Introduction

Miriam Hyman was one of the 52 people killed in the "7/7" London bombings of 7th July 2005.

Miriam's memorial is The Miriam Hyman Children's Eye Care Centre (MHCECC) within the L V Prasad Eye Institute in Odisha, India. Miriam appreciated her own eye care services.

The commonest childhood cancer is Retinoblastoma – eye cancer. Typically, the treatment requires 6 cycles of chemotherapy, 6 times examination under anaesthesia and at least 2 times CT scan. The total treatment cost of each child is Rs 48,000.

The MH CECC in Bhubaneswar, Odisha, typically treats 17-20 children in a year with retinoblastoma.

Impact

A grant of £5000 would treat up to 10 children with retinoblastoma at LVPEI.

Details 

LVPEI established a tertiary eye care facility in Bhubaneswar, the capital city of the eastern Indian state of Odisha, in July 2006. The centre has all clinical and laboratory facilities (Pathology) for care of all types of eye cancer. 

Retinoblastoma is the commonest eye cancer in children. It constitutes nearly 3% of all childhood malignancies. Nearly 66% of cases are diagnosed before the age of 2 years and 95% before the age of 5 years. It has a much higher incidence in India (6-10 cases per million population) compared to the USA and Europe (2-5 cases per million population). It is among the top 5 cancers in children in India.  

The success of treatment lies in 

1. Early diagnosis by clinical examinati0n (dilated eye exam, and imaging- Fundus photo, B Scan, CT/MRI scan)

2. Laser and/or cryo therapy

3. Chemotherapy in combination with laser/cryotherapy

4. Radiotherapy with or without chemotherapy

Most benefit is derived from Laser, Cryo and Chemotherapy either alone or in combination.  

Despite these treatment modalities and expected cure, the survival rate in India (and other similar developing countries) is significantly lower compared to the more developed countries. 

The challenges faced in our care (and India) are (1) Late presentation due to ignorance of both families of people affected and the referring physician, and (2) the cost of care 

Facts about our experience with retinoblastoma at MH CECC

Annual volume of new cases: 25- 30 new cases

Economically under privileged annul volume: 20-22 new cases

Both eyes involvement: 25-30%

Treatment modalities: Systemic and local/intraocular chemotherapy, focal laser therapy, cryotherapy and surgery. 

Eye salvage rates: 80% 

Five-year survival rates: 75%. 

Patient drop out between treatment: 5-8% (economic reasons)

CASE STUDIES

1) Ashutosh Mishra, Puri, Odisha, India

Ashutosh (seen above with his mother and maternal grandmother) was only 3 months old when he presented to us with retinoblastoma (the commonest intraocular cancer in very young children and potentially lethal if not treated) in both eyes. The left eye had very advanced tumor and there was no scope of visual recovery in that eye. Added to this was also a risk of tumor spread out of the eye. We counseled his parents that it would be best for that eye to be surgically removed. Though devastated by the news, his mother showed exemplary courage in agreeing to go ahead with this decision. The tumor in his right eye was successfully treated by multiple cycles of chemotherapy and laser applications. This timely treatment ensured that we were able to save his right eye. Today Ashutosh has good vision in his right eye. He is preparing to join school and can now look forward to leading as normal a life as any other child.

The LV Prasad Eye Institute at Bhubaneswar in Odisha sees around 25 such new retinoblastoma patients every year and provides protocol based management to these children with this potentially lethal cancer of the eyes. Our fight continues against the low levels of awareness of this cancer in the community, the advanced disease presentation that we often get to see and the resource constraints that we face on a regular basis. In spite of all this, it is gratifying to note that we have been able to make a difference to the lives of children like Ashutosh.

2) Junaid Mohammed, Jatni, Odisha, India

Junaid came to us with retinoblastoma (the commonest intraocular cancer in very young children and potentially lethal if not treated) in both eyes when he was about 1 year old. On examination, he was found to have moderately advanced tumor in both of his eyes. He was treated with multiple cycles of chemotherapy and laser therapy. We were able to salvage both his eyes as the tumors regressed well with the treatment that was carried out. He has been on regular follow up with us for the past 2 years to monitor the status of both his eyes. Meanwhile, he has grown up into a mischievous lad who is endearing to all who know him and is looking forward to joining school very soon.

The LV Prasad Eye Institute at Bhubaneswar in Odisha sees around 25 such new retinoblastoma patients every year and provides protocol based management to these children with this potentially lethal cancer of the eyes. Our fight continues against the low levels of awareness of this cancer in the community, the advanced disease presentation that we often get to see and the resource constraints that we face on a regular basis. In spite of all this, it is gratifying to note that we have been able to make a difference to the lives of children like Junaid.

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