Bridging the diagnostic and therapeutic gaps in retinoblastoma: A referral center's perspective from Southeast Asia

Abstract

Purpose: To highlight diagnostic and therapeutic disparities in retinoblastoma care and share our institutional approach to bridging these gaps in a resource-limited setting in Southeast Asia. Design: Perspective and selected literature review. Methods: A narrative overview of our referral center's experience was combined with key findings from the literature. We describe evolving diagnostic resources, as well as treatment advancements such as intra-arterial chemotherapy (IAC) and high-dose intravitreal topotecan. Results: Significant disparities persist between high- and low-resource settings in both diagnosis and treatment of retinoblastoma. While high-income countries have access to advanced tools such as aqueous humor analysis, molecular diagnostics, and globe-salvaging therapies, many lower-resource centers must rely primarily on clinical examination and imaging, as aqueous humor testing remains unavailable in most regions. In these settings, close clinical monitoring is essential, particularly in diagnostically uncertain cases. Treatment options are also limited, with restricted access to IAC and other advanced modalities. At our center, protocol refinements, multidisciplinary coordination, and adaptation of emerging therapies have contributed to improved outcomes. In institutions without IAC capability, high-dose intravitreal topotecan may offer a feasible alternative when used in combination with other available treatments. Conclusion: Retinoblastoma management in resource-limited settings requires tailored approaches. Institutional adaptation of IAC protocols and incorporation of emerging therapies such as high-dose intravitreal topotecan can improve outcomes, even in advanced disease. Broader access to diagnostic tools, regional training, and inter-institutional collaboration are essential to bridge global gaps in retinoblastoma care.