Landon's Story: Retinoblastoma* Survivor Refractive Error Detected in Vision Screening Secondary to More Serious Pathology

The Ryan family has experienced this situation firsthand and is incredibly grateful for the service of Impact America and their Focus First program. The Focus First program ensures that children in urban and rural communities receive comprehensive vision care during their crucial formative years. During the 2017-2018 school year, Focus First provided vision screenings to more than 23,000 children across Tennessee. Nearly ten percent of these children were flagged for full eye exams and are receiving comprehensive follow-up care from Sight Savers America, Vanderbilt Health Eye Institute, Southern College of Optometry and local eye care providers. Without the Focus First program, Landon, the Ryan’s daughter, may not have her vision today.

Sarah and Dave Ryan became aware of Landon’s vision abnormality after Focus First performed a vision screening at Landon’s daycare using the Welch Allyn Spot Vision Screener. The Spot Vision Screener is an instrument-based vision screener that can help quickly and easily detect vision issues on patients from six months of age through adult. As simple as taking a picture, the Spot Vision Screener can detect common vision problems such as myopia, hyperopia, astigmatism, anisometropia, strabismus and anisocoria without much cooperation from the child. While not a replacement for a comprehensive eye exam, Spot Vision Screener helps healthcare providers and organizations preserve sight and prevent blindness in children by referring them to an eye care specialist.² Landon’s vision screening results with Spot Vision Screener indicated she had myopia and would need a comprehensive eye exam by a pediatric ophthalmologist as soon as possible. Refractive errors sometimes can be secondary to more serious pathology, and in this instance a failed vision screening lead to a serious diagnosis upon full vision exam.³ “Everyone thought we were crazy to immediately schedule an appointment with a pediatric ophthalmologist, but I am so thankful we did,” said Sarah.

The Ryan family traveled thirty minutes to Chattanooga, TN, to meet with Dr. Rachel Brown, O.D. at SouthEast Eye Specialists. After a few tests including an ultrasound, Dr. Brown confirmed Landon’s nearsightedness was indicative of multiple tumors in Landon’s eyes. One tumor in Landon’s right eye had grown to a massive size, which was most likely impacting her vision. Sarah recalled her shock at learning that her happy, outgoing baby had an undetected vision problem. “We didn’t really believe it at first and thought it was a mistake,” she said.

It was imperative to get further evaluation as soon as possible since Landon was only 10 months old at the time. The Ryans made an appointment with Dr. Anthony Daniels at the Vanderbilt Eye Institute, two and a half hours away from their home in Signal Mountain, Tennessee. Dr. Daniels quickly confirmed their worst fear, bilateral retinoblastoma.

Retinoblastoma is a cancer that starts in the retina, located at the back of the eye. The retina consists of nerve tissue that senses light and relays the signal to the optic nerve. It is the most common type of eye cancer in children.⁴ When Landon received the diagnosis of bilateral retinoblastoma, the doctors were concerned the cancer had moved into her optic nerve. Thankfully, the MRI results indicated the cancer hadn’t moved into the optic nerve, but Landon would need two rounds of intra-arterial chemotherapy. Intra-arterial chemotherapy (IAC) is a method of delivering chemotherapy directly into the blood supply of the tumor.⁵

Two Years Old and Cancer Free

Landon traveled to the Vanderbilt Eye Institute every month for the first year to have eye exams under anesthesia and to make sure no new tumors had formed. While Landon was under anesthesia, there was always the possibility of needing to use cryotherapy or lasers to treat tumor growth.

Because of the early vision screening with Spot Vision Screener and the treatment she received with Dr. Brown and the team at Vanderbilt Eye Institute, Landon has progressed to seeing Dr. Daniels every three months for treatment until age five.

*Note: Spot Vision screener is intended to detect Hyperopia, Myopia, Astigmatism, Anisometropia, Anisocoria, and Strabismus. It is not intended to screen or detect Retinoblastoma.