Abstract
PurposeLeukocoria is the most common presenting sign for pediatric eye disease including retinoblastoma and cataract, with worse outcomes if diagnosis is delayed. We investigated whether individuals could identify leukocoria in photographs (photoleukocoria) and examined their subsequent Internet search behavior.MethodsUsing a web-based questionnaire, in this cross-sectional study we invited adults aged over 18 years to view two photographs of a child with photoleukocoria, and then search the Internet to determine a possible diagnosis and action plan. The most commonly used search terms and websites accessed were recorded.ResultsThe questionnaire was completed by 1639 individuals. Facebook advertisement was the most effective recruitment strategy. The mean age of all respondents was 38.95 ± 14.59 years (range, 18–83), 94% were female, and 59.3% had children. An abnormality in the images presented was identified by 1613 (98.4%) participants. The most commonly used search terms were: “white,” “pupil,” “photo,” and “eye” reaching a variety of appropriate websites or links to print or social media articles.ConclusionsDifferent words or phrases were used to describe the same observation of photoleukocoria leading to a range of websites. Variations in the description of observed signs and search words influenced the sites reached, information obtained, and subsequent help-seeking intentions.Translational RelevanceIdentifying the most commonly used search terms for photoleukocoria is an important step for search engine optimization. Being directed to the most appropriate websites informing of the significance of photoleukocoria and the appropriate actions to take could improve delays in diagnosis of important pediatric eye disease such as retinoblastoma or cataract.
Highlights
The ‘red reflex’ occurs when unobstructed visible light enters the eye through the pupil, and is reflected back from the vascular layer of the eye.[1]
Testing the red (Bruckner) reflex has long been used as a screening tool in newborns and for postnatal eye examinations to detect the presence of any intraocular pathology that could compromise normal vision development,[2,3,4] as well as detecting the presence of strabismus or anisometropia.[5]
Leukocoria can herald the presence of congenital cataract or retinoblastoma in children, and less frequently Coats’ disease, retinal detachment, or persistent fetal vasculature.[6,7]
Summary
The ‘red reflex’ occurs when unobstructed visible light enters the eye through the pupil, and is reflected back from the vascular layer of the eye.[1] While a ‘red eye’ may commonly appear in photographs, when a flash is used, a white reflex or pupil (leukocoria) can be a sign of significant pediatric eye disease. Testing the red (Bruckner) reflex has long been used as a screening tool in newborns and for postnatal eye examinations to detect the presence of any intraocular pathology that could compromise normal vision development,[2,3,4] as well as detecting the presence of strabismus or anisometropia.[5]. Well as treatment of its underlying cause, affords the child the best possible visual outcome.[8,9,10,11] In the case of retinoblastoma, the most common pediatric intraocular neoplasm,[12] early diagnosis can be life saving. Published reports of delayed diagnosis of retinoblastoma indicate that parents are most likely the first to observe and report this finding, they are generally unaware that it is a sign of this potentially fatal disease.[11,13]
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