Awareness is increasing of retinoblastoma’s early sign – a white glow in the pupil of the eye, seen in flash photos and dim light.  This is great news as awareness is the key to early diagnosis of this aggressive eye cancer affecting babies and young children.  However, at the same time, the emerging public knowledge can cause alarm and distress among those concerned about a white eye glow in photos of both children and adults.  Here are 10 things to remember and actions to take if you are concerned about a white pupil photograph.

1. Retinoblastoma in adults is exceptionally rare.  95% of cases are diagnosed in children younger than 5 years old. Learn about retinoblastoma
2. Retinoblastoma is the most serious condition causing white pupil in photos.  Other sight-threatening conditions include cataract, coats disease, ocular albinism, anisometropia (a severe refractive error).  All can be treated effectively with early diagnosis. Can you tell which child in these photos has retinoblastoma?
3. Most white pupil photos show a normal optic nerve reflex, caused when a camera flash hits the optic disc directly.  This harmless reflection most often occurs when the eye is turned about 15° towards the nose. Learn about what causes white pupil
4. Eye conditions causing white pupil usually cause sight loss before the sign appears in flash photos – prompting an affected adult to seek medical care.  Learn about white pupil in adults
5. Very young children cannot articulate that they are losing sight, and as they adjust very well to gradual sight loss, people around them often do not realize this is happening.  Therefore, when white pupil appears repeatedly in a young child’s photos, both eyes should be checked promptly by a paediatrician, family doctor or ophthalmologist. Learn about the red reflex eye exam
6. If you see a white pupil in a flash photograph, use the PhotoRED technique described here to check for normal red eye reflex.  Learn the PhotoRED Technique
7. If a white pupil appears repeatedly in photos taken with the PhotoRED technique, both eyes should be checked urgently by an ophthalmologist to rule out serious eye conditions and threat to sight or life.  Learn about the red reflex eye exam
8. A white pupil that appears in one photo, or multiple photos from the same angle, while all other photos appear normal, is likely to be a normal optic nerve reflex.
9. Smartphones frequently capture normal optic nerve reflex due to the type of flash used.  They are not a universally reliable tool for red reflex screening photos.
10. If you are concerned about white pupil in your child’s / your own photos, request a simple red reflex eye exam in a darkened room from your primary doctor to allay your fears.  This simply involves turning down the lights and shining an ophthalmoscope (looks like a hand held torch) into each eye.  Learn about the red reflex eye exam