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{{Retinoblastoma}}
{{Retinoblastoma}}
{{CMG}}{{AE}}{{Simrat}}
{{CMG}}; {{AE}} {{Sahar}} {{Simrat}}
==Overview==
==Overview==
According to the United States Preventive Services Task Force, screening for retinoblastoma is not recommended. There is no widely accepted screening protocol of retinoblastoma for the general population. However, children at increased risk of retinoblastoma based on known 13q deletion or [[family history]] should be evaluated by an [[ophthalmologist]] shortly after birth. In all offsprings and siblings of patients with retinoblastoma, screening dilated [[fundus]] examinations are recommended.<ref name="RothschildLévy2011">{{cite journal|last1=Rothschild|first1=P-R|last2=Lévy|first2=D|last3=Savignoni|first3=A|last4=Lumbroso-Le Rouic|first4=L|last5=Aerts|first5=I|last6=Gauthier-Villars|first6=M|last7=Esteve|first7=M|last8=Bours|first8=D|last9=Desjardins|first9=L|last10=Doz|first10=F|last11=Lévy-Gabriel|first11=C|title=Familial retinoblastoma: fundus screening schedule impact and guideline proposal. A retrospective study|journal=Eye|volume=25|issue=12|year=2011|pages=1555–1561|issn=0950-222X|doi=10.1038/eye.2011.198}}</ref>
Early [[diagnosis]] of retinoblastoma is necessary to obtain the best outcomes for preservation of the [[vision]] and the eye. In 2018, a group of experts in clinical retinoblastoma care and [[ophthalmic]]
[[pathology]] and [[genetics]] suggested a risk-stratified schedule for [[ophthalmic]] [[screening]] [[Examination|examinations]]. Estimated risk of retinoblastoma development is calculated according to the relativity of individuals to the family member with retinoblastoma.
==Screening==
* In 2018, a group of experts in clinical retinoblastoma care and [[ophthalmic]] [[pathology]] and [[genetics]] suggested a risk-stratified schedule for [[ophthalmic]] [[Screening (medicine)|screening]] [[Examination|examinations]].<ref name="SkaletGombos2018">{{cite journal|last1=Skalet|first1=Alison H.|last2=Gombos|first2=Dan S.|last3=Gallie|first3=Brenda L.|last4=Kim|first4=Jonathan W.|last5=Shields|first5=Carol L.|last6=Marr|first6=Brian P.|last7=Plon|first7=Sharon E.|last8=Chévez-Barrios|first8=Patricia|title=Screening Children at Risk for Retinoblastoma|journal=Ophthalmology|volume=125|issue=3|year=2018|pages=453–458|issn=01616420|doi=10.1016/j.ophtha.2017.09.001}}</ref>
* This panel of experts recommended that all [[Child|children]] with an elevated risk of retinoblastoma (above the population risk) should be [[Screening (medicine)|screened]] via regular [[Fundoscopy|fundoscopic examinations]].
*To schedule a [[screening]] plan, the risk of [[tumor]] development must be determined using the [[infant]] relationship to the family member with retinoblastoma.
*The table below is an estimate of [[Patient|patients']] risk for the development of retinoblastoma depending on the relation of the [[patient]] to the affected individual:
{| border="3"
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Relative of patient}} !! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Bilateral involvement (100%)}} !! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Unilateral involvement (15%)}}
|-
! style="padding: 5px 5px; background: #DCDCDC; " |Offspring (infant)
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | 50  || style="padding: 5px 5px; background: #F5F5F5;" align="center" | 7.5
|-
! style="padding: 5px 5px; background: #DCDCDC; " | Parent
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |5
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.8
|-
! style="padding: 5px 5px; background: #DCDCDC; " | Sibling
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |2.5
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.4
|-
! style="padding: 5px 5px; background: #DCDCDC; " | Niece/nephew
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |1.3
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.2
|-
! style="padding: 5px 5px; background: #DCDCDC; " | Aunt/uncle
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.1
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.007
|-
! style="padding: 5px 5px; background: #DCDCDC; " | First cousin
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.05
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |0.007
|}
{|
! colspan="2" style="background:#DCDCDC;" align="center" + |The above table adopted from Ophthalmology journal <ref name="SkaletGombos2018">{{cite journal|last1=Skalet|first1=Alison H.|last2=Gombos|first2=Dan S.|last3=Gallie|first3=Brenda L.|last4=Kim|first4=Jonathan W.|last5=Shields|first5=Carol L.|last6=Marr|first6=Brian P.|last7=Plon|first7=Sharon E.|last8=Chévez-Barrios|first8=Patricia|title=Screening Children at Risk for Retinoblastoma|journal=Ophthalmology|volume=125|issue=3|year=2018|pages=453–458|issn=01616420|doi=10.1016/j.ophtha.2017.09.001}}</ref>
|-
|}
* Next step in assessing the risk of these [[Child|children]] is to estimate the approximate relative risk of retinoblastoma development according to the percentage mentioned in the above table.


