title: Impact of vision loss among survivors of childhood central nervous system astroglial tumors.
abstract: BACKGROUND
  The impact of impaired vision on cognitive and psychosocial outcomes among long-term survivors of childhood low-grade gliomas has not been investigated previously but could inform therapeutic decision making.
  
  
  METHODS
  Data from the Childhood Cancer Survivor Study were used to investigate psychological outcomes (measures of cognitive/emotional function) and socioeconomic outcomes (education, income, employment, marital status, and independent living) among astroglial tumor survivors grouped by 1) vision without impairment, 2) vision with impairment (including unilateral blindness, visual field deficits, and amblyopia), or 3) bilateral blindness. The effect of vision status on outcomes was examined with multivariate logistic regression with adjustments for age, sex, cranial radiation therapy, and medical comorbidities.
  
  
  RESULTS
  Among 1233 survivors of childhood astroglial tumors 5 or more years after their diagnosis, 277 (22.5%) had visual impairment. In a multivariate analysis, survivors with bilateral blindness were more likely to be unmarried (adjusted odds ratio (OR), 4.7; 95% confidence interval [CI], 1.5-15.0), live with a caregiver (adjusted OR, 3.1; 95% CI, 1.3-7.5), and be unemployed (adjusted OR, 2.2; 95% CI, 1.1-4.5) in comparison with those without visual impairment. Bilateral blindness had no measurable effect on cognitive or emotional outcomes, and vision with impairment was not significantly associated with any psychological or socioeconomic outcomes.
  
  
  CONCLUSIONS
  Adult survivors of childhood astroglial tumors with bilateral blindness were more likely to live unmarried and dependently and to be unemployed. Survivors with visual impairment but some remaining vision did not differ significantly with respect to psychological function and socioeconomic status from those without visual impairment. Cancer 2016;122:730-739. © 2016 American Cancer Society.
authors.affiliation: Division of Pediatric Hematology and Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio.|Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Peter M K
authors.initials: PM
authors.lastname: de Blank
authors.affiliation: Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisher
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Lu
authors.initials: L
authors.lastname: Lu
authors.affiliation: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: Department of Pediatrics, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, New York.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.affiliation: Division of Radiation Oncology, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Chris
authors.initials: C
authors.lastname: Vukadinovich
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents; D001254:Astrocytoma / Q000150:complications / Q000523:psychology* / Q000628:therapy; D001766:Blindness / Q000209:etiology / Q000523:psychology*; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D057187:Independent Living / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D012923:Social Class; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014786:Vision Disorders / Q000209:etiology / Q000523:psychology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: childhood cancer survivors; optic pathway glioma; pediatric glioma late effects; vision loss