PMC8333276_01
Case presentation. (A-E) Case 1 MRI axial (A) and coronal (B) view (T1 + contrast). Yellow circles indicate the remaining tumor mass after chemotherapy. (C) Schematic of the visual field defects. (D) Diagram of the optic pathway indicating the location of the injury. (E) Esterman binocular field test at baseline (pre-treatment). Black dots correspond to unseen point of light. (F-J) Case 2 MRI axial (F) and coronal (G) view (T1 + contrast). Yellow circles indicate the remaining tumor mass after chemo- and focal radiotherapy. (H) Schematic of the visual field defects. (I) Diagram of the optic pathway indicating the location of the injury. (J) Esterman binocular field test at baseline (pre-treatment). Black dots correspond to unseen point of light.
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A 32-year-old female was diagnosed with bitemporal hemianopia and left exotropia consecutive to a suprasellar non-germinatous germ cell tumor diagnosed at the age of 13 (Figures 1F-J) (Table 1). The end of treatment MRI still showed a 1.5-cm residual mass in the suprasellar region, inseparable from the hypothalamus and optic chiasm, which remained unchanged over time (Figures 1F,G). Her visual impairment, corresponding to a bitemporal hemianopia (Figures 1H-J), was detected at the time of initial diagnosis did not improve despite the successful management of her tumor.
PMC8333276_02
Case presentation. (A-E) Case 1 MRI axial (A) and coronal (B) view (T1 + contrast). Yellow circles indicate the remaining tumor mass after chemotherapy. (C) Schematic of the visual field defects. (D) Diagram of the optic pathway indicating the location of the injury. (E) Esterman binocular field test at baseline (pre-treatment). Black dots correspond to unseen point of light. (F-J) Case 2 MRI axial (F) and coronal (G) view (T1 + contrast). Yellow circles indicate the remaining tumor mass after chemo- and focal radiotherapy. (H) Schematic of the visual field defects. (I) Diagram of the optic pathway indicating the location of the injury. (J) Esterman binocular field test at baseline (pre-treatment). Black dots correspond to unseen point of light.
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A 32-year-old female was diagnosed with bitemporal hemianopia and left exotropia consecutive to a suprasellar non-germinatous germ cell tumor diagnosed at the age of 13 (Figures 1F-J) (Table 1). The end of treatment MRI still showed a 1.5-cm residual mass in the suprasellar region, inseparable from the hypothalamus and optic chiasm, which remained unchanged over time (Figures 1F,G). Her visual impairment, corresponding to a bitemporal hemianopia (Figures 1H-J), was detected at the time of initial diagnosis did not improve despite the successful management of her tumor.
Principle of audiovisual stimulation program (NeurofyResearch). Sequence of the visual task. (1) Eight yellow still spheres are present in a virtual cube. (2) One of these spheres turns red for 5 s (cued target) and returns to yellow. (3) All spheres randomly move following linear paths across the visual field encompassing the blind field and bouncing on one another and on the walls of the virtual 3D cube when collisions occurred. (4) After 30 s, the spheres stopped moving. (5) The patient had to select the cued target using a hand-guided virtual laser pointer. (6) A correct selection is considered a positive hit.
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After one of the spheres was cued (turning red for 5 s and switching back to yellow, Figure 2), the spheres move for 20 s following random linear paths, bouncing on one another and on the walls of a virtual 3D cube when collisions occur. The overall span of the movement of the spheres covers 78  and 50  of horizontal and vertical visual angle, respectively (Figure 2).
Case 1:Visual outcome measures. (A) Contrast sensitivity at baseline (gray line) and at the end of the treatment (week 7:black line) in the left (OS) and the right (OD) eye. (B) Esterman binocular field test post-treatment (week 7). Red squares indicate newly acquired points, black circles indicate lost points, compared to baseline. (C) Monocular Humphrey full-field test (81 points) post-treatment (week 7) in the left (OS) and right (OD) eye. Red squares indicate newly acquired points, and black circles indicate lost points, compared to baseline. (D) Reading speed at baseline, week 3, and post-treatment (week 7). (E) Quality of life scores at baseline, week 3, and post-treatment (week 7). Gray shaded areas in (A,D,E) indicate the values of the coefficient of repeatability (+-COR). OD, oculus dexter; OS, oculus sinister; W, week.