==Screening==
*Relatives are categorized into three categories:
There is no widely accepted screening protocol of retinoblastoma for the general population. However, children at increased risk of retinoblastoma based on known 13q deletion or [[family history]] should be evaluated by an [[ophthalmologist]] shortly after birth.  
**'''High risk:''' Those with a risk percentage > 7.5%
*Screening should then be conducted every 1 to two months during the first two years of life. After that screening should be conducted  every three to four months until the child is three to four years of age, and every six months until five to six years of age unless genetic testing of the child reveals that he or she does not have the germline mutation identified in the affected relative, in which case screening examinations are not necessary. Retinoblastoma surveillance examinations are usually performed with the patient under general anesthesia to permit complete detailed examination of the ocular fundus.<ref>{{cite book | last = Pizzo | first = Philip | title = Principles and practice of pediatric oncology | publisher = Wolters Kluwer/Lippincott Williams & Wilkins Health | location = Philadelphia, PA | year = 2011 | isbn = 160547682X }}</ref>.
**'''Intermediate risk:''' Those with a risk percentage between 1% and 7.5% (including 7.5%)
*Although it is not clear whether early diagnosis can impact survival, screening with [[MRI ]]has been recommended as often as every 6 months for 5 years for those suspected of having heritable disease or those with unilateral disease and a positive [[family history]]. [[CT scans]] are generally avoided for routine screening in these children because of the perceived risk of exposure to [[ionizing radiation]]. At the time of diagnosis, patients who are asymptomatic of an intracranial [[tumor]] have a better outcome than do patients who are symptomatic.
**'''Low risk:''' Those with a risk percentage < 1%
*The American Academy of Pediatrics recommends red reflex testing  infants, neonates, and children before discharge from the neonatal nursery and at all subsequent routine health clinic visits. Abnormal red reflex requires immediate referral to an [[ophthalmologist]]. As some children with retinoblastoma present with [[strabismus]], all children with strabismus should be evaluated through a dilated eye exam for retinoblastoma. In all offsprings and siblings of patients with retinoblastoma, screening dilated [[fundus]] examinations are recommended.
*American Association of [[Ophthalmic]] [[Oncologists]] and [[Pathologists]] (AAOOP) [[Medical guideline|guideline]] recommends scheduled [[eye examination]] for the [[screening]] of children at high risk of developing retinoblastoma. [[Screening (medicine)|Screening]] should be initiated at [[birth]] and continued till the age of 7 years.<ref name="SkaletGombos2018">{{cite journal|last1=Skalet|first1=Alison H.|last2=Gombos|first2=Dan S.|last3=Gallie|first3=Brenda L.|last4=Kim|first4=Jonathan W.|last5=Shields|first5=Carol L.|last6=Marr|first6=Brian P.|last7=Plon|first7=Sharon E.|last8=Chévez-Barrios|first8=Patricia|title=Screening Children at Risk for Retinoblastoma|journal=Ophthalmology|volume=125|issue=3|year=2018|pages=453–458|issn=01616420|doi=10.1016/j.ophtha.2017.09.001}}</ref>
*Proposed fundus screening guidelines, based on the absolute risk, depending on the clinical context or genetic testing.<ref name="RothschildLévy2011">{{cite journal|last1=Rothschild|first1=P-R|last2=Lévy|first2=D|last3=Savignoni|first3=A|last4=Lumbroso-Le Rouic|first4=L|last5=Aerts|first5=I|last6=Gauthier-Villars|first6=M|last7=Esteve|first7=M|last8=Bours|first8=D|last9=Desjardins|first9=L|last10=Doz|first10=F|last11=Lévy-Gabriel|first11=C|title=Familial retinoblastoma: fundus screening schedule impact and guideline proposal. A retrospective study|journal=Eye|volume=25|issue=12|year=2011|pages=1555–1561|issn=0950-222X|doi=10.1038/eye.2011.198}}</ref>
*No further [[Eye examination|examination]] is required after the age of 7 years except for those who are known carriers of the [[RB1]] [[gene]] [[mutation]].
*For those who are carries of the [[RB1]] [[gene]] [[mutation]], [[screening]] should be continued indefinitely after the age of 7 years and should be done annually or every 2 years.


