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Similar to Benjamin’s story, a parent, relative or family friend is often the first to identify “The Glow.” To learn more about how to spot “The Glow” and if you should seek care, click on the questions for detailed answers.
Explanation of "The Glow"
What is “The Glow”?
Leukocoria, the medical term used to describe “The Glow” is an abnormal red eye reflex, common to several devastating childhood eye diseases and is seen as a yellow “glow” in the pupil. Leukocoria actually means white pupil, and prompt attention by appropriate medical personnel is recommended if “The Glow” is seen in multiple photos.
How common is “The Glow”?
According to the National Eye Institute, there is a potential incidence rate of 20,000-30,000 cases per million children each year. Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in childhood.
"The Glow" in Photos
How do I check for glowing eyes in my child’s photos? How do I spot Leukocoria?
Parents or family members are often the first to notice a white or golden glow present in photographs of their children’s eyes. Below are a few steps to help you detect “The Glow.”
- Use uncorrected photos. If the photo was red-eye re-touched or if the camera has a red-eye correction feature, existing Leukocoria may not be visible.
- Find photos where your child is looking directly at the camera.
- Choose photos with a dark background, preferably photos taken at night.
- With the photos you have selected, look for either a white, yellow or gold pupil. Because of the glimmer of Leukocoria, it is sometimes referred to as a cats-eye glow.
I’ve seen “The Glow” in three photos. I’m very worried … should I panic?
Feel concerned, but there is no need to panic. We understand this is frightening, but remember that most of the diseases and disorders associated with “The Glow” are highly treatable and correctable.
Up to one in 80 children will exhibit “The Glