Visual Field Outcomes in Optic Pathway Glioma After Bevacizumab Therapy

Systemic bevacizumab is a promising therapy for optic pathway glioma (OPG) radiographic tumor burden1, but little is known about its impact on visual function2,3. Our objective is to characterize visual field outcomes associated with bevacizumab-based therapy (BBT) for OPG.

Poster 342 Visual field outcomes in optic pathway glioma after bevacizumab therapy Daniel Nelson1, Benjamin Siegel2, Tobey MacDonald3, David Wolf3, Jason Peragallo1 Emory University School of Medicine, Department of Ophthalmology, Atlanta, USA, 2Emory School of Medicine, Department of Neurology, Atlanta, Georgia, USA, 3Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, USA 1 Introduction: Systemic bevacizumab is a promising therapy for optic pathway glioma (OPG) radiographic tumor burden1, but little is known about its impact on visual function2,3. Our objective is to characterize visual field outcomes associated with bevacizumab-based therapy (BBT) for OPG. Methods: We performed a retrospective chart review of OPG patients treated with BBT between 2011 and 2020 at Children’s Hospital in Atlanta and Emory University Eye Clinic. Visual acuity (VA), visual field (VF), and radiographic information was noted at baseline and post-treatment. Visual field testing was performed with either Goldmann kinetic perimetry or Humphrey automated 24-2 perimetry. Clinically significant visual field change criteria included between (1) full field and any field loss, (2) quadrantic and hemifield loss, or (3) generalized constriction4. Results: 9 total patients were identified. The cohort had a median age of 10.7 years (IQR 9.1 – 16.1) at time of BBT initiation. 4 patients had improvement in visual fields, 3 patients had worse visual fields, and 2 patients had stable visual fields. Some patients experienced visual field decline despite stable MRI (2/9), and others demonstrated radiographic progression despite improved visual fields (3/9). Overall, 5 patients had radiographic progression after BBT. Conclusions: Visual field change in our cohort was highly variable. Visual field outcomes were discordant with radiographic changes. Several patients had advanced disease by time of BBT, which may limit conclusions. Prospective studies are needed to better characterize bevacizumab visual field outcomes, and compare these against outcomes with conventional chemotherapy regimens for OPG. References: 1. Lu VM, Welby JP, Nesvick CL, Daniels DJ. Efficacy and safety of bevacizumab in progressive pediatric lowgrade glioma: a systematic review and meta-analysis of outcome rates. Neurooncol Pract. 2020;7(4):359-368. 2. Avery RA, Hwang EI, Jakacki RI, Packer RJ. Marked recovery of vision in children with optic pathway gliomas treated with bevacizumab. JAMA Ophthalmol. 2014;132(1):111-114. 3. Yamasaki F, Takano M, Yonezawa U, et al. Bevacizumab for optic pathway glioma with worsening visual field in absence of imaging progression: 2 case reports and literature review. Childs Nerv Syst. 2020;36(3):635-639. 4. Heidary G, Fisher MJ, Liu GT, et al. Visual field outcomes in children treated for neurofibromatosis type 1-associated optic pathway gliomas: a multicenter retrospective study. J aapos. 2020;24(6):349.e341-349.e345. Abstract Type: Epidemiological Study (cohort, case-control, and cross-sectional studies, including electronic health record analyses and chart reviews with subgroup comparisons) Keywords: pediatric neuro-ophthalmology, visual fields, tumors Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Daniel Nelson, [e-mail] 498 | North American Neuro-Ophthalmology Society