Altered Neuroretinal Tissue in Childhood Cancer Survivors: Data From the German CVSS Study

This study reports on alterations of the peripapillary retinal nerve fiber layer (pRNFL) in long-term childhood cancer survivors (CCS) for the first time.

In the Cardiac and Vascular Late Sequelae in Long-Term Survivors of Childhood Cancer-Study (CVSS), a cross-sectional study, 1002 CCS (aged 23-48 years) diagnosed with neoplasia before the age of 15 years were prospectively enrolled in an ophthalmological examination including pRNFL-measurements with spectral-domain optical coherence tomography. An age- and sex-matched sample of the population-based Gutenberg Health Study (GHS) served as the comparison group. Differences in pRNFL in CCS with cancer types and treatments were explored.

Four hundred forty-nine CCS had pRNFL imaging and were included with a mean follow-up of 28.9 years. The pRNFL was 3.38 µm thinner in CCS compared with the GHS controls (P < 0.0001). The pRNFL was thinner in CCS with central nervous system tumors (P < 0.001), leukemia (P < 0.001), renal tumors (P = 0.004), neuroblastoma (P < 0.001), soft-tissue sarcoma (P = 0.003), and malignant bone tumor (P = 0.004), but not different after lymphoma and germ cell tumor. Treatment with platin derivates (P = 0.02) and cranial radiation (P = 0.02) were negatively associated with pRNFL. Subgroup analysis revealed a thinner pRNFL in leukemia CCS and treatment with anthracyclines (P < 0.001) and methotrexate (P = 0.01). No association was found for ifosfamide, vinca alkaloids, asparaginase chemotherapy, and cardiac radiation.

The pRNFL is thinner in CCS with most common tumor entities, except lymphoma and germ cell tumors. Cranial radiation and platin derivates had negative effects on the pRNFL thickness.

Follow-ups are needed to evaluate if this might result in increased risk for neurodegenerative ophthalmic diseases, like glaucoma.