Challenges In The Management Of Retinoblastoma At Peripheral Eye Clinics In Ghana

Abstract

Introduction: Retinoblastoma is the commonest childhood intraocular tumour with fatal consequence if untreated. The study purposed to determine, from general ophthalmologists at peripheral eye clinics in Ghana, the clinical stage of the disease at presentation to such centres, the challenges associated with its management and to seek recommendations for improvement in the management of retinoblastoma.
Methods: A comparative, cross-sectional study was conducted among general ophthalmologists over two time periods: Period 1 (2005-2007) and Period 2 (2014- 2016). One ophthalmologist from each peripheral eye clinic in Ghana was interviewed face-to-face, by
telephone or email using a structured questionnaire after verbal informed-consent.
Results: Responses were received from 24 out of 26 general ophthalmologists in Period 1 and from 35 out of 37 in Period 2. On the average 82 and 95 cases were seen respectively for the two periods. Specifically, 69 cases were seen in the year 2007 and 64 in 2016. The estimated age-specific incidence rates (ASR) for Periods 1 and 2 were 20.3 and 17.3 per million person-years respectively. The common clinical presentations reported by the ophthalmologists were leukocoria followed by proptosis and redness of eyes in both study periods. Diagnosis of retinoblastoma using clinical features supported by imaging (ultrasonography and CT-Scan) was done by 10 out of 24 (41.7%) in Period 1, as compared with 18/35 (51.4%) in Period 2 (p=0.461). Majority of ophthalmologists referred all their patients for treatment elsewhere in both periods on account of lack of resources for management including lack of general anaesthesia. Management challenges included abandonment of treatment by caretakers, lack of resources for management and refusal of treatment by caretakers with reasons such as cost, distance, fear of surgery and fear of bigger hospitals. Recommendations
for improvement in management included need for standardized treatment guidelines, early detection through health education and funding for care.
Conclusion: Patients with retinoblastoma present with clinically advanced disease to ophthalmologists in peripheral eye clinics in Ghana. There is abandonment and refusal of treatment by caretakers in these centres citing cost and distance as some reasons, and very little improvement over the past decade. Early detection, health education among the general public and health workers, and standardised treatment guidelines are needed to improve on patients’ management and survival.