Ocular late effects in childhood and adolescent cancer survivors: a report from the childhood cancer survivor study.
BACKGROUND
Approximately 80% of children currently survive 5 years following diagnosis of their cancer. Studies based on limited data have implicated certain cancer therapies in the development of ocular sequelae in these survivors.


METHODS
The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort study investigating health outcomes of 5+ year survivors diagnosed and treated between 1970 and 1986 compared to a sibling cohort. The baseline questionnaire included questions about the first occurrence of six ocular conditions. Relative risks (RR) and 95% confidence intervals (CI) were calculated from responses of 14,362 survivors and 3,901 siblings.


RESULTS
Five or more years from the diagnosis, survivors were at increased risk of cataracts (RR: 10.8; 95% CI: 6.2-18.9), glaucoma (RR: 2.5; 95% CI: 1.1-5.7), legal blindness (RR: 2.6; 95% CI: 1.7-4.0), double vision (RR: 4.1; 95% CI: 2.7-6.1), and dry eyes (RR: 1.9; 95% CI: 1.6-2.4), when compared to siblings. Dose of radiation to the eye was significantly associated with risk of cataracts, legal blindness, double vision, and dry eyes, in a dose-dependent manner. Risk of cataracts were also associated with radiation 3,000+ cGy to the posterior fossa (RR: 8.4; 95% CI: 5.0-14.3), temporal lobe (RR: 9.4; 95% CI: 5.6-15.6), and exposure to prednisone (RR: 2.3; 95% CI: 1.6-3.4).


CONCLUSIONS
Childhood cancer survivors are at risk of developing late occurring ocular complications, with exposure to glucocorticoids and cranial radiation being important determinants of increased risk. Long-term follow-up is needed to evaluate potential progression of ocular deficits and impact on quality of life.
Whelan
Kimberly F
KF
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA. kwhelan@peds.uab.edu
Stratton
Kayla
K
Kawashima
Toana
T
Waterbor
John W
JW
Castleberry
Robert P
RP
Stovall
Marilyn
M
Sklar
Charles A
CA
Packer
Roger J
RJ
Mitby
Pauline
P
Aitken
Candice L
CL
Blatt
Julie
J
Robison
Leslie L
LL
Mertens
Ann C
AC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005123:Eye / Q000187:drug effects; D005128:Eye Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors; D055815:Young Adult
D005938:Glucocorticoids