Premature ocular aging features in childhood acute lymphoblastic leukemia survivors

• Main Authors: Chandrasekaran, Sudhashini, Ramli, Norlina, Jamaluddin Ahmad, Marium, Effendi, Irina, Amir, Nurul Najieha, Chow, Rhuen Chiou, Chee, Caroline Ka Lin, Azanan, Mohamad Shafiq, Abd Ghafar, Sayyidatul Syahirah, Ariffin, Hany Mohd, Kamalden, Tengku Ain Fathlun Tengku
• Format: Article
• Published: Mary Ann Liebert, Inc 2021
• Subjects: R Medicine; RC0254 Neoplasms. Tumors. Oncology (including Cancer); RJ Pediatrics
• Online Access: http://eprints.um.edu.my/34423/
• Institution: Universiti Malaya

Childhood cancer survivors (CCS) demonstrate features of premature aging in a multitude of organ systems. The aim of this pilot study is to determine the presence of premature ocular aging features in CCS, specifically childhood acute lymphoblastic leukemia (ALL) survivors. Methods:This prospective case-control study was conducted over a period of 21 months, starting July 2015 till March 2017. A total of 59 childhood ALL survivors who attended the Paediatric Oncology Clinic of University Malaya Medical Centre (UMMC) and 48 age, race, and gender-matched controls went through a series of ocular examinations and tests. Inclusion criteria used to recruit survivors were age above 16 years, history of ALL in childhood, completion of treatment for ALL, and a remission period of at least 5 years. Patients with ocular disease and those who received hematopoietic stem cell transplantation were excluded. The parameters measured were visual acuity, amplitude of accommodation, pupil cycle time (PCT), and tear break-up time (TBUT). Results:Survivors of childhood ALL demonstrated significant differences in amplitude of accommodation, PCT, and TBUT compared to age-matched controls. Survivors had a lower median (interquartile range IQR]) amplitude of accommodation compared to controls (11.0 D 9.0-13.0] vs. 12.0 D 10.5-15];p = 0.045). Survivors also showed a longer median (IQR) PCT in comparison to controls (931.00 mseconds (857.00-1063.00) vs. 875.50 mseconds (825.75-966.00);p = 0.024). In addition, median (IQR) TBUT was worse in survivors in comparison to the control group (9 seconds 6-13] vs. 11 seconds 10-15];p = 0.001). Conclusion:Survivors of childhood ALL demonstrate premature ocular aging features compared to age-matched controls. Thus, survivors may benefit from having ocular examinations as part of their routine late-effects screening to detect age-related ocular morbidities early in its course.