Colorimetric and longitudinal analysis of leukocoria in recreational photographs of children with retinoblastoma

PLoS One. 2013 Oct 30;8(10):e76677. doi: 10.1371/journal.pone.0076677. eCollection 2013.

Abstract

Retinoblastoma is the most common primary intraocular tumor in children. The first sign that is often reported by parents is the appearance of recurrent leukocoria (i.e., "white eye") in recreational photographs. A quantitative definition or scale of leukocoria--as it appears during recreational photography--has not been established, and the amount of clinical information contained in a leukocoric image (collected by a parent) remains unknown. Moreover, the hypothesis that photographic leukocoria can be a sign of early stage retinoblastoma has not been tested for even a single patient. This study used commercially available software (Adobe Photoshop®) and standard color space conversion algorithms (operable in Microsoft Excel®) to quantify leukocoria in actual "baby pictures" of 9 children with retinoblastoma (that were collected by parents during recreational activities i.e., in nonclinical settings). One particular patient with bilateral retinoblastoma ("Patient Zero") was photographed >7, 000 times by his parents (who are authors of this study) over three years: from birth, through diagnosis, treatment, and remission. This large set of photographs allowed us to determine the longitudinal and lateral frequency of leukocoria throughout the patient's life. This study establishes: (i) that leukocoria can emerge at a low frequency in early-stage retinoblastoma and increase in frequency during disease progression, but decrease upon disease regression, (ii) that Hue, Saturation and Value (i.e., HSV color space) are suitable metrics for quantifying the intensity of retinoblastoma-linked leukocoria; (iii) that different sets of intraocular retinoblastoma tumors can produce distinct leukocoric reflections; and (iv) the Saturation-Value plane of HSV color space represents a convenient scale for quantifying and classifying pupillary reflections as they appear during recreational photography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms
  • Child, Preschool
  • Color*
  • Diagnosis, Computer-Assisted / methods
  • Female
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Photography / methods*
  • Pupil Disorders / diagnosis*
  • Pupil Disorders / physiopathology
  • Pupil Disorders / therapy
  • Reproducibility of Results
  • Retinal Neoplasms / diagnosis*
  • Retinal Neoplasms / physiopathology
  • Retinal Neoplasms / therapy
  • Retinoblastoma / diagnosis*
  • Retinoblastoma / physiopathology
  • Retinoblastoma / therapy
  • Sensitivity and Specificity
  • Time Factors

Grants and funding

This work was supported by a laboratory start-up fund provided to Bryan F. Shaw from the College of Arts and Sciences at Baylor University. This work was also supported by the Mukai Fund, at Massachusetts Eye and Ear Infirmary. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.