ALBANY, N.Y. -- Kim Gaito wondered why she didn't notice the
signs earlier. Flipping through a photo album today, she can easily
spot the white reflection in her toddler's eye that was caused by a
rare and potentially fatal cancer.
``It is so obvious now,'' said Gaito, who lives in suburban
Albany. ``Her eye looks like the flash went off in it.''
Although it sounds strange, photos are actually one of the
earliest ways parents can detect these malignant eye tumors, known
as retinoblastoma.
The cancer strikes at birth or during the first few years of a
child's life, and affects about 5,000 children worldwide. In the
United States, an estimated 350 children will be diagnosed this
year, usually by the time they are 2 1/2.
Yet the earliest symptoms are often overlooked by parents who
assume they or their camera are to blame for the peculiar white
reflection in their photos. And most pediatricians and family
practitioners don't routinely screen for the cancer at well-child
visits.
``More than half of the children who get this in the year 2000
will die,'' said Dr. David Abramson, director of the Ophthalmology
Center at New York Presbyterian Hospital: University Hospital of
Columbia and Cornell. ``In Latin America, for example, only half
the children survive the disease.''
For children born in the United States, the odds are much better
because of revolutionary strides in treatment over the past five
years, from lasers to chemotherapy.
But again, the key is early detection. ``Family practice
physicians and pediatricians need to be looking for an abnormal
pupil or abnormal light reflex,'' said Dr. George Stasior, an
Albany ophthalmologist working to raise awareness of the problem.
``We're asking the doctors to ask their parents if they notice
anything unusual and if they do, to bring in a photograph of their
child.''
White reflections in photos, however, aren't the only clue
parents should be aware of.
A child may have what looks like a cataract. Other symptoms
include a red, painful eye; poor vision; inflammation of tissue
around the eye or an enlarged or dilated pupil.
The standard treatment for the condition has been to remove the
affected eye or eyes to prevent the spread of the cancer. About 75
percent of all cases will involve only one eye.
``The first thing you have to get the parents to understand is,
you have to save the child's life; next you try to save the eye,''
Stasior said.
Studies have shown that although radiation may shrink the size
of the cancerous tumors, it poses special risks, especially for
children under one. Infants who have been treated with radiation
end up having a higher risk of other cancers later in life,
Abramson said.
In Gaito's case, three doctors agreed that the best course of
treatment for her daughter was to have the eye removed. Haley, now
2 1/2, has been fitted with a prosthetic eye.
While growing up with one eye isn't expected to be a problem,
Haley still needs frequent visits to specialists to make sure the
cancer hasn't returned or begun to grow behind the other eye. ``We
do have to worry about it coming back,'' her mother said.
Although researchers aren't exactly sure why retinoblastoma
occurs, it is known to be associated with an abnormality on the
chromosome responsible for controlling retinal cell division.
In children with retinoblastoma, retinal cell division becomes
unchecked, causing the growth of tumors. Although the disease may
sometimes be hereditary, the majority of retinoblastoma patients
have no history of the disease.
As with many cancers, gene therapy holds promise for the future
treatment of retinoblastoma, Abramson said. Other potential
approaches include in-vitro fertilization for parents who carry the
abnormal gene to pre-select healthy zygotes.
Within the next decade, Abramson also predicts progress will be
made in treating this condition before the baby is born.
In the interim, parents remain the best watchdogs for detecting
this cancer early.
Gaito decided to get Haley's eye checked after consulting with a
neighbor, who confirmed her suspicions that something didn't look
right. Ironically, she had just taken her daughter in for her
2-year-old check-up, and the pediatrician didn't notice anything.
``I just wish someone had informed me, because maybe we could
have caught it earlier,'' Gaito said. ``This could have been very
serious if I hadn't done anything about it.''
