This retrospective observational case series reports outcomes of children followed-up for at least 10 years with optic pathway glioma (OPGs) related to neurofibromatosis type 1 (NF1) between January 1985 and July 2007. They observed 45 children for a mean of 14 years (range 10-21 years) recording their visual acuity per eye and per patient and the presence of optic nerve head pallor. They found that abnormal visual acuity (considered moderate to severe impairment) in the more severely affected eye was present in 36% of the patients and in both eyes in 11%. Optic nerve head pallor of one or both nerves was present in 62%. Nearly all patients who were asymptomatic at presentation with normal visual acuity and optic nerves, preserved their good vision in both eyes. They therefore concluded that children with NF1-associated OPG whose examination signs and symptoms were normal at initial examination had excellent long-term visual and anatomical outcomes. This is the first study with very long follow-up of OPG in NF1. However by excluding all those patients who had less than 10 years follow-up means that those patients who may have no visual implications and therefore less follow-up have not been included.