The earliest sign of a life-threatening childhood cancer can appear in the most ordinary place, a photograph. In 2020, the Shah family in Mumbai came across such a detail in a photograph of their ten-month-old
son, the child’s right pupil was not reflecting the familiar red of a camera flash. Instead, it appeared cold, pale white.
That white glow was leukocoria, the earliest and most telling visible sign of retinoblastoma, an aggressive, fast-growing cancer of the retina. Mansi and Mahesh’s infant son was diagnosed shortly after with retinoblastoma, a rare but aggressive eye cancer.
According to the American Cancer Society, nearly 2 out of 3 retinoblastoma tumors are diagnosed in children younger than 2 years of age, and almost all retinoblastoma is diagnosed in children younger than 5. With India alone bearing roughly 1 in 4 of the world’s retinoblastoma cases, as per a 2025 IJO research, with the estimates still hover between 1,500 and 2,000 new diagnoses annually, a figure unchanged in recent 2025 meta-analyses despite modest global incidence rises.
“If you notice a white glow in your child’s pupil in a photograph, do not wait. Seek specialist medical advice immediately,” cautions Dr. P. Vijay Anand Reddy, Director & Senior Consultant, Apollo Cancer Centre, Hyderabad.
Retinoblastoma develops in the retina and almost exclusively affects children under the age of two. What makes it particularly challenging is not just its rapid growth, but its lack of early, obvious symptoms. The World Health Organization’s CURE-ALL initiative has flagged retinoblastoma as an “index cancer” (the largest, most aggressive, or most significant tumor) precisely because early detection is cheap, visible, and curative yet systemic gaps in parental education and frontline screening keep the disease lethal in lower-middle-income settings.
Young children cannot describe visual disturbances. There is no pain in the initial stages, no behavioural shift dramatic enough to trigger immediate concern. The disease progresses quietly, often until visible signs emerge externally or vision is already compromised.
Globally, retinoblastoma accounts for a small fraction of childhood cancers, yet its impact is disproportionately high in countries with delayed diagnosis patterns. India alone contributes nearly one in four cases worldwide, with an estimated 1,500 to 2,000 new diagnoses each year.
Both Mansi and Mahesh found themselves confronting a fear no parent is prepared for. The repeated white reflection in their son’s eye, visible across several photographs, had already raised concerns. When medical evaluation confirmed the presence of a tumour in his retina, that concern turned into something far more serious.
By the time of diagnosis, baby’s condition had progressed to Group D retinoblastoma, an advanced stage in which the cancer had spread within the eye, making treatment significantly more complex than in earlier phases.
For decades, cases at this stage have followed a predictable course. Enucleation, the surgical removal of the entire eye while leaving the surrounding muscles and orbital structures intact, has long been considered the safest and most effective way to prevent the cancer from spreading. It is a decision rooted in survival, though it comes at the cost of vision and physical appearance.
Seeking alternatives, the family was referred to a Cancer Centre in Hyderabad, where the 10-month-old was treated by Dr. P. Vijay Anand Reddy, at Apollo.
Rather than proceeding with conventional treatment, the medical team opted for intra-arterial chemotherapy (IAC), a more targeted and increasingly adopted approach in select advanced cases. The technique allows chemotherapy to be delivered directly to the tumour, limiting its impact on the rest of the body.
The procedure is intricate involving guiding a microcatheter, an extremely thin and flexible tube, through the femoral artery located in the groin. From there, it is carefully navigated through the vascular system to reach the ophthalmic artery, the blood vessel that supplies the eye. Once in position, a concentrated dose of chemotherapy is administered directly to the tumour site.
After three cycles of treatment, the tumour had reduced by 90%. The baby not only survived but also retained his eye and vision.
“Every child deserves a chance to see the world,” said Dr. Reddy. “With early referral, we can save both the eye and the life. The tragedy is when they reach us too late.”
His team has performed over 700 such procedures, reporting an eye-salvage rate of around 70% in cases that would previously have required eye removal.
What Are The Early Signs Of Eye Cancer In Children?
Leukocoria, the white reflection seen in photographs, remains the most recognisable indicator. In a healthy eye, the retina reflects red due to its blood supply. When a tumour is present, the reflection can appear white or pale yellow.
Warning signs include:
- White or yellow glow in the pupil in photographs
- Crossed or misaligned eyes
- Persistent redness or swelling
- Difficulty tracking objects
- Unusual clumsiness or hesitation in movement
These symptoms may not always appear together and can easily be overlooked, particularly in infants.