{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
* The following table is the recommended [[eye examination]] schedule for unaffected [[Child|children]] of families with retinoblastoma depending on their age and risk percentage of [[tumor]] development:
|valign=top|
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Clinical context or genetic testing}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Risk category or Age}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Risk to carry germinal RB1 mutation}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|High risk}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Overall RB risk for the childa (%)}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Intermediate risk}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Fundus screening protocol recommendations}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Low risk}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Children known to carry RB1 mutation
Birth to 8 weeks
| style="padding: 5px 5px; background: #F5F5F5;" |
*Every 2 - 4 weeks
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monthly
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monthly
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
> 8 - 12 weeks
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monthly
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monthly
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monthly
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
> 3 - 12 months
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monthly
| style="padding: 5px 5px; background: #F5F5F5;" |
*Every 2 months
| style="padding: 5px 5px; background: #F5F5F5;" |
*Every 3 months
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
> 12 - 24 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Known (100%)
*Every 2 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*90
*Every 3 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*First week after birth, then every month up to 18 months of age, then every 3 months up to 4 years of age
*Every 4 months
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Parent bilaterallyb affected
> 24 - 36 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*100%
*Every 3 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*45
*Every 3 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Every 6 months
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Parent unilaterally affected
> 36 - 48 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*10%
*Every 4 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*4
*Every 4 - 6 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*First month after birth, then every 2 months up to 2 years of age, then every 6 months up to 4 years of age
*Every 6 months
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Sibling bilaterallyb affected
> 48 - 60 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*100%
*Every 6 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*4
*Every 4 - 6 months
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Annually
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
5 - 7 years
| style="padding: 5px 5px; background: #F5F5F5;" |
*Every 6 months
| style="padding: 5px 5px; background: #F5F5F5;" |
*Annually
| style="padding: 5px 5px; background: #F5F5F5;" |
*Annually
|}
{|
! colspan="2" style="background:#DCDCDC;" align="center" + |This table is adopted from Ophthalmology journal<ref name="SkaletGombos2018">{{cite journal|last1=Skalet|first1=Alison H.|last2=Gombos|first2=Dan S.|last3=Gallie|first3=Brenda L.|last4=Kim|first4=Jonathan W.|last5=Shields|first5=Carol L.|last6=Marr|first6=Brian P.|last7=Plon|first7=Sharon E.|last8=Chévez-Barrios|first8=Patricia|title=Screening Children at Risk for Retinoblastoma|journal=Ophthalmology|volume=125|issue=3|year=2018|pages=453–458|issn=01616420|doi=10.1016/j.ophtha.2017.09.001}}</ref>
|-
|}
|}
Abbreviations: RB, retinoblastoma; RB1, retinoblastoma gene.
*The schedule presented above is general [[Medical guideline|guideline]] for at-risk [[Child|children]] when no [[Lesion|lesions]] of concern have been noted. Some [[Child|children]] may require more frequent [[Eye examination|examinations]].


