Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

Age-related changes of vitamin C levels in aqueous humour

Background/Aim. Age-related cataract is a common disease among senior population. Vitamin C is the most effective reducing hydrosoluble antioxidant causing reduction in the levels of free radicals in crystaline lens. The aim of this study was to evaluate the age-related change of vitamin C (L-ascorbic acid) level in the aqueous humor of patients with senile cataract. Methods. This prospective study included 74 patients, divided into 3 age groups, with age-related cataract, underwent routine phaco cataract surgery with intraocular lens implantation. Aqueous humor was aspirated from 74 eyes at the beginning of phacoemulsification. The levels of vitamin C (L-ascorbic acid) in aqueous humor were determined with high-performance liquid chromatography (HPLC). Results. The average age of patients included in the study was 65 ± 9.85 years (54-87 years). The level of vitamin C in aqueous humor was 152.78 ± 7.0125 μg/mL in the group A (50-59 years), 134.15 ± 5.1569 μg/mL in the group B (60-69 years) and 106.51 ± 5.44 μg/mL in the group C (over 70 years). Conclusion. The amount of vitamin C in aqueous humor of patients with age-related cataract is decreasing with age. There was a statistically significant change (p < 0.001) of vitamin C aqueous concentration in the patients of different age. This decrease could play a role in susceptibility to cataract formation in older population