Pediatric ophthalmologists recommend taking a flash photograph once a month of infants and children up to five years of age to check for normal red eye reflex or the presence of a white pupil,  known as leukocoria.   Photographs taken in a dimly lit room at close range and from a variety of angles, with the red eye reduction feature OFF, are most likely to show leukocoria.

 
The Granny Test for Retinoblastoma

The Granny Test is not a medically definitive test for retinoblastoma.  What it is meant to illustrate is how something most grandparents (and parents) do anyway – taking pictures of their grandchildren – can be used to look for signs of retinoblastoma.
The photo array shown below (using a child without retinoblastoma) illustrates the following key factors in photographing retinoblastoma:

• Pictures should be taken in a dimly lit room;
• The zoom feature on the camera can be used for a close-up view of the face/eyes;
• A flash must be used;
• The red eye reduction feature must be turned off;
• Pictures should be taken from a variety of angles with the child not always looking directly at the camera;

Please note that scientific research has shown that cell phone cameras, because of the different flash used (LED), are not successful in capturing retinoblastoma.

Leukocoria is most often obvious in flash photographs, as the pupil is exposed to a lot of light but the duration of the exposure is so short the pupil does not have time to constrict. This provides a remarkable view of the retina which when healthy, reflects light back as “red eye”.  In a child with retinoblastoma, the tumor prevents the light from reaching the retina, and instead the flash is reflected off the tumor, giving the pupil a white appearance.

Retinoblastoma can affect one or both eyes and is not necessarily visible in every photograph. It depends on the size and location of the tumor or tumors, and the angle at which the photograph is taken. 

 “In both of these children leukocoria showed in the left eye in only some of the pictures. Both children had retinoblastoma.”

Normal Direct Optic Nerve Reflection

Not every example of photoleukocoria turns out to be retinoblastoma. A normal healthy eye may show a white reflection in a photograph when the optic nerve is  perfectly aligned with the flash. However, the only way to differentiate between an optic nerve reflection and a serious eye problem, is for an optometrist or ophthalmologist to examine the eye carefully with the pupil widely dilated.

There are other eye conditions which may present themselves with leukocoria in photographs.  A child displaying these symptoms should be referred to an ophthalmologist immediately to have his/her pupils dilated for an exam to rule out serious eye disease.

To visit our leukocoria photo gallery click here.

Click here for a PDF file pamphlet "Know The Signs".

Click here for a PDF file pamphlet to print and take to your pediatrician if you suspect retinoblastoma.