SYSTEMATIC REVIEW article
Front. Ophthalmol.
Sec. Neuro-Ophthalmology Disorders
This article is part of the Research TopicReviews in Neuro-Ophthalmology DisordersView all articles
The Role of Optical Coherence Tomography in the Evaluation of the Para-chiasmal Lesion: A Systematic Review and Meta-Analysis
Provisionally accepted
Lim Khai Shin, Alva1
Tng Wen Xu, Abel2Theng Wei De Bryan1Lee Teck Kwong Bernett1Chin Chee Fang3
Kelvin Zhenghao Li3*
Heather E Moss4- 1Lee Kong Chian School of Medicine, Singapore, Singapore
- 2National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
- 3Tan Tock Seng Hospital Department of Ophthalmology, Singapore, Singapore
- 4Stanford University, Stanford, United States
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While magnetic resonance imaging is currently the primary diagnostic tool for pituitary tumors, optical coherence tomography (OCT) may be used in evaluating the visual pathway impact of these lesions. This study evaluates the utility of OCT in patients with chiasmal compression from para-chiasmal lesions and determines its role in predicting visual field outcomes post-operatively. A search of 5 databases identified OCT studies in patients with neoplasms affecting the optic chiasm. Meta-analyses compared 1. healthy controls versus patients, 2. good versus poor visual recovery postoperatively, and 3. patients with versus without visual field defects (VFDs). Standardized mean differences (SMD) and mean differences (MD) were used. A review of 97 studies (5300 patient eyes, 2209 controls) demonstrated significantly thinner peripapillary retinal nerve fiber layer (pRNFL) and macular RNFL (mRNFL), ganglion cell complex (mGCC), and ganglion cell – inner plexiform layer (mGCIPL) in patients as compared to controls. On pRNFL analysis, 4-sector analysis demonstrated that patients had thinner RNFL in all quadrants compared to controls, with the greatest thinning in the inferior quadrant (MD -16.37μm [-22.35, -10.39]) and the least in the nasal quadrant (MD -10.91μm [-16.45, -5.38]). mRNFL analysis showed the greatest thinning in the supero-nasal (MDs -11.57μm [-19.32, - 3.83]) and infero-nasal sectors (MD -11.39μm [-17.38, -5.40]). Meta-analysis of mGCIPL sectors found the infero-nasal region to have the most thinning. Patients with good visual recovery had higher preoperative mean pRNFL thickness (MD 11.35μm [6.20, 16.49]). Associations between OCT changes, neoplasms affecting the optic chiasm and visual outcomes demonstrate its potential to support diagnosis and prognosis for patients with para-chiasmal lesions. Further research is needed to ascertain the relevance of pre-perimetric OCT changes.
Keywords: Pituitary, Parachiasmal neoplasm, Optical Coherence Tomography, Retinal NerveFiber Layer, Ganglion cell layer, Ganglion cell complex
Received: 24 Aug 2025; Accepted: 09 Dec 2025.
Copyright: © 2025 Khai Shin, Alva, Wen Xu, Abel, Wei De Bryan, Teck Kwong Bernett, Chee Fang, Li and Moss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kelvin Zhenghao Li
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