Are the 2016 Guidelines on the Neuro-ophthalmic Evaluation of Pituitary Adenomas Already Obsolete?

The 2016 neurosurgical guidelines on pretreatment ophthalmology evaluation in patients with pituitary adenomas recommend preoperative, "optical coherence tomography (OCT) to measure both retinal nerve fiber layer (RNFL) thickness and the presence of damage to the ganglion cell layer (GCL) on algorithms that segment the macular cube," to assess prognosis for visual recovery[1]. Although RNFL and GCL thickness are routinely used to predict recovery of visual function after treatment[2-4], the importance of OCT for compressive optic neuropathy/chiasmopathy diagnosis is less well recognized. We report a patient series with sellar masses causing mass effect on the anterior visual pathways, normal visual fields (VF) but binasal decreased GCL thickness, suggesting preclinical evidence of compression.