What is Retinoblastoma?

This week’s blog on ‘Retinoblastoma’ has been contributed by Dr. Namir Kafil-Hussain, Consultant Paediatric Ophthalmologist, Specialist in Children’s Eye Diseases, Strabismus (Squint) and Paediatric Cataract Surgery
Retinoblastoma is an eye cancer that occurs most commonly in childhood under the age of 5. . Two thirds of children are diagnosed before the age of two and almost 95% by the age of 5.
It is estimated that 5000-8000 children develop retinoblastoma worldwide every year. The incidence rate of retinoblastoma in United States and Europe is approximately 1:15000 live births. However, the rate appears to be higher in Africa and India.
Its present in two forms, bilateral (hereditary) form (25% of all cases) and unilateral (75% of all cases, 90% of which are non-hereditary).
The most common presentation is leucocoria which is an abnormal white reflection in the eye (60%) and 20% as squint, the misaligned position of the eye).
The best approach to manage this condition is based on early detection and early diagnosis.
It involves Paediatric Ophthalmologist, Ophthalmic Oncologist and Paediatric Oncologist. The aim of the treatment is primarily to preserve the life of the child. Secondly, to preserve vision and finally, to preserve the eye. It is highly curable if identified in early stages; more than 90% of children survive in high income countries and up to 40% in less privileged countries. Treatment includes radiotherapy, chemotherapy and sometimes enucleation of the eye with tumor. Children with bilateral disease and gene mutation are at higher risk for secondary cancers. This increases with radiation therapy.
It is very important to for parents, Pediatricians, Ophthalmologists and other healthcare professional involved in childcare to detect abnormal white reflection (absence of red reflex) during routine checkups of the children.
Leucocoria can be seen in the eye with the tumor due to the reflection of the white flash light from abnormal white retina in the back of the eye.
In the modern phone cameras, a red eye reduction feature is included so that the red reflex is prevented in the photos. There are few iPhone applications (apps) which are designed to detect the white reflex. However, there are certain limitations with these apps.
A thorough eye examination by a Paediatric Ophthalmologist is essential to detect the tumor in its early stages when concerns arise by parents with these apps or iPhone photos.

Don’t Run Risk Of Damaging Your Vision With Poor Food Choices, Doctors At Moorfields Eye Hospital Dubai Warn

15 July 2019, Dubai – United Arab Emirates: From managing our weight, fighting diseases, to giving us the energy we need to work or study each day, there are many well-known benefits to a healthy and balanced diet.
Making the correct choices when it comes to what you eat each day can also play a significant role in keeping your eyes healthy and maintaining your vision throughout your lifetime.
As well as treating a range of vision-related ailments each day, Doctors at Moorfields Eye Hospital Dubai explain to patients how their daily food choices can have a huge impact on their eyes.
Dr. Luisa Sastre explains how a rich and varied diet filled with some of the most common foods found in most people’s kitchens are essential to the health of your eyes.
“A healthy diet can play a significant role in preventing the development of diseases like macular degeneration and diabetic retinopathy,” says Dr. Sastre.
“There is evidence that certain nutrients protect our body from damaging substances. These nutrients are called antioxidants and are found in many common and popular foods. They play a vital role in the health of the retina.”
A diet rich in foods such as eggs, fish, fruit, nuts, citrus fruits, leafy greens, and, yes, even carrots, actively promotes healthy vision.
Meat isn’t off the menu either, with beef, lamb, and turkey all beneficial thanks the amount of zinc they contain, which helps delay age related sight loss.
Dr. Sastre also recommends oysters, which contain essential zinc and copper, while dark chocolate is packed with antioxidants and essential nutrients.
“It’s easy to make the right dietary choices when it comes to looking after the health of your eyes,” says Dr. Sastre. “There are so many foods that have been proven to be beneficial that almost every kind of diet, personal taste and food choice is catered to.”
“These foods can easily be incorporated into a person’s daily eating habits and are going to have a big impact on your overall health and that of your eyes.”
For optimum health benefits, Dr. Sastre recommends eating five portions of fruits and very lightly cooked vegetables per day, as well as two servings of cold-water fish (salmon, sardines, herring) each week.
“Make your plate as colourful as possible,” says Dr. Sastre. “Think of each meal as if you’re making a rainbow with lots of different types fresh, natural and brightly coloured foods served together.
“If you eat a healthy diet including at least five portions of fruit and vegetables a day, you should not need a supplement.”
While eating correctly can play a significant role in maintaining the health of your eyes, it is equally important to avoid foods that can be harmful to your vision if consumed in large amounts over a period of time. These include sugary and salty items as well as foods high in saturated and trans fats.
“Diabetic retinopathy is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness. If you are a diabetic, you should avoid sugar,” says Dr. Sastre.
“The same applies to salt. If you are hypertensive you should try to limit the amount of salt that you eat to no more than 2,300 milligrams (about one teaspoon of salt) a day. That includes all the salt you eat, whether it was added in cooking or at the table, or already present in food products.”
If you suffer from high cholesterol, Dr. Sastre advises avoiding saturated fat (found in some meats, dairy products, baked goods, and deep-fried and processed foods) as well as trans fats (mostly in foods made with hydrogenated oils and fats, such as stick margarine, crackers, and french fries).
“Instead of these bad fats, try healthier fats such as lean meat, nuts, and unsaturated oils like olive, and sunflower oils,” says Dr. Sastre.
“The old saying ‘you are what you eat’ is profoundly true to this day. What we eat has a massive impact on our health and our entire system, and that especially means our eyes.”
Dr. Sastre’s top 10 foods for healthy vision:

