Visual Pathway Tumor Presenting as Visual Disturbances without Extraocular Signs

Purpose: To evaluate visual pathway tumor presenting as visual disturbances without extraocular signs and assess the usefulness of various examinations.

Methods: Only 35 patients with intracranial tumors (22 males and 13 females) who were initially diagnosed at our hospital and confirmed by magnetic resonance imaging were enrolled, and previously known intracranial tumor patients and patients with strabismus or proptosis were excluded. Best corrected visual acuity (BCVA), pupillary reflex test, fundus examination, color vision test and visual field test were done to evaluate visual impairments. We investigated the incidence of intracranial tumors and sensitivity of tests.

Results: The most common tumors were pituitary tumors (60.0%), followed by meningioma (20.0%) and optic nerve glioma (5.7%). The BCVA ranged from 1.0 to no light perception and the visual acuity of 3 patients was 1.0 in both eyes. Positive relative afferent pupillary defect was seen in 71.4% and abnormal disc findings were found in 58.8% of patients. The color vision test was more specific (sensitivity: 76.6%), and all patients had abnormal visual field defects.

Conclusions: Pituitary tumor is the most common intracranial tumor. Among tests, a visual field test is a more sensitive test than other tests for detecting compressive optic neuropathy.