All physicians should be aware of the early symptoms and signs of cancer. Depending on the type of cancer, failure to make an early diagnosis can pose a threat to the involved organ and, more importantly, to the patient's life. These principles are particularly true with regard to retinoblastoma, a disease that affects infants and young children. Failure to recognise retinoblastoma at an early stage can lead to blindness, cosmetic deformities, and, in advanced cases, even death.1-3

In this issue of the BJO, Goddard and colleagues report their observations on delayed diagnosis of retinoblastoma and its effects on type of treatment and outcome (p 1320). They found that there was an increased risk of delayed diagnosis in younger children, in children who presented with strabismus rather than leucocoria, and in those who were evaluated initially by a health visitor rather than a medical physician. This delay in diagnosis appeared to increase the risk of local tumour invasion. Fortunately, there were no deaths in this group of patients.

Many years ago, enucleation was the only acceptable treatment for retinoblastoma. Although enucleation was probably a life saving procedure in many cases, it eliminated any chance of vision in the affected eye and it was associated with the …