title: Visual acuity and pattern of visual field loss at presentation in pituitary adenoma.
abstract: Our purpose was to analyse the demographics, prevalence and pattern of visual field defects in patients with pituitary adenoma. We prospectively recruited 103 consecutive patients (206 eyes) presenting to a neurosurgical unit with pituitary adenoma. Ophthalmological examination and standard automated perimetry (Humphrey, 24-2 threshold) was performed. Severity of visual field defects was also assessed. The mean population age was 53.9 years (standard deviation=15). Visual loss was the most common reason for presentation (39%) followed by endocrine abnormality (21%) and headache (15%). Patients with endocrine abnormality on presentation were 10.9 years younger than those presenting with visual loss (p=0.001). Bitemporal defects were the most prevalent pattern (n=22, 41%) followed by homonymous defects (n=7, 13%). Of the patients with visual field loss, 33% had unilateral visual field defects. The mean visual acuity in those with bitemporal defects was 6/7.5 with half of these patients having 6/6 vision in both eyes. In conclusion, the majority of patients with pituitary adenoma have visual acuity better than 6/7.5 despite having visual field defects. While a bitemporal pattern of visual field loss is the most common, a significant proportion of patients had unilateral and altitudinal defects. Assessment of the visual field is essential to rule out chiasmal compression.
authors.affiliation: Department of Ophthalmology, Faculty of Medical & Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Ogra
authors.affiliation: Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Nichols
authors.affiliation: Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: Stanley
authors.initials: S
authors.lastname: Stylli
authors.affiliation: Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kaye
authors.affiliation: Shiley Eye Centre, UCSD, La Jolla, CA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Savino
authors.affiliation: Department of Ophthalmology, Faculty of Medical & Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: h.daneshmeyer@auckland.ac.nz.
authors.forename: Helen V
authors.initials: HV
authors.lastname: Danesh-Meyer
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D011446:Prospective Studies; D014786:Vision Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult
keywords: Chiasmal compression; Optic chiasm; Optic nerve; Pituitary adenoma; Pituitary tumour; Visual acuity; Visual field defect