• Steven A Newman, Roger E Turbin, Mary E Bodach, Luis M Tumialan, Nelson M Oyesiku, Zachary Litvack, Gabriel Zada, Chirag G Patil, and Manish K Aghi.
• *Department of Ophthalmology, University of Virginia, Charlottesville, Virginia; ‡Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey, Newark, New Jersey; §Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶Barrow Neurological Institute, Phoenix, Arizona; ∥Department of Neurosurgery, Emory University, Atlanta, Georgia; #Department of Neurosurgery, George Washington University, Washington, DC; **Department of Neurological Surgery, University of Southern California, Los Angeles, California; ‡‡Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; §§Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
• Neurosurgery. 2016 Oct 1; 79 (4): E530-2.

BackgroundNonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary tumors. Visual symptoms from NFPAs are common and include visual field defects, loss of central vision, and motility problems resulting in diplopia.ObjectiveTo create evidence-based guidelines in an attempt to formulate guidance for preoperative ophthalmologic evaluation of NFPA patients.MethodsAn extensive literature search was performed. Only clinical articles describing preoperative ophthalmologic evaluation of adult patients with NFPA were included. To ascertain the class of evidence for the posttreatment follow-up, the authors used the Clinical Assessment evidence-based classification.ResultsSix studies met the inclusion criteria with respect to the questions regarding the preoperative ophthalmologic evaluation of NFPA patients. Based on the studies located through the search, the authors formulated evidence-based recommendations as they pertain to the necessity of ophthalmologic evaluation before surgical treatment.ConclusionPreoperative ophthalmologic evaluation is recommended. Such evaluation can provide prognostic factors for recovery and, when paired with postoperative evaluation, documents postoperative change. In addition to formal ophthalmologic examination, tests of value include automated static perimetry and optical coherence tomography. Older patients and patients with longer duration (>4 months) of vision loss should be counseled regarding the reduced chance of postoperative vision improvement. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_4.AbbreviationsNFPA, nonfunctioning pituitary adenomaOCT, optical coherence tomography.

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