Disparities in Retinoblastoma Treatment and Staging Noted in Study

To mitigate disparities in retinoblastoma care influenced by geography and income, the study suggests improving early detection, strengthening referral networks and enhancing access to specialized care, particularly in non-metropolitan regions. Photo: Julia Canestraro, OD. Click image to enlarge. In a recent study, researchers evaluated the association between area of residence and access to retinoblastoma care, finding that geography influences outcomes inasmuch as it reflects poverty, insurance status and access to care issues. Two notable takeaways: city-dwellers had better outcomes (given easier access to specialists) and poorer families were more likely to present with advanced disease. The findings were reported in American Journal of Ophthalmology.A total of 1,375 pediatric retinoblastoma patients ages 15 and younger diagnosed with retinoblastoma between 2000 and 2021 were included. The researchers examined how geography relates to treatment modality, stage at diagnosis and time to treatment, while accounting for race/ethnicity and neighborhood median household income.Between 2000 and 2021, there was a significant decline in enucleation and radiotherapy usage due to improvements in care, while the use of globe-sparing therapies like chemotherapy and localized tumor excision increased.Metropolitan residence and non-Hispanic white race were independently associated with lower odds of enucleation in this study. Geography was found to modify the impact of race and income on care. Racial disparities in enucleation were more pronounced in non-metropolitan settings and less so in cities. “Disparities such as these may potentially reflect broader social factors, including unequal utilization of red-reflex screening at pediatrician visits, delayed evaluation and cost-related barriers preventing referral to specialized centers,” the authors wrote in their paper. “Similarly, children who were non-white presented with more advanced disease, especially among those living in non-metropolitan counties.” Lower-income children in non-metropolitan counties had significantly higher odds of presenting with advanced (regional/distant) disease compared to higher-income peers, a disparity not observed in metropolitan areas. “The amplification of this income-stage association in non-metropolitan counties further suggests that socioeconomic disadvantage may delay recognition and referral primarily in settings where access to pediatric ophthalmology and subspecialty care is limited,” the authors explained in their paper.There were no statistically significant differences in the time from diagnosis to treatment initiation based on geography, race/ethnicity or income. This finding is important, the researchers said, because it suggests that once a diagnosis is made, treatment begins with comparable timeliness across groups. “Therefore,” they wrote, “disparities in management may arise upstream—due to lack of screening with pediatricians, access to care for strabismus and leukocoria symptoms noted by family, referral and access to diagnostic expertise, rather than within the treatment window itself.”With no differences in time to treatment after diagnosis, inequities may arise earlier in the care pathway, during disease recognition and referral. Strengthening early detection, referral networks and access to advanced therapies in non-metropolitan regions may help reduce these disparities.Click here for the journal source. Shah J, Pathuri S, Ong J, et al. The role of geography in United States retinoblastoma care. Amer J Ophthalmol. March 28, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.