  1. Nuts and Seeds: Legumes contain healthy fats, vitamin E and copper, which are essential to maintaining the biochemical functions of the body and could play a role in maintaining a healthy retina.
  2. Fish: Many fish are rich in Omega 3 fatty acid. They have a powerful anti-inflammatory effect that helps your heart and brain stay healthy, as well as your retina. The recommendation is to eat at least two servings of cold-water fish per week. Salmon, sardines, and herring are top sources of Omega-3s; halibut and tuna are also good sources.
  3. Eggs: Eggs contain healthy fats, lutein and zeaxanthin, which are important nutrients. Lutein and zeaxanthin are antioxidants that act as natural sunblock for the macula (the central area of the retina), absorbing the damaging blue wavelengths of light.
  4. Colourful Foods: Such as oranges, sweet corn and peppers contain zeaxanthin. These foods need to be consumed in our diet as the human body does not produce these antioxidants naturally. They should be very lightly cooked because over-cooking them may destroy the pigments.
  5. Meats: Beef, turkey and lamb contain zinc, which promotes eye health and helps delay age-related sight loss.
  6. Oysters: Oysters contain essential zinc and copper. It is important to consume a good amount of zinc as a deficiency may lead to poor night vision.
  7. Leafy Greens: Leafy vegetables such as kale, spinach and lettuce are rich in lutein.
  8. Dark Chocolate: Contains less milk as well as sugar. It boasts high amounts of antioxidants and essential nutrients. Consuming dark chocolate promotes better overall health.
  9. Carrots: Carrots are rich in vitamin A and beta carotene. Vitamin A is important for healthy vision as it helps protect your retina. Deficiency in Vitamin A is a leading cause of blindness and can lead to eye diseases such as cataracts and macular degeneration.
  10. Citrus Fruits: Fruits such as lemons, oranges, and grapefruits contain high amounts of vitamin C which help fight age-related eye problems.

Moorfields Warns Parents Of The Risks Of Kids Having Too Much Screen Time During Summer

7 July 2019, Dubai – United Arab Emirates:

  • With an increase in use of digital technology, Digital Eye Strain (DES) has become more common amongst children
  • Up to 20 per cent of children suffer from DES globally
  • DES symptoms include eye irritation, a burning sensation in the eyes, headaches and sensitivity to light

