Can parents use digital cameras and smart phones to potentially screen their children for the most common form of pediatric eye cancer? Researchers believe so.
A research team from Baylor University in Waco, Texas, and Harvard University in Boston, Massachusetts, discovered that evidence of leukocoria or “white eye”, the cardinal symptom of retinoblastoma, can be seen in photographs during the earliest stages of the disease. Their findings, based on a review of baby pictures, potentially may pave the way for a new diagnostic tool that will enable earlier diagnosis and treatment. The research was published in PLOS One (2013; doi:10.1371/journal.pone.0076677).
Retinoblastoma, mostly occurs in children between birth to age 5 years, and is an aggressive eye cancer that, if not treated in time, can be fatal if it spreads to the brain. Although children in the United States who are treated for retinoblastoma have a 95% survival rate, that figure drops below 50% for children in developing countries. However, surviving retinoblastoma is just the first hurdle. Typically, “survivors experience moderate to severe vision loss” and, in some cases, loss of both eyes, but early detection and treatment can increase the chances of survival and vision preservation.
Historically, children with retinoblastoma exhibit persistent leukocoria in photographs. Despite this link, digital photography has not been intentionally used by doctors to screen for retinoblastoma because “white eye” is assumed to be a symptom of advanced retinoblastoma, not early-stage retinoblastoma—a paradigm dispelled by the Baylor-Harvard study.
“Diagnosing retinoblastoma continues to be a major challenge. One of the most effective methods for detecting it appears to be amateur photography,” said lead author Bryan F. Shaw, PhD, of Baylor. “In a majority of retinoblastoma cases, it is the parents that initiate the diagnosis based on seeing leukocoria or ‘white eye’ in photos of their children.”
The researchers analyzed more than 7,000 recreational photographs or baby pictures of nine retinoblastoma patients and 19 children without the disease. After analyzing the pictures and quantifying the daily occurrence of leukocoria, Shaw was able to determine that ‘white eye‘ is not necessarily a symptom of advanced retinoblastoma, but that leukocoria can be a symptom of retinoblastoma in its earliest stages.
“Although leukocoria is the most common presenting sign of retinoblastoma, occurring in 50% of new patients, it is usually not detected by the parents or the pediatrician until the tumor is of significant size,” said coauthor Shizuo Mukai, MD, of Harvard. Their research is a pivotal step in laying the groundwork for creating software “to alert unsuspecting parents to the emergence of recurrent leukocoria,” Shaw said. In developing countries, where most deaths occur, speeding up diagnoses could save lives.
“In Namibia or India, for example, a parent’s access to digital photography is probably going to continue to increase at a faster rate than their access to monthly pediatric eye exams,” explained Shaw. “If we can create software that can detect leukocoria and alert a parent when it begins to occur persistently, then I believe digital photography can eradicate metastatic retinoblastoma from this world and prevent most of the deaths that occur.”