Importance of Early Diagnosis and Treatment in getting better Visual Performance in Retinoblastoma: A Research Article

Abstract

Background: Retinoblastoma is the most common paediatric cancer which occurs due to uncontrolled division of Retinoblast cells, which are precursor of photoreceptor cells. Prevalence of retinoblastoma is approximately 1 in 17,000 live births worldwide and 1 in 10,000 in India. Annually around 3,000-3,350 children are dying due to retinoblastoma. Treatment options for retinoblastoma depend on nature of tumor and patient age, which involves Focal therapy, Chemotherapy and Enucleation.

Objective: Aim of this study is to find the impact of delayed diagnosis and treatment on visual outcome of patients.

Method: A cross-sectional study of 45 eyes with regressed Retinoblastoma in 36 patients is done at Eye OPD, to find delay in treatment and its relation to visual outcome. Delay in treatment is assessed by questionnaires based history taking and reduced visual outcome is measured by assessment of Visual Acuity, Colour vision, Refraction, Contrast sensitivity, Visual fields and results of electrophysiological tests like visual evoked response (VER) and Electroretinogram (ERG). Data is statistically analyzed and presented graphically to guide Retinoblastoma management team about importance of early diagnosis and treatment in getting better visual outcomes in retinoblastoma patients.

Results: Based on research analysis of data average delay in treatment after diagnosis recorded in our study population was 19.6 ± 15.0 months. Correlation of delay in treatment to Grade of Retinoblastoma present at the time of initiation of treatment and Visual Acuity achieved after treatment in patients of our study group showed that, all 4 patients reporting with delay of < 6 months had Grade A RB(Vn.>6/12), all 10 patients reporting between 6-12 months also had Grade A RB(Vn.>6/12), 9 patient reporting between 12-18 months had 73% Grade A RB(Vn.>6/12) and 27% Grade B RB(Vn.<6/12->6/60), 5 patient reporting between 18-24 months had 71% Grade B RB(Vn.<6/12->6/60) and 29% Grade D(Vn.<3/60) RB while  patient reporting with delay of  >24 months had 9% Grade B RB(Vn.<6/12->6/60) and 18% Grade C RB(Vn.< 6/60->3/60), and 73% Grade D RB(Vn.<3/60). Reduced capacity of Colour vision, Contrast sensitivity, VER and ERG is recorded in study population. It is observed in study population that delay in treatment leads to poor Grade of Retinoblastoma present at the time of initiation of treatment leading to poorer Visual performance after treatment.

Conclusion: It is observed in our study tumour progression is initially slow till 18 months after that it grows exponential. Visual outcome seen in patients after treatment is related to delay in the treatment hence a higher degree of awareness in guardian and health care worker can reduce delay in treatment leading to better visual outcome and enhanced quality of life of patient