Recognising retinoblastoma

Retinoblastoma is a childhood cancer affecting the eyes of children. As the name suggests the tumour occurs in the retina, which is the neural tissue inside our eyes that turns light into vision. It’s fair to say that most people have never even heard of retinoblastoma. It goes without saying that it would be a wonderful world indeed if we were never heard of another child with it again. The reality is however that this is the most common primary eye cancer in children, occurring in approximately 1 in 10,00 births. Early detection can dramatically change the outcome for children and their families, so it’s important that the message about retinoblastoma gets out as far and wide as possible.

Detecting retinoblastoma can be as simple as taking a photo. The commonest presentation and the most important sign of retinoblastoma is a white reflex in the eye when light shines in. A camera flash usually causes a red reflex in eyes as the light bounces off the retina. Retinoblastoma tumours are characteristically white, so a white reflex may be due to light bouncing off the white tumour instead of the reddish retina. As retinoblastoma causes poor vision, another common presentation in children is with a turned or misaligned eye. Although retinoblastoma is thankfully relatively rare, the importance of having your child’s eyes checked if there is any concern is clear.

If a child is diagnosed with retinoblastoma in Australia, thankfully the outcomes are overwhelmingly positive with over 95% of children surviving. Given that the tumour affects the retina however, 95% of children experience moderate to severe vision loss or complete blindness in the affected eye. The earlier we detect and treat the tumour the more that can be done to save vision. The story could not be more different sadly for children in developing countries where the mortality rate is only 70%. There are several reasons why successful treatment is more difficult to accomplish in that setting, among them delayed diagnosis, inadequate treatment facilities, financial barriers and a lack of trained doctors.

So what to do?

If you see a white light reflex in your child’s eye directly or in a photo, or if you have concerns regarding your child’s eyes, make sure that they get their eyes checked as soon as possible. Most of the time that we see children for this reason we find that everything is actually normal, but we would hate to miss any children with retinoblastoma or delay their treatment.

Dr Michael Jones, paediatric ophthalmologist – Sydney Ophthalmic Specialists