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Related Experiment Videos

Vigabatrin-associated visual field defects in children.

I M Russell-Eggitt1, D A Mackey, D S Taylor

  • 1Great Ormond Street Hospital for Children, London, UK. isabelle.re@dial.pipex.com

Eye (London, England)
|October 12, 2000
PubMed
Summary
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Vigabatrin (VGB) treatment in children with epilepsy can cause irreversible visual field loss. Caution is advised, especially in those with pre-existing visual pathway damage, as monitoring is difficult.

Area of Science:

  • Neuroscience
  • Ophthalmology
  • Pediatric Neurology

Background:

  • Vigabatrin (VGB) is an anti-epileptic drug used since 1989, primarily by blocking GABA transaminase.
  • While VGB use in adults has decreased due to reports of irreversible visual field constriction, it remains a first-line treatment for certain pediatric epilepsy syndromes.
  • Monitoring visual fields in children with epilepsy receiving VGB is challenging, and some patients have pre-existing visual field defects.

Observation:

  • This study examined ophthalmic findings in 14 children treated with VGB at Great Ormond Street Hospital.
  • Goldmann visual fields were assessed in children able to perform the tests.

Findings:

  • Ten of the 14 children exhibited visual field constriction attributed to VGB.
  • Two additional patients showed suspicious visual field defects possibly linked to VGB.

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  • In four cases with pre-existing visual pathway damage, two showed increased optic disc pallor alongside constricted visual fields; however, seven patients had normal optic discs despite visual field constriction. Visual acuity remained generally normal.

    • Implications:

    • VGB should be used cautiously in children, particularly those with pre-existing visual pathway damage.
    • The benefits of VGB must be weighed against the risk of irreversible visual field damage.
    • Current perimetry methods for visual field monitoring are often not feasible for children with epilepsy, highlighting a critical gap in patient safety.