Retinoblastoma has been recognized as one of the most common forms of childhood malignancy, which can lead to death due to progression and the spread of cancer to brain tissue if not treated earlier in the course of illness. It is reported mostly in children under 5 years of age. However, researchers from Harvard Medical School and Baylor University have suggested that parents can use smart phone cameras and other forms of multimedia devices to identify retinoblastoma in their children.
According to the latest study published in PLOS ONE, scientists identified that one of the earliest signs of retinoblastoma — white eye (also known as leukocoria in sophisticated medical terms) — can be identified via digital photography earlier in the course of pathology.
Data indicates that surgical treatments are often curable in 95% of the cases (especially in developed countries like the United States). Unfortunately, in most developing countries, the survival rate after surgery is 50%, and most children develop progressive loss of vision (unilateral or bilateral); but nevertheless, early identification and treatment increases the rate of survival across the board.
Regardless of the fact that leukocoria is one the most cardinal symptoms of retinoblastoma, clinicians hardly ever used digital photography to screen early cases. This was partly attributed to the misconception that leukocoria is an advanced symptom of malignancy, which has now been rectified by the research conducted by Baylor University researchers in collaboration with Harvard College researchers.
Baylor Media Communications recently reported an interview of assistant professor of chemistry and biochemistry in Baylor’s College of Arts & Sciences, Bryan F. Shaw (who is also lead author of the study). Shaw said:
“Diagnosing retinoblastoma continues to be a major challenge. One of the most effective methods for detecting it appears to be amateur photography. 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.”
Shaw discussed how his wife Elizabeth noticed the white-eye on their son Noah in family photographs that later inspired Shaw to advocate this potentially useful and practical screening method for the early detection of retinoblastoma in children.
“Newborns and infants don’t typically get checked out by an ophthalmologist, but many of them do get their retinas scanned multiple times a week, when mom or dad are snapping pictures to share on Facebook.”
Details of the Study:
During the course of the study, the research team collected, studied and analyzed over 7,000 “baby-clicks,” or recreational photographs, that belonged to 19 normal children and 9 children with active retinoblastoma.
Shaw also analyzed his son’s picture and concluded that, unlike the proper misconception, the white-eye can also suggest an early disease (since Noah showed signs at an age as young as 12 days). Shaw also identified that color concentration measurement, saturation, and intensity of white eye are indicative of the intensity of disease (lower concentration indicates a severe disease or larger tumor).
“From our work, we were able to create the first quantitative scale of leukocoria by which to evaluate the intensity of retinoblastoma-linked leukocoria. We were able to determine that the frequency of leukocoria can correlate with the clinical severity of retinoblastoma. Leukocoria can emerge in low frequency in early-stage retinoblastoma and increase in frequency during disease progression and decrease during disease remission.”
Shaw observed that most parents tend to miss diagnosis in children, due to the smaller size of the tumor and less evident eye-related changes. This hypothesis was recently supported by a further observation revealed by Shaw and Harvard Medical School associate professor of ophthalmology Shizuo Mukai (who is also co-author of the study). Mukai, a pediatric retina specialist, surgically removed Naoh’s tumor, and specializes in pediatric ophthalmological diseases.
Dr. Mukai commented:
“Although leukocoria is the most common presenting sign of retinoblastoma occurring in 50 percent of new patients, it is usually not detected by the parents or the pediatrician until the tumor is of significant size.”
Shaw suggested that identification of functional screening methods can help in reducing the morbidity and mortality in developing countries. He said:
“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. 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.”
Researchers also contributed from Baylor University, Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Alex Kentsis of Memorial Sloan-Kettering Cancer Center.