Saving Eyes, Saving Lives

Dr. Carlos Leal co-chairs INCTR’s retinoblastoma subcommittee.

Retinoblastoma (RB) has one of the best cure rates of all pediatric cancers - if it is diagnosed early. For the past two decades, Dr. Carlos Leal has been a leading proponent of early detection and treatment of this rare tumor in young patients throughout Mexico.

An oncologist practicing at the Instituto Nacional de Pediatria in Mexico City, where he took his medical training, Dr. Leal enjoys the benefits of well-equipped facilities dedicated exclusively to clinical treatments and research in pediatrics. The government-supported teaching hospital sets the national standards of patient care and, in training the next generation of medical professionals, seeks to remedy the shortage of pediatric oncologists throughout the country.

With the help of the National Academy of Medicine and the support of Dr. Roberto Rivera-Luna and the INCTR, Dr. Leal created the first collaborative group for pediatric oncology in his country. The Mexican Retinoblastoma Group (RTBMex), a team of pediatric ophthalmologists established in 2003, has developed a national protocol that has been accepted by the National Seguro Popular health insurance program. Only 50% of the Mexican population is covered by other forms of health insurance, but the national insurance program provides medical coverage for all uninsured children with cancer.

This is a tremendous accomplishment, given the group’s initial findings in 2003. In a retrospective review of 500 RB cases diagnosed at 16 institutions over a six-year span, a large number of patients presented in advanced stages and treatment schemes varied widely. From this study, Dr. Leal says, it was clear that the group needed to work collaboratively to develop a national early detection program as well as a treatment protocol.

With the participation of 27 centers, the group created a National Retinoblastoma Registry. Early diagnosis and education were priorities. Under Dr. Leal’s leadership, the group also developed a national treatment protocol with guidelines for the management of retinoblastoma. Today, all Mexican children, from Tijuana to Cancun, receive the same high quality treatment.

Dr. Leal also serves as co-chair of INCTR’s subcommittee on retinoblastoma, endeavoring to share his knowledge and experience in treating patients with RB with colleagues in developing countries.

“One of the principal problems in developing countries is late diagnosis, which leads to a high mortality rate,” says Dr. Leal. “Early diagnosis is an important modality we can put into practice cheaply and easily to avoid the critical problems we experience when diagnosis is late. We have been able to bring about a huge change in the retinoblastoma field in my country through the work of the Mexican Retinoblastoma Group and the development of the national treatment protocol,” he says.
To help educate the public about Rb, Dr. Leal’s group launched a program that placed posters in childhood vaccination clinics frequented by young parents.

As part of his work with INCTR, Dr. Leal has been involved with a study designed to identify the causes of late presentation in RB in 10 countries with limited resources. He has also contributed to RB programs throughout Latin America. With public outreach programs in Saõ Paulo, Buenos Aires and Lima, doctors are saving eyes through early diagnosis. Supported by St. Jude Children’s Hospital, trained ophthalmologists from Latin America countries are traveling to remote regions of central Guatemala and Honduras to provide training in the diagnosis and treatment of young patients with RB, effectively saving the lives of hundreds of children.

“The most important thing is to make a prompt diagnosis so we can save the eyes,” notes Dr. Leal. “In poor countries, the general rule is to perform enucleation, or removal of the diseased eye. In Mexico and in other Latin American countries, earlier diagnosis makes it possible to have a target of performing enucleation in only half of our patients.”

The gold standard for Rb diagnosis is the Ret Cam, a sophisticated camera that allows the physician to photograph the inside of the eye and pinpoint the areas that require treatment. With this $100,000 piece of equipment, Dr. Leal says, they could save another 50 eyes each year. A small price to pay - but developing the necessary funding is not easy.

Marcia Landskroener for INCTR