A screening test for retinoblastoma may be no further away than your pocket or purse.
In a study published in PLOS One,1 a research team led by Bryan Shaw, PhD, assistant professor of chemistry and biochemistry at Baylor University, Waco, TX, reported that photographs taken with digital cameras and smart phones can reveal leukocoria, or “white eye”, the cardinal symptom of retinoblastoma, in the early stages of disease. Their findings may lead to a new diagnostic tool enabling earlier diagnosis and treatment of retinoblastoma, an aggressive eye cancer that occurs primarily in children from birth to age 5. If not treated in time, retinoblastoma may spread to the brain and be fatal.
“Diagnosing retinoblastoma continues to be a major challenge. One of the most effective methods for detecting it appears to be amateur photography,” said Dr. Shaw. “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.”
It has long been known that children with retinoblastoma exhibit persistent leukocoria in photographs. However, digital photography has not been intentionally used by doctors to screen for retinoblastoma because white eye was assumed to be a symptom of advanced disease.
Dr. Shaw’s motivation for studying the use of digital photography to detect retinoblastoma was personal—he and his wife first noticed their son Noah’s white eye in family photographs. Noah was diagnosed with bilateral tumors and treated successfully.
“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,” Dr. Shaw said.
During the study, researchers analyzed more than 7,000 recreational photographs of nine patients with retinoblastoma and 19 children without the disease. After analyzing his son’s 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 can appear in its earlier stages. In Noah’s case, it was noticeable in photographs taken when he was just 12 days old.
Shaw also found that the intensity of white eye was different in each of his son’s eyes and that the saturation was lower in the eye with the larger tumors. These findings suggest that a digital camera may not only alert parents that their child might have retinoblastoma, but may also inform a healthcare professional of its severity.
“From our work, we were able to create the first quantitative scale of leukocoria by which to evaluate the intensity of retinoblastoma-linked leukocoria,” Dr. Shaw said. “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 believes that amateur digital photography will find its greatest use for identifying children with white eye in developing countries. “In Namibia or India, for example,” he said, “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.”
- Abdolvahabi A, Taylor BW, Holden RL, et al. Colorimetric and longitudinal analysis of leukocoria in recreational photographs of children with retinoblastoma. PLOS One. 2013;8(10):e76677.