Comment on: Lag time for diagnosis and treatment in 1120 retinoblastoma children: Analysis from INPOG-RB-19-01
Year: 2025
Type: letter
Abstract: Dear Editor, We read with great interest the article by Das et al.,[1] “Lag time for diagnosis and treatment in 1120 retinoblastoma children: analysis from INPOG-RB-19-01.” This prospective, multicentric study is an important contribution to retinoblastoma literature from India, and we commend the authors for compiling such comprehensive national data. However, we believe some aspects of the study merit further discussion. The concept of system lag time is defined in the methods section as the interval between the first contact with a healthcare provider and treatment initiation. However, this category includes multiple variables that may contribute differently to delays. The discussion mentions possible system-related bottlenecks, such as the lack of pediatric general anesthesia facilities and the need for referral to specialized centers for focal therapy, chemotherapy, or radiotherapy. A more detailed breakdown of treatment lag time into parent-related and healthcare system-related components would improve clarity and provide targeted solutions. Understanding delays within hospitals, including scheduling of examinations under anesthesia or interdepartmental coordination, would offer further insight. One significant finding is that 15.4% of children who presented with extraocular retinoblastoma had a total lag time of less than 1 month. This points toward the possibility of biologically aggressive tumors rather than merely delayed diagnosis. While the authors acknowledge this and call for molecular and genetic studies to assess tumour biology, this finding deserves more emphasis, as it may impact the future of risk stratification and tailored treatment approaches. It is worth noting that reference 26, cited to support the hypothesis of aggressive tumour biology in African cohorts, appears to refer to a study from Brazil. Clarification of this reference would be appropriate. The observation that only 61.3% of ophthalmologists and 50.5% of pediatricians diagnosed retinoblastoma at the first consultation is noteworthy. While the study does not elaborate on the reasons for this, the discussion rightly suggests that greater awareness among ophthalmologists is needed. The high rate of missed diagnosis by trained eye care providers suggests a gap in clinical training or familiarity with early signs of the disease. Future studies could explore whether additional factors, such as subspecialty training, institutional protocols, or region-specific barriers, influenced this diagnostic gap. Although the study identifies parental lag time from lack of awareness about the disease as a major contributor to delay in retinoblastoma diagnosis and treatment initiation, other unmeasured sociocultural factors may also play a role. Cultural beliefs, gender bias, health literacy, financial constraints, and decision-making hierarchies within families could all impact care-seeking behavior. Additionally, factors such as maternal empowerment and autonomy may influence early recognition and action, as reflected by the significant association of maternal education (illiterate/primary education) and age at pregnancy (<20 years) with increased parental lag time. A broader assessment of these social determinants could offer a more nuanced understanding of parental delay. Overall, the study presents an important dataset that has the potential to inform policy and intervention planning. We hope that future work will focus on identifying and addressing institutional delays within the treatment system, improving diagnostic accuracy among frontline healthcare providers, and exploring biological and molecular markers of aggressive disease. Further integration of community-level behavioral and social factors may also help in designing more comprehensive strategies to reduce delays in retinoblastoma diagnosis and treatment. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Source: Indian Journal of Ophthalmology
Authors: Ritesh Verma, Bolajoko A Adewara
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414512426