = 0.04) than patients free of visual field defects. At the end of the fol low-up period, visual field examination remained abnormal in 32 (10.4%). Re turn to a normal visual field examination after treatment was more frequent ly observed in patients who were less than 40 years of age at the time of d iagnosis (P = 0.004), Secondary empty sella syndrome was the main cause of visual field defects after treatment. Abnormal visual field, either at the time of diagnosis or during follow-up, decreased from 27% of patients betwe en 1951 and 1975 to 15.4% of patients between 1976 and 1996, when modern ne uroimaging techniques became available. Conclusions: Endocrinologic and neuroimaging follow-up of patients with acr omegaly should be accompanied by ophthalmic assessment. Factors predictive of visual field defects have been identified. (C) 2000 by the American Acad emy of Ophthalmology.