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The urgency for decompression, and preferred timing of surgery related to the preoperative severity of dysfunction is unknown.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Systematic review for evidence to provide clinical guidance for timing of surgical decompression of the optic chiasm, and a cohort study of 30 NFMA patients, in whom mean deviation (MD), and severity of visual dysfunction was assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p><jats:italic>Systematic review<\/jats:italic> 44 studies were included with a total of 4789 patients. Postoperatively, visual field defects improved in 87.0% of patients, stabilized in 12.8% and worsened in 1.0%. Specific protocols regarding timing of surgery were not reported. Only seven studies (16.7%) reported on either the duration of visual symptoms, or diagnostic, or treatment delay.<\/jats:p>\n                <jats:p><jats:italic>Cohort study<\/jats:italic> 30 NFMA patients (50% female, 60 eyes, mean age 58.5\u2009\u00b1\u200914.8\u00a0years), had a median MD of\u2009\u2212\u20095.3 decibel (IQR\u2009\u2212\u20093.1 to\u2009\u2212\u200910.1). MD was strongly correlated with clinical severity (r\u2009=\u2009\u2009\u2212\u20090.94, P\u2009&lt;\u20090.0001), and were used for severity of defects cut-off values: (1) normal\u2009&gt;\u2009\u2009\u2212\u20092\u00a0dB, (2) mild\u2009\u2212\u20092\u00a0dB to\u2009\u2212\u20094\u00a0dB, (3) moderate\u2009\u2212\u20094 to\u2009\u2212\u20098\u00a0dB, (4) severe\u2009\u2212\u20098 to\u2009\u2212\u200917\u00a0dB, (5) very severe\u2009&lt;\u2009\u2009\u2212\u200917\u00a0dB.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Surgical decompression is highly effective in improving visual function. Uniform, quantitative grading of visual dysfunction was lacking. MD is a promising quantitative outcome measure. We provide recommendations for the evaluation of timing of surgery, considering severity of visual impairment, which will need further validation based on expert clinical practice.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11102-020-01044-0","type":"journal-article","created":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T03:32:06Z","timestamp":1589772726000},"page":"417-429","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study"],"prefix":"10.1007","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4956-4037","authenticated-orcid":false,"given":"Iris C. 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The term \u2018Refer within 3 days\u2019 should read \u2018Refer as soon as possible\u2019. Corrected version of Figure 2 is given below.","order":4,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare no financial or other conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}