With an increasing number of children in the UAE spending more time in front of a screen rather than playing outdoors during the searing summer months, Moorfields Eye Hospital Dubai has warned against the dangers of not monitoring screen time for kids over the school holidays.
Irritation, burning sensation, eye strain, headaches, tired eyes and sensitivity to light are just some of the symptoms that children are suffering from, and most of the time it is due to spending too much time in front of a digital screen.
A recent European study reported that by three years of age, 68 per cent of children regularly use a digital device and 54 per cent undertake online activities. Since 1971, the incidence of short sightedness in the USA has nearly doubled to 42 per cent, while in Asia, up to 90 per cent of teenagers and adults are now short sighted.
Dr. Namir Kafil-Hussain, Consultant Pediatric Ophthalmologist at Moorfields Eye Hospital Dubai, says: “As children spend more time glued to digital screens, there is an increasing concern from their parents and health workers about the long-term potential harm to their eye growth.
“DES is a well-recongised condition that has become increasingly prevalent in the last twenty years with up to 20 per cent of children estimated to suffer from it. There are two groups of symptoms; those associated with reduced blinking and dry eyes such as irritation, a burning sensation in the eyes, eye strain, headaches, tired eyes, sensitivity to light, and those associated with focusing such as blurred vision at near, blurred vision at distance after digital device use and difficulty in re-focusing.”
Dr. Hussain pointed out that Moorfields Eye Hospital receives several children with problems related to excess screen time, he says: “It has been advised that children and adolescents should not have screen time for more than two hours per day. However, this guidance can be very challenging for students who do most of their homework in front of computers.
“Too much screen time leads to increased light exposure, especially blue light, which can lead to deprivation of sleep and reduction of alertness the next morning.”
Here, Dr. Hussain provides 10 tips to aid parents in protecting their children’s sight:

  1. Set up a daily screen time limit. It is advisable to use a kitchen timer or a phone timer as a reminder.
  2. After completing a level of video game, advise the child to look through a window for 20 seconds (20 seconds break for every 20 minutes play).
  3. Alternate between a real hard copy book and e-books.
  4. Encourage outdoor activities such as playing sports and swimming. Sunlight has shown to slow the progression of short-sightedness.
  5. Adjust the brightness and contrast of your child’s device.
  6. Avoid using devices outside in bright light as the glare on screen can create strain.
  7. Activate the night mode to eliminate blue light emission for a normal sleep pattern and ideally stop screen time for one hour before bed.
  8. Remind them to blink when watching on a digital screen.
  9. Encourage the child to hold the device farther away, 18-24 inches.
  10. Encourage the child to use good posture to reduce neck and shoulder pain.

Moorfields Eye Hospital Emphasises The Importance Of Nystagmus Awareness Day

Dubai, 23 June 2019: Nystagmus is a relatively unheard of, but complex eye condition. With Nystagmus Awareness Day (20 June) just around the corner, there is no better time to learn about the visual impairment, which causes involuntary eye movements, and affects 1:1000 people.
Flickering from side to side or from up and down, nystagmus is caused by an altered functioning of the brain, especially in the area that is responsible for eye movement and positioning. Two forms of the conditions exist, the first variant appears in the early months of infancy, and the second develops later in life.
Experts from Moorfields Eye Hospital Dubai note that the condition is common among children and can be congenital (infantile) or acquired. Infantile usually presents itself at birth or in the first six months, whilst acquired can be caused by diseases such as multiple sclerosis, a brain tumor, inner ear infection, trauma (head injury) and even as side effects of certain medications.
All types of Nystagmus are involuntary, which means that patients cannot control their eyes. According to experts at Moorfields, most of these patients have some sort of visual disability, which ranges from very mild to severe.
Occurring both in isolation and in relation to other medical conditions. Key indicators of the condition include wobbly eyes, defective vision, and a head tilt.
Nystagmus itself does not have a cure, yet some of its underlying conditions may be treated. With neurological therapy and other treatments, which look to address cataracts and strabismus, those with nystagmus may also consider surgery for their head tilt. As researchers look at methods of prevention and cure, the understanding of the condition remains incomplete. Researchers hope that in the near future, medical practices will be developed to help control the condition and aid those who are subject to it.
Since the condition primarily affects children the most, it is essential to look at the relationship between academic performance and the ailment. With better care, glasses, contact lenses, and low visual aids, children with nystagmus can be nudged towards performing their best in school.
As more conditions are discussed in the public sphere, there is an increased support system made available to those who are subject to it. Allowing for better services, employment opportunities, increased research into the area and overall, an improved quality of life, raising awareness for a condition helps to act as a part of a solution.
International Nystagmus Awareness Day helps to act as a reminder for all those who are in need to be listened to and supported. Helping to simplify diagnosis, treatment, prevention, and cure, the day is marked to lend a spotlight to the condition.
The hospital provides world class outpatient diagnostic and treatment for the full range of both surgical and non-surgical related eye conditions, for both adults and children, from basic screenings and eye health checks, to retinal surgery, laser refractive surgery, cataracts, corneal grafts, diabetic retinopathy treatment, squint correction surgery, oculoplastic surgery, genetic eye disease consultations and counseling, and ocular oncology services through permanent and visiting consultants.