The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 3, May/June 2018 Review Article

Retinoblastoma for Pediatric Ophthalmologists

AlAli, Alaa; Kletke, Stephanie; Gallie, Brenda; Lam, Wai-Ching

Author Information

From the *Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto; †Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto; ‡Techna Institute, University Health Network, Toronto; §Departments of Molecular Genetics and Medical Biophysics, University of Toronto, Toronto, Canada; and ¶Department of Ophthalmology, The University of Hong Kong, Hong Kong.

Reprints: Wai-Ching Lam, MD, FRCSC, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong. E-mail:


Retinoblastoma can present in 1 or both eyes and is the most common intraocular malignancy in childhood. It is typically initiated by biallelic mutation of the RB1 tumor suppressor gene, leading to malignant transformation of primitive retinal cells. The most common presentation is leukocoria, followed by strabismus. Heritable retinoblastoma accounts for 45% of all cases, with 80% being bilateral. Treatment and prognosis of retinoblastoma is dictated by the disease stage at initial presentation. The 8th Edition American Joint Committee on Cancer (AJCC) TNMH (tumor, node, metastasis, heritable trait) staging system defines evidence-based clinical and pathological staging for overall prognosis for eye(s) and child. Multiple treatment options are available in 2018 for retinoblastoma management with a multidisciplinary team, including pediatric ocular oncology, medical oncology, radiation oncology, genetics, nursing, and social work. Survival exceeds 95% when disease is diagnosed early and treated in centers specializing in retinoblastoma. However, survival rates are less than 50% with extraocular tumor dissemination. We summarize the epidemiology, genetics, prenatal screening, diagnosis, classification, investigations, and current therapeutic options in the management of retinoblastoma.

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