a-The risk is computed assuming a 90% penetrance of the disease and a 50% risk to inherit the mutated allele from a parent. For unaffected parents of a bilaterally affected child, the risk to carry germinal mutation for each parent is 5%.
* The American Association of [[Ophthalmic]] [[Oncologists]] and [[Pathologists]] (AAOOP) [[Medical guideline|guideline]] also suggests a single dilated [[Fundus (eye)|fundus]] [[Physical examination|examination]] to evaluate for [[asymptomatic]] spontaneously regressed retinoblastoma or retinoma in all first-degree relatives of a [[patient]] with retinoblastoma, including older siblings if the [[RB1]] [[genetic analysis]] of the relatives is not done.


b-Or unilateral retinoblastoma with multifocal tumours.
===[[Genetic testing|Genetic Testing]] for Children with Retinoblastoma===
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | |A01=[[Genetic testing]] for children with Retinoblastoma}}
{{familytree | | | | | | | | | | | | | | | |!| | | }}
{{familytree | |,|-|-|-|-|-|v|-|-|-|-|-|-|-|+|-|-|-|-|v|-|-|-|.| | }}
{{familytree | |!| | | | | |!| | | | | | | |!| | | | |!| | | |!| | | }}
{{familytree | D01 | | | | D02 | | | | | | D03 | | | D04 | | D05 |D01=Not available|D02=[[Blood]]: [[RB1]] [[mutation]](+)<br>([[germline mutation]])|D03=Blood: [[RB1]] [[mutation]](-)<br>[[Tumor]]: [[RB1]] [[mutation]](+)|D04=[[Blood]]: [[RB1]] [[mutation]](-)<br>[[Tumor]]: [[RB1]] [[mutation]](-)|D05=[[Blood]]: [[RB1]] [[mutation]](-)<br>[[Tumor]]: not available}}
{{familytree | |!| | | | | |!| | | | | | | |!| | | | |!| | | |!| }}
{{familytree | E01 | | | | E02 | | | | | | E03 | | | |`| E04 |'| |E01=Ophthalmic [[screening]] for all<br>the relatives with greater risk than the population |E02=Assessment of relatives<br>for familial retinoblastoma|E03=Ophthalmic [[screening]] and [[genetic analysis]]<br>not required for first degree relatives|E04=No need for [[genetic analysis]] of first degree relatives}}
{{familytree | | | | | |,|-|^|-|.| | | | | |!| | | | | | |!| }}
{{familytree | | | | | F01 | | F02 | | | | F03 | | | | | F04 |F01=Relatives with [[RB1]] [[mutation]]|F02=Relatives without [[RB1]] [[mutation]]|F03=Ophthlamic [[screening]] for future offspring unless negative for parent's [[mutation]]|F04=Future offspring of affected child require ophthalmic [[screening]]}}
{{familytree | | | | | |!| | | |!| | | |}}
{{familytree | | | | | G01 | | G02 | | |G01=Ophthalmic [[screening]] for children as high risk|G02=Ophthalmic [[screening]] not required}}
{{familytree/end}}
{|
! colspan="2" style="background:#DCDCDC;" align="center" + |The above table is the recommended genetic analysis guidline for families with affected individuals and adopted from Ophthalmology journal<ref name="SkaletGombos2018">{{cite journal|last1=Skalet|first1=Alison H.|last2=Gombos|first2=Dan S.|last3=Gallie|first3=Brenda L.|last4=Kim|first4=Jonathan W.|last5=Shields|first5=Carol L.|last6=Marr|first6=Brian P.|last7=Plon|first7=Sharon E.|last8=Chévez-Barrios|first8=Patricia|title=Screening Children at Risk for Retinoblastoma|journal=Ophthalmology|volume=125|issue=3|year=2018|pages=453–458|issn=01616420|doi=10.1016/j.ophtha.2017.09.001}}</ref>
|-
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 23:59, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Simrat Sarai, M.D. [3]

Overview

Early diagnosis of retinoblastoma is necessary to obtain the best outcomes for preservation of the vision and the eye. In 2018, a group of experts in clinical retinoblastoma care and ophthalmic pathology and genetics suggested a risk-stratified schedule for ophthalmic screening examinations. Estimated risk of retinoblastoma development is calculated according to the relativity of individuals to the family member with retinoblastoma.

