Effect of sellar and parasellar brain tumors on retinal thickness and visual fields: A cross-sectional comparative study

Purpose: To compare retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, and visual field parameters in patients with sellar and parasellar brain tumors and to evaluate their associations with tumor size. Methods: This hospital-based cross-sectional comparative study was conducted over 18 months at a tertiary care center. Patients aged 12–60 years with magnetic resonance imaging (MRI)-confirmed sellar or parasellar tumors underwent best-corrected visual acuity assessment, automated perimetry (Humphrey 30-2), and spectral-domain optical coherence tomography for RNFL and GCC analysis. Tumor size was recorded from MRI. Results: Sixty-seven patients (31 sellar, 36 parasellar) were analyzed. Superior quadrant RNFL thickness in the right eye was significantly reduced in sellar tumors ( P = 0.029). Parasellar tumors were significantly larger in size ( P < 0.001). Tumor size showed significant associations with visual acuity and visual field indices in sellar tumors but not in parasellar tumors. Conclusion: Sellar tumors were associated with more consistent structural and functional visual impairment compared with parasellar tumors despite a smaller mean tumour size likely due to early chiasmal compression. RNFL thinning on optical coherence tomography may reflect early structural involvement of the optic pathway and may complement automated perimetry and neuroimaging in clinical evaluation.