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J. H. Francis, A. E. Rizzuti, D. H. Abramson; Systemic Chemotherapy for Retinoblastoma: Losing Sight of Visual Outcome. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1686.
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An attempted meta-analysis of visual outcome in retinoblastoma eyes treated with chemotherapy; including a discussion of failed meta-analysis due to inadequate visual outcome reporting.
Review of literature within the past 12 years with exclusion of reviews, comments and those reporting on chemotherapy after enucleation.
Among 88 papers, 66 were eliminated for lack of visual outcome reporting. And of the remaining 22 papers, 15 were less informative for a variety of reasons. For example, 6 papers offered only qualitative data, and lacked uniformity. 12 papers provided numerical visual data but made it nearly impossible to decipher the associated RE Group of the patient, or whether they had received chemotherapy. One paper included only RE Groups I-III and 2 papers dedicated their papers to groups IV or V. Therefore, only 7 studies provided quantitative visual acuities of chemotherapy treated patients whom could be distinguished by Reese-Ellsworth classification. Also of note, 3 papers included the International Classification for Retinoblastoma and among the 17 papers providing follow-up intervals, the mean was 40 months.
Visual outcome is underreported in chemotherapy-treated retinoblastoma literature: a mere 8% of papers in our investigation provided useful information on visual acuity. Given vision is an important (and commonly the third) endpoint in retinoblastoma treatment; we suggest establishing a better understanding of vision and visual predictors in chemotherapy treated eyes. As newer treatments are explored and eyes (that would have previously been enucleated) are saved, we urge that visual acuity reporting become standard; preferably with defined interval acuities which may better account for the visual data over time.
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