Delayed Diagnosis of Retinoblastoma: Analysis of Degree, Cause, and Potential Consequences

Linda J. Butros, David H. Abramson, Ira J. Dunkel

Article Figures & Data

TABLE 1.
Interval From Presenting Signs to the Diagnosis of Retinoblastoma
Presenting Sign Interval (Days)* Median Interval (Months) Range (Months)
0 1–14 15–30 31–60 >60
Leukocoria 3 5 7 4 18 1.5 0–46
Strabismus 1 2 3 0 9 2.5 0–24
Other presenting signs 5 1 1 1 1 0 0–12
↵* Total number of signs is larger than total number of patients secondary to 2 presenting signs in some patients. One patient with no delay had no reported presenting sign.
TABLE 2.
Presenting Signs in Patients With Delayed Referral From the PCP
Presenting Sign Interval (Days) Median Interval (Months) Range
1–14 15–30 31–60 >60
Leukocoria 1 0 0 5 5.3 2 d–46 mo
Strabismus 0 0 0 5 4 2.6–24 mo
Other presenting signs 0 1 1 1 2 1–12 mo

TABLE 3.

Textbook Recommendations Regarding the Red Reflex Examination

Textbook	Recommendations
Rudolph’s Pediatrics, 20th Edition 1996^14,19	Focusing down to the retina and visualizing retinal vessels will verify a normal retina is being seen…A white pupillary reflex is abnormal and may occur with a large retinoblasto ma or developmental abnormalities.¹⁹ … Referral of patients with leukocoria to an ophthalmologist is usually indicated.¹⁴
Nelson Textbook of Pediatrics, 15th Edition 1996¹⁵	Ideally, every child should have a thorough ophthalmologic examination sometime in early childhood, preferably by the age of 3–4 years; these are the crucial years for detect ion and treatment of amblyopia, strabismus, high refractive errors, and many other significant disorders. (A table suggests the red reflex test be performed from the newborn period through the 5-year examination).
Oski’s Pediatrics, Third Edition 1999¹⁸	In the funduscopic examination, use a zero lens and note the presence of a red reflex, or hemorrhages…Any obstruction, such as corneal or lenticular cataract, will obliterate part or all of the red reflex.
Nelson Textbook of Pediatrics, 16th Edition 2000¹⁷	The presence of bilateral red reflexes suggests the absence of cataracts or of intraocular pathology (chapters 629, 634–639). Leukocoria (white pupillary reflex) suggests cataract, tumor…and warrants an ophthalmologic consultation.

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Presenting Sign	Interval (Days)*					Median Interval (Months)	Range (Months)
Presenting Sign	0	1–14	15–30	31–60	>60	Median Interval (Months)	Range (Months)
Leukocoria	3	5	7	4	18	1.5	0–46
Strabismus	1	2	3	0	9	2.5	0–24
Other presenting signs	5	1	1	1	1	0	0–12

Presenting Sign	Interval (Days)				Median Interval (Months)	Range
Presenting Sign	1–14	15–30	31–60	>60	Median Interval (Months)	Range
Leukocoria	1	0	0	5	5.3	2 d–46 mo
Strabismus	0	0	0	5	4	2.6–24 mo
Other presenting signs	0	1	1	1	2	1–12 mo