Visual-Perceptual Deficits in a Child Survivor of Acute Lymphoblastic Leukemia

Background. Children with Acute Lymphoblastic Leukemia (ALL) undergo an aggressive regimen of radiation and chemotherapy to treat this deadly disease. Survivors of this aggressive treatment do experience impairment in cognitive functions. A recent literature search yielded a few articles illustrating post treatment brain function impairments of these survivors. A case of a child is presented to illustrate her visual and cognitive effect of her treatment. Case Report. GL is an 11-year-old WF referred to the Nova Southeastern University Pediatric Eye Clinic by a school psychologist for a visual perceptual evaluation. She presented with complaints of having trouble reading, difficulty with word recognition, having frequent letter reversals when copying assignments and difficulty recognizing words with similar beginnings and endings. She also used her finger to read and often loses her place when reading. These symptoms were present since she was in first grade and she continued to struggle in school despite academic interventions. Her medical history was remarkable for aggressive chemotherapy treatment for Acute Lymphoblastic Leukemia diagnosed at the age of 3 years. GL’s initial unaided visual acuity was 20/20 in both eyes at distance and near. However, her ocular motilities were inadequate in fixation, pursuits and saccades. No ocular misalignment was noted with adequate stereopsis, vergence ranges and facility. Her accommodative function was adequate with good accommodative amplitudes and facility. Visual perceptual testing noted poor spatial awareness skills, particularly with recognition of reversals on the Jordan test and the Gardner Reversal Frequency Recognition test and performed at a 5-year-old level. On the Piaget Right-Left Awareness Test she had great difficulty with body mapping tasks. Furthermore, her performance on the Berry VMI test and Wold Copy Test was below age level, indicating poor fine motor and copying skills, with noted difficulty crossing the midline on the copying form test. Visual analysis testing revealed reduced visual memory and visual sequential memory on the TVPS test. In addition, her tracking skills were inadequate with poor results on the DEM test, including many errors. She was diagnosed with Ocular Motor Dysfunction, visual perceptual deficiencies in the areas of laterality/directionality, visual memory, visual sequential memory and visual motor integration. GL completed her 7- month VT program to address all these issues. She showed remarkable improvements in all areas of visual perception and eye tracking to the age equivalent of > 12.11 years. Conclusion. Visual perceptual testing is warranted in all survivors of Acute Lymphoblastic Leukemia. These patients need to be carefully monitored for cognitive impairment many years after their treatment and can overcome difficulties if managed appropriately.