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CS improved at 2 cyc/deg from 1.65 to 2.1 logits [COR +-0.24 logits ] in OS (Figure 3A). CS increased at 0.5, 2, and 6 cyc/deg for OD from 1.54 to 1.85 logits, from 1.85 to 2.1 logits, and from 1.6 to 1.95 logits [COR +-0.24 logits ], respectively (Figure 3A). Visual field analysis revealed that the number of points seen in the binocular Esterman field of vision test increased from 66 points seen at baseline to 69 at week 3 and 73 at week 7 with some reorganization (black circles indicate loss of points, red squares indicate acquired points, net change: +7 points, all in the blind left hemifield, +5.8% from baseline, Table 2, Figure 3B). Importantly, 3 adjacent points at 60  eccentricity in the left blind hemifield were detected at week 7, suggesting an improved peripheral visual perception in the blind field (Figure 3B red squares). Table 2, Figure 3C). There was a minor increase in the number of points seen in OD with some reorganization (net change: +2 points in the blind left hemifield, +2.5% from baseline, loss of fixation 1/19-5.3%, Table 2, Figure 3C). Reading speed improved from 109 words per minute (wpm) to 160 at week 3 and to 120 at week 7 [+10% between baseline and week 7, Figure 3D, black dots, COR +-8.6 wpm, Table 2]. No variations in visual acuity, RS, FS, or quality of life scores were observed between baseline, week 3, and week 7 (Table 2, Figure 3E).
Case 2:Visual outcome measures and quality of life. (A) Contrast sensitivity at baseline (gray line) and at the end of the treatment (week 6:black line) in the left (OS) and the right (OD) eye. (B) Esterman binocular field test post-treatment (week 6). Red squares indicate newly acquired points, and black circles indicate lost points, compared to baseline. (C) Monocular Humphrey full-field test (120 points) post-treatment (week 6) in the left (OS) and right (OD) eye. Red squares indicate newly acquired points, and black circles indicate lost points, compared to baseline. (D) Reading speeds at baseline, week 3, and post-treatment (week 6). (E) Quality of life scores at baseline, week 3, and post-treatment (week 6). Gray shaded areas in (A,D,E) indicate the values of the coefficient of repeatability (+-COR). OD, oculus dexter; OS, oculus sinister; W, week.
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Reading speed improved from 109 words per minute (wpm) to 160 at week 3 and to 120 at week 7 [+10% between baseline and week 7, Figure 3D, black dots, COR +-8.6 wpm, Table 2]. CS improved at 4 and 6 cyc/deg from 1.74 to 2.23 logits and from 1.41 to 1.95 logits [COR +-0.24 logits ], respectively, in OS (Figure 4B). CS improved at 0.5 and 6 cyc/deg for OD from 1.54 to 1.85 logits and from 1.6 to 1.95 logits [COR +-0.24 logits ], respectively (Figure 4A). The Esterman binocular field testing showed a minor increase in the number of points seen between baseline and week 6 with some reorganization (black circles indicate loss of points, red squares indicate acquired points, net change: +3 points in the scotomas, +2.5% from baseline, Table 3, Figure 4B). Monocular visual field analysis using Humphrey full-field analysis (120 points) indicated a decrease in the number of perceived points for both OS (net change: -6 points, 4 of them in the blind left hemifield, -5% from baseline, loss of fixation 2/15-13.3%, Table 3, Figure 4C) and OD (net change: -2 points in the blind right hemifield, -1.6% from baseline, loss of fixation 2/17-11.7%, Table 3, Figure 4C). Table 3, Figure 4D]. This improvement is corroborated by an increase in the quality of life score in the reading section of the questionnaire [+4.7 logits, COR +-0.44 logits, Table 3, Figure 4E:black squares]. The mobility section of the quality of life questionnaire showed only minor improvement [+0.62 logits, COR +-0.44 logits, Table 3, Figure 4E:black triangles].