Red Reflex Test Helps Rule Out Retinoblastoma

General Practitioners (GPs) in the United Kingdom are being urged to ensure every squint is checked to rule out eye cancer.

The Childhood Eye Cancer Trust (CHECT; London, United Kingdom) is urging that all squints in babies and young children be checked with a red reflex test to exclude a diagnosis of retinoblastoma (Rb). As squints are common in babies up to the age of three months, the only way to determine whether this is a sign of a much more serious condition is to carry out the test, a noninvasive procedure that involves looking in the eye with a hand-held ophthalmoscope.


To promote this message, CHECT has developed e-cards and an email campaign that GPs can share and forward on to colleagues. The campaign asks that particular attention be paid to children with a recently onset squint; a white pupillary reflex (leukocoria); an abnormal reflex in photographs taken with a flash; a change in color of the iris; or a deterioration in vision. According to figures released by CHECT, 26% of babies and young children diagnosed with Rb presented with a squint, which is the second most common symptom of the disease (after leukocoria).

“In our experience, some babies and young children are facing serious delays in receiving life-saving treatment as a result of parents either being told incorrectly that their baby's squint is completely normal, or being given a non-urgent squint referral,” said Joy Felgate, CEO of CHECT. “If you are unable to confidently rule out retinoblastoma with a red reflex test, NICE guidelines state an urgent referral must be made to the local ophthalmology department stating 'suspected retinoblastoma.'”

Retinoblastoma is a fast-growing cancer that develops from the immature cells of a retina, affecting mainly children up to five years of age. Early detection of this aggressive condition is crucial to offer the child the best chance of saving their vision, their eyes, and their life. There are two forms of the disease, a heritable form and nonheritable form; about 55% of children with Rb have the nonheritable form. In about two thirds of cases, only one eye is affected (unilateral retinoblastoma); in the other third, tumors develop in both eyes.

Related Links:
Childhood Eye Cancer Trust
CHECT Red Reflex Poster