Categories: Oncology

Awareness on Retinoblastoma

  1. What do you mean by Retinoblastoma? How serious is it?

Retinoblastoma is a tumour or cancer that arises from within the eye. If not treated, it can not only destroy vision but spread and pose a threat to life as well.

  1. How common is this disease? Does it affect children?

It is a rare tumour. On average 1500 new cases occur all over India, every year. Unfortunately, this disease almost always affects children below 5 yrs. of age.

  1. So if this is cancer, can it be cured?

Yes, unlike other cancers, up to 90-95% of cases can be cured. With advanced chemotherapy techniques and local forms of therapy, we are able to preserve vision also in many cases.

  1. What happens to the eye?

The outcome of the eye depends on how early we catch the disease. If we can catch it very early like what we call Gp A or B, then local lasers alone can be used for tackling the disease, with minimal impact on vision. As the stage advances, we need to use other techniques like chemotherapy. When more than 70% eye is filled with a tumour, by then the eye is almost blind and we may have to remove the affected eye to save the life of the child. We usually combine this with eye plastic surgery and artificial eye fitting, so that the overall look or cosmesis doesn’t suffer.

  1. So how can we detect the disease early?

Early detection is the key to success in Retinoblastoma.  All that is needed is a detailed eye examination, in any suspected case. Early detection in Retinoblastoma means better outcomes. Being a rare disease we need to raise awareness. That is why every year in May we celebrate Retinoblastoma awareness Fortnight to spread awareness about this condition.

  1. But aren’t these small kids? Below 5 years? So how do we do an eye examination?

What we must always remember is that there is no such thing as ‘Too young’ for an eye test. What we do is a red reflex test where we shine a torch-like device in the baby’s eyes from a 1-metre distance and watch for the natural red glow in the eyes-something similar to the red-eye we get in mobile photography. An asymmetrical red glow is considered normal. A white glow/or shine from eyes like a cat’s eye or dog’s eye is abnormal and should be followed by a detailed eye examination. Again, these tests can be done in newborns also. So we really don’t need the child to learn to read out the vision test charts.

  1. When and where can we do these tests? Any minimum age?

This form of eye screening is a no-touch technique that takes hardly 1 second. It is recommended even in newborns and can be done by the paediatrician taking care of the child. This red reflex test can pick up to 10 other eye problems apart from eye cancer, so is a very useful test. It should be done at the time of discharge from the hospital when the child is born and is advised for 6 months, especially when the child visits the doctor for vaccination.

  1. Any specific children who are at risk for this disease?

In approximately 1/3rd cases, this disease could be hereditary, meaning that it may run in the family. In these, the disease affects both eyes and they develop signs early. In these cases, periodic detailed eye testing between 0-5 yrs. is crucial. All siblings of a child diagnosed to have Retinoblastoma, and offspring’s of a person who had Retinoblastoma as a child must undergo this periodic eye test up to the age of 5 yrs. so as to pick the disease early. We also have genetic blood tests to detect the same, early.

  1. What is the minimum age of testing?

There is no minimum age; this test can be done in newborns as well.

The ideal age group benefitting from this screening test is 0 to 5 years.

Any eye abnormality when detected earlier has a positive impact on the outcomes and is more likely to enable better vision recovery.

  1. So what can we do?

Encourage the Red Reflex test….or the Grand ma’s test- in 0-5-year-olds

This is popularised as the ‘grandma’s test’ in Canada it is a routine practice that grandparents are enthusiastic about clicking the baby’s pictures.

The red reflex in the eyes is a natural phenomenon, where if a light is flashed into the eyes, the back of the eyes (retina) reflects it. In daily life, we may witness this phenomenon during photographs taken on cell phones or cameras.

So if parents, grandparents, birthday photographers observe that a particular eye of a baby doesn’t give the red glow and instead gives a white glow consistently, they must not ignore it or wait for the child to grow up, they must reach out to an eye doctor for a detailed eye check-up. This observation is especially useful if the child is unable to read or speak or has any illness preventing him/her to undergo formal eye testing.

Even if it does turn out to be an eye cancer, remember it is curable. So never lose heart.

Dr. Himika Gupta, Consultant – Ophthalmology, Paediatrics and Dr. Sujata Mushrif, Consultant – Haemato Oncology, Oncology, Paediatrics, SRCC Children’s Hospital, Mumbai

Narayana Health

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