The ophthalmologist views the retina with an indirect ophthalmoscope to determine the presence of tumors. A lid speculum or metal clip is placed between the eyelids to help keep the child's eye open. During the examination, the ophthalmologist uses a Q-tip or a metal scleral indenter (which looks like a pen with a flattened tip) to press on the scleral surface of the eye to push the most forward portions of the retina into view. Because the child is under anesthesia and his or her eye is numbed, they experience little or no discomfort from this process.

A sketch, or fundus drawing, is made of the tumor(s) of the eye. Sometimes photographs of the view through the indirect ophthalmoscope, fundus photos, are also taken of the tumor(s). Both the fundus drawing and the fundus photos serve as "maps" for the tumor(s) in the eye. Future examinations will be based on these original drawings and photographs; new drawings and photographs may be sketched and taken at each follow-up visit.

Ultrasound examination, which uses sound waves to penetrate and outline structures in the eye, confirms that retinoblastoma tumors are present and determines their thickness or height. Black and white polaroids of the ultrasound images may be taken initially and during the follow-up visits.

An X-ray test called a CAT-scan (computed axial tomography) is also performed to determine if there is any tumor outside the eye or in the brain. An MRI (magnetic resonance imaging), which uses magnetic waves to image the eyes, the orbits, and the brain, may also be performed.

Children who are diagnosed with retinoblastoma are also seen by a pediatric oncologist (children's cancer physician). The pediatric oncologist determines whether there is cancer anywhere else in the child's body. A physical examination and sometimes blood tests, a spinal tap (to see if there are cancer cells in the central nervous system), and a bone marrow biopsy (a sample of the blood cells taken from the bone) are performed by a pediatric oncologist.

Retinal drawing of retinoblastoma

CT scan of retinoblastoma

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