Consulting room in sight of cure Dr Debraj Shome

DNA SUNDAY HEALTHLINE 07/09/2006, MUMBAI

Ocular oncology is a newly-emerging field in ophthalmology which includes detection and treatment of eye cancer, the orbit (bony socket encasing the eye), eye lid and the surrounding face. Treatment for these cancers has to be a delicate balance between destroying the tumour and preserving the vision. Very few centres in India offer holistic treatment for these cancers.

One of the most common eye cancers is retino

blastoma, which occurs in children aged one to five years. Its incidence is about 1 in 15,000 to 1 in 18,000 live births. Its occurrence peaks in the first year of life and declines with age. India can expect 1,000-1,500 new cases of retinoblastoma every yea; this is around the third of the cases worldwide. There is no race or gender predisposition to retinoblastoma, and both eyes are affected equally. However heredity does increase chances of contracting disease.

The tumour starts in the retina and in later stages spreads to the entire eye Orbital structure, brain and other organ. If detected at an early stages, this tumour may be completely cured – with chemotherapy and laser treatment _ with vision preserved. In the intermediate and the final stages, it may results in loss of the eye or even death. The primary goal is to safeguard the child’s life salvaging the eye and visions are secondary and tertiary goals. Prior to the century retinoblastoma was a uniformly fatal disease. Improvement in diagnostic and treatment modalities, greater social awareness and earlier patients diagnosis have improve prognosis with survival rates currently exceeding 90 per cent in most industrialised countries.

In India, the problems are lack of awareness, misdiagnosis and inadequate treatment facilities. The cancer is detected only in the advance stage is 70 per cent of the cases while almost 60 per cent have orbital diseases. As a result, over 60-75 per cent patients need to have their eye removed and 20 per cent of patients with orbital disease die.Lack of awareness among general practitioner and general ophthalmologist compound difficulty in early diagnosis.

Eye cancers, especially in children, display few or no symptoms initially, so public awareness and regular eye check-ups are essential to detect the disease. Parents should seek expert opinion in case of white pupilary reflex, protrusion of the eye, and squinting and redness of the child’s eye.

It is important to remember that retinoblastoma is only the tip of the iceberg when it comes to eye cancers. The writer is an ophthalmic plastic surgeon and consultant at Aditya Jyot Eye Hospital, wadala, and Tata Memorial centre, parel.