Long-term visual acuity outcomes after radiation therapy for sporadic optic pathway glioma

  • Sahaja AcharyaEmail author
  • Sophia Quesada
  • Kenneth Coca
  • Cody Richardson
  • Mary E. Hoehn
  • Jason Chiang
  • Ibrahim Qaddoumi
  • Frederick A. Boop
  • Amar Gajjar
  • Thomas E. Merchant
Clinical Study



Children with sporadic optic pathway glioma (OPG) commonly experience a decline in visual acuity (VA). This study aimed to quantify long-term VA outcomes after definitive radiation therapy (RT).


From 1997 to 2017, 41 patients underwent RT for OPG and had baseline VA testing. All patients underwent serial VA testing every 3–6 months during the first 5 years and annually thereafter. The cumulative incidence of VA decline or improvement (per eye) was estimated using death as a competing risk.


Mean follow-up was 5 years. Most tumors (93%) involved the postchiasmatic optic tracts and/or hypothalamus. Of the tumors tested for BRAF alterations (n = 15), 67% had a BRAF fusion. Median time to VA decline was 20 months in the eye with worse vision and 22 months in the better eye. For the worse eye, the 5-year cumulative incidences of VA decline and improvement were 17.9% [95% confidence interval (CI) 7–32.8%] and 13.5% (95% CI 4.7–26.7%), respectively. For the better eye, the 5-year cumulative incidences of VA decline and improvement were 11.5% (95% CI 3.5–30.7%) and 10.6% (95% CI 2.6–25.2%), respectively. Visual outcomes did not correlate with radiographic evidence of tumor progression.


The 5-year cumulative incidence of VA decline was low. VA decline is most likely to occur within the first 2 years after RT and is not associated with radiographic progression of disease, highlighting the need for frequent ophthalmologic exams during this period.


Optic glioma Visual acuity Radiation BRAF 



The authors thank Keith A. Laycock, PhD, ELS, for scientific editing of the manuscript and Tina D. Davis MBA, RHIA, Erin Kelly, MSW, and Samantha Buhler, CCRP, for assistance in data collection.


All authors receive research support from the American Lebanese Syrian Associated Charities (ALSAC).

Compliance with ethical standards

Conflict of interest

No conflicts of interest.

Supplementary material

11060_2019_3264_MOESM1_ESM.docx (14 kb)
Supplementary file1 (DOCX 13 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sahaja Acharya
    • 1
    Email author
  • Sophia Quesada
    • 1
  • Kenneth Coca
    • 1
  • Cody Richardson
    • 2
  • Mary E. Hoehn
    • 2
  • Jason Chiang
    • 3
  • Ibrahim Qaddoumi
    • 4
  • Frederick A. Boop
    • 5
  • Amar Gajjar
    • 4
  • Thomas E. Merchant
    • 1
  1. 1.Department of Radiation OncologySt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of OphthalmologyUniversity of Tennessee Health Science CenterMemphisUSA
  3. 3.Department of PathologySt. Jude Children’s Research HospitalMemphisUSA
  4. 4.Division of Neuro-Oncology, Department of OncologySt. Jude Children’s Research HospitalMemphisUSA
  5. 5.Division of Pediatric Neurosurgery, Department of SurgerySt. Jude Children’s Research HospitalMemphisUSA

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