Screening

Relative of patient Bilateral involvement (100%) Unilateral involvement (15%)
Offspring (infant) 50 7.5
Parent 5 0.8
Sibling 2.5 0.4
Niece/nephew 1.3 0.2
Aunt/uncle 0.1 0.007
First cousin 0.05 0.007
The above table adopted from Ophthalmology journal [1]
  • Next step in assessing the risk of these children is to estimate the approximate relative risk of retinoblastoma development according to the percentage mentioned in the above table.
  • Relatives are categorized into three categories:
    • High risk: Those with a risk percentage > 7.5%
    • Intermediate risk: Those with a risk percentage between 1% and 7.5% (including 7.5%)
    • Low risk: Those with a risk percentage < 1%
  • American Association of Ophthalmic Oncologists and Pathologists (AAOOP) guideline recommends scheduled eye examination for the screening of children at high risk of developing retinoblastoma. Screening should be initiated at birth and continued till the age of 7 years.[1]
  • No further examination is required after the age of 7 years except for those who are known carriers of the RB1 gene mutation.
  • For those who are carries of the RB1 gene mutation, screening should be continued indefinitely after the age of 7 years and should be done annually or every 2 years.
  • The following table is the recommended eye examination schedule for unaffected children of families with retinoblastoma depending on their age and risk percentage of tumor development:
Risk category or Age High risk Intermediate risk Low risk

Birth to 8 weeks

  • Every 2 - 4 weeks
  • Monthly
  • Monthly

> 8 - 12 weeks

  • Monthly
  • Monthly
  • Monthly

> 3 - 12 months

  • Monthly
  • Every 2 months
  • Every 3 months

> 12 - 24 months

  • Every 2 months
  • Every 3 months
  • Every 4 months

> 24 - 36 months

  • Every 3 months
  • Every 3 months
  • Every 6 months

> 36 - 48 months

  • Every 4 months
  • Every 4 - 6 months
  • Every 6 months

> 48 - 60 months

  • Every 6 months
  • Every 4 - 6 months
  • Annually

5 - 7 years

  • Every 6 months
  • Annually
  • Annually
This table is adopted from Ophthalmology journal[1]

Genetic Testing for Children with Retinoblastoma

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Genetic testing for children with Retinoblastoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Not available
 
 
 
Blood: RB1 mutation(+)
(germline mutation)
 
 
 
 
 
Blood: RB1 mutation(-)
Tumor: RB1 mutation(+)
 
 
Blood: RB1 mutation(-)
Tumor: RB1 mutation(-)
 
Blood: RB1 mutation(-)
Tumor: not available
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmic screening for all
the relatives with greater risk than the population
 
 
 
Assessment of relatives
for familial retinoblastoma
 
 
 
 
 
Ophthalmic screening and genetic analysis
not required for first degree relatives
 
 
 
 
 
No need for genetic analysis of first degree relatives
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Relatives with RB1 mutation
 
Relatives without RB1 mutation
 
 
 
Ophthlamic screening for future offspring unless negative for parent's mutation
 
 
 
 
Future offspring of affected child require ophthalmic screening
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmic screening for children as high risk
 
Ophthalmic screening not required
 
 
The above table is the recommended genetic analysis guidline for families with affected individuals and adopted from Ophthalmology journal[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 Skalet, Alison H.; Gombos, Dan S.; Gallie, Brenda L.; Kim, Jonathan W.; Shields, Carol L.; Marr, Brian P.; Plon, Sharon E.; Chévez-Barrios, Patricia (2018). "Screening Children at Risk for Retinoblastoma". Ophthalmology. 125 (3): 453–458. doi:10.1016/j.ophtha.2017.09.001. ISSN 0161-6420.