EUA – Exam Under Anaesthesia
EUA is a routine procedure to examine the eyes and monitor retinoblastoma while your child is asleep.
Your child will be examined under general anaesthetic, usually in an operating room. However, EUA is not itself an operation.
Tests and treatments may be done during the exam. Your doctor will seek consent from you before or during the EUA for any treatments and additional procedures.
Before the anaesthetic, your child will be given drops to make the pupils bigger. Children with lighter eyes often need fewer drops because their iris is thinner and less pigmented than darker eyes, thus more sensitive to dilation.
The drops do feel uncomfortable, and may sting, and this can upset children. The discomfort passes in about 30 seconds. Preparing your child and giving lots of encouragement is very helpful. For specific suggestions on how to help your child when giving eye drops, visit the guidance in our Child Life section.
During the EUA
An average EUA lasts about 45minutes. The ophthalmologist carefully examines the eye with an indirect ophthalmoscope (this looks like a miner’s light). At many hospitals, a Retcam is also used. High resolutions images appear in real time on a computer screen, so the entire medical team can see inside the eye.
Ultrasound, Retcam photographs and fundus drawings map the size, shape, and location of each tumour in each eye. A fundus drawing is a hand-drawn or computer generated diagram of the retina. This records where and how tumours were treated during the EUA, and notes suspicious areas for follow-up.
If treatments or invasive tests are needed, you will be asked to give consent before or during the EUA. These procedures include:
After the EUA
Your child will be taken to the recovery room. From there, you may be taken to a bed on the ward or you may be allowed to leave once your child is fully awake and has had something to drink.
Your child’s eyes may stay dilated for several hours or up-to several days after the EUA. Dilated eyes can be sensitive to light so it may be helpful to bring some sunglasses or a broad-rimmed hat to aid your child’s comfort.
The ophthalmologist will discuss the findings with you immediately after the EUA or before the end of clinic. He will also discuss when the next exam will be, and you should have an appointment before leaving the hospital.
Frequency of EUAs
Repeated EUAs are necessary to monitor and treat retinoblastoma, and may be done as frequently as every 2-4 weeks during and immediately after treatment. The ophthalmologist will discuss with you the appropriate schedule for your child. Always ask for clarification if you are unsure of the schedule.
Your child’s schedule will depend on RB1 genetics in your family, location of tumours, the presence of vitreous seeding, response to treatment, and the age of your child. A planned EUA schedule will be altered if tumours relapse or if new tumours develop. Generally, EUAs will continue for at least two years beyond the last treatment or until your child is three years old, whichever is later.
Generally, surveillance EUAs looking for new tumours in at risk children can be replaced with office exams by age 3, when the risk of new tumours decreases. The age at which children can manage an office exam varies widely, but can be significantly lowered with good child life support.
Questions to Ask the Ophthalmologist
- What time is the EUA scheduled?
- How long is the exam likely to last?
- Who will perform my child’s exam / treatment?
- What procedures will be carried out during the exam, on which eye, and why?
- Can I see / have copies of the Retcam images / ultrasounds / fundus drawings?