Pediatric Homonymous Hemianopia

Abstract

Homonymous hemianopia is a disabling condition caused by numerous lesions affecting the retrochiasmal visual pathways. Little is known about homonymous hemianopia in childhood. All patients seen in the Neuro-Ophthalmology Unit at Emory University with homonymous hemianopia (confirmed by Goldmann, Humphrey, or confrontation visual fields) between 1989 and 2004 were included. Demographic characteristics, clinical features, and evolution of the visual field defects were compared between the pediatric group (18 years of age or younger) and the adult group (older than 18 years). Among 852 patients with homonymous hemianopia, there were 81 children (86 homonymous hemianopias) and 771 adults (818 homonymous hemianopias). Formal visual field testing was obtained in 93% of pediatric cases and 96% of adults; a majority of patients in both groups were evaluated with Goldmann visual field testing. Demographic and visual field characteristics were similar in both groups. Significant differences were noted for the causative lesions and their location. Traumatic brain injury (34%) and tumor (27%) were the most common causes of homonymous hemianopia in the pediatric group, whereas infarction (63%), traumatic brain injury (12%), and hemorrhage (11%) were the most common causes in the adult group. Most lesions involved the optic radiations (37%), followed by the occipital lobes (26%), in the pediatric group, whereas occipital lobes (47%), followed by optic radiations (32%), were most commonly involved in adults. Approximately one third of the pediatric patients were seen in follow-up, and one third of these homonymous hemianopias spontaneously improved over the course of time. Of the 16 pediatric homonymous hemianopias evaluated within 1 month of onset of the cerebral disorder, 8 (50%) improved. Trauma and tumors are the most common cause of homonymous hemianopia in childhood. Although spontaneous improvement can be expected in approximately one third to one half of patients within the first few months, the recognition of homonymous hemianopia frequently is delayed in this population.