The parents of an Iowa Falls toddler noticed something was “different” about their son’s left eye, and pursued medical attention right away—something doctors say could have saved the boy’s life.

Niall Hoy was one when he was diagnosed with retinoblastoma after his parents, Alexandra Vaughn and Benjamin Hoy, noticed a difference in the reflections between his left eye and his right eye. The right eye had a red reflection, particularly in photos, but the reflection in his left eye was yellow. Because of the aggressiveness of the cancer, Niall’s eye was removed and a prosthetic eye put in its place.

Without the immediate treatment, Niall’s outcome may not have been so positive.

Parents as part of the care team

Culver Boldt, MD, an ophthalmologist at University of Iowa Hospitals and Clinics who specializes in eye cancers, credits Niall’s parents with having the forethought to recognize a potential problem.

“The biggest thing is to have parents who recognize when things are different,” Boldt says. “Your pupils usually look black, but if you shine a light in your eyes—or use a flash—you get that red reflection. But if you have a big white reflection, you may have a tumor back there.”

What a specialist can determine

Taking your child to a vision specialist is important, he says. Many tumors start off to the side of the eye, and if a light is shined straight into such an eye, there will be no white reflection in the pupil. It is not until the tumor gets larger and involves the center of the eye that the white reflex will be seen when a light is shined straight into the eye. Most pediatricians are trained to examine the eye by shining a light straight into the pupil, and this method of examination can miss early tumors.

Also, he says, most pediatricians don’t have the means to dilate the eye. For Niall’s parents, seeing their son’s eye after it was dilated was a game-changer—that was when they decided to take him to UI Stead Family Children’s Hospital.

“Eventually you should really get your child into the hands of someone who can properly dilate the eye and look into the back of the eye,” Boldt says.

close up of a child's eyes, showing cloudiness in one

What parents should look for

Arlene Drack, MD, is an ophthalmologist with UI Stead Family Children’s Hospital. She, too, applauds Vaughn and Hoy for noticing something different in their son’s eye and offers tips for helping other parents be more aware.

“The difference in the way eyes look in photographs is a very important sign for retinoblastoma,” she says, “but there are a number of other serious eye conditions that can present in a similar way. They are not all life-threatening, but they can cause blindness or loss of vision in children if not detected early.”

Some things Drack says parents should look for:

  • Having one eye that crosses inward or drifts outward
  • The child always closes the same eye when out in bright sunlight
  • The child is unable to see in the dark and always clings to someone
  • The child’s eyes shake or “jiggle”

Drack says relying on whether the child can see can be misleading.

“One important thing for parents to know is that if a child loses vision in only one eye there will be no sign that the child can’t see well because they will just switch to using the better eye,” she says. “Parents should not be falsely reassured if they notice a problem in one eye but the child seems to see perfectly well—get it checked out.”

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