The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Eye and vision defects in under-five-year-old children in Oman: A public health intervention study

Purpose : To identify under-five-year-old children with vision or ocular defect in two provinces (Wilayats) of central Oman in 2006. Study Design : Public health intervention study. Materials and Methods : Ocular examination in Manah Wilayat was conducted by nursing staff of the primary health center (PHC) and in Mudhaiby Wilayat was conducted by a trainee Omani optometrist. Abnormal sized eyeball, strabismus, nystagmus and white pupil were recorded. Visual acuity was tested by LOGMAR chart with Lea′s symbols in children> 2 years of age and preferential viewing was assessed by Lea′s grating paddle or ′Hiding Heidi′ picture in children ≤2 years age. Data was analyzed using Statistical Package for Social Studies (SPSS 12). Result : Among 1,520 examined children, three children had absent eyeball bilaterally and three had unilaterally absent eyeball. Strabismus and nystagmus were detected in 44 (2.9%) and 18 (1.2%) children respectively. ′Hiding Heidi′ test was normal in 530/537 (87%) of children. Distant vision reading was ≥0.32 in 386/448 (86.2%) eyes. Preferential looking test suggested that half of the children had defective vision (>2cpcm). Screening at ′1-2 year′ and ′3-4 years′ age group could significantly predict eye problems ( P≤0.001). Conclusion : Eye and vision screening of under-five kids helped in detection of eye problems in early stages. Instead of universal screening, high risk population or children of ′3 to 4′ years for vision and ′1 to 2′ years for ocular abnormalities is proposed The existing health services could not detect some children with eye problems and they were identified during such screening

The impact of spectacle wear compliance on the visual function related quality of life of Omani students: A historical cohort study

Background: Eye screening and refractive services to students are part of a school health initiative in Oman. We evaluated the impact of the compliance of spectacle wear on the vision related quality of life (VFQ) among 12-13 years old and 15-16 years old Omani students with refractive error. Materials and Methods: This historical cohort study was conducted in 2012. Students using spectacles and those not using spectacles after 1 year of prescribing/providing spectacles were interviewed to assess their VFQ. The VQ 20 questionnaire with 5 graded close-ended responses was adopted for this purpose. The responses for the VFQ related to different visual functions of students who were/were not spectacle wear compliant, were compared. Results: Our cohort had 124 students in each group. The overall VFQ was significantly higher among the compliant spectacle wearers (compliant group) compared with the non-complaint wearers (non-compliant group) (relative risk [RR] =4.7% [95% of the confidence interval (CI): 2.8-6.6]). The association of gender and the grade level was not significant (P > 0.05). However, the variation of governorate was significantly associated to the difference of VFQ in both groups (χ2 = 16.6, degrees of freedom = 4, P = 0.0003). The VFQ related to the near work (RR = 1.3) and school related activities (RR = 1.3) was better in the compliant group. Conclusion: VFQ was better among those students who were spectacle wear compliant compared with those who were not. VFQ related to near work and school related activities seem to be the most influenced by spectacle wear compliance

Hearing Health Practices and Beliefs among over 20 year-olds in the Omani Population

Objectives: The objective of this study was to investigate hearing health practices and beliefs among people over 20 years old in the Omani population. Methods: This descriptive study was conducted in Oman during 2007–2008. Arabic speaking health staff interviewed a total of 598 selected people from urban and rural Oman and also industrial workers using a closed ended questionnaire with 15 questions. Participants’ responses to the hearing practice related questions were graded into excellent (≥20 points), average (10 to 19) and poor (<10 points). The responses to the questions about hearing beliefs were grouped into excellent (≥25 points), good (5 to 24), average (-4 to 4), poor (-24 to -5) and very poor (<-25) grades. We calculated the frequencies, percentage proportions and 95% confidence intervals of the different grades of beliefs and hearing practice. The rates were also compared among different subgroups. We performed regression analysis to identify predictors of good hearing practice and scientific beliefs. Results: Among the 598 participants, an ‘excellent’ grade of hearing practice and belief was noted in 386 (64.5% [95% CI 60.7–68.4]) and average in 205 (34.3% [95% CI 29.5 – 37.1]). Being in the 20 to 39 years age group (OR =1.67) and an urban resident (OR= 0.53) were both predictors of an excellent grade of hearing practice, while male gender (OR = 1.71) and illiteracy (OR= 1.80) were predictors of scientific beliefs. Conclusion: We noted high levels of good hearing practice and low levels of modern scientific beliefs among Omani participants. The Ear Health Care program of Oman should focus on improving the knowledge about healthy hearing so that attitudes and hearing practices are improved and noise-induced hearing loss can be prevented or delayed.

Socioeconomic Inequality across Religious Groups: Self-Selection or Religion-Induced Human Capital Accumulation? The Case of Egypt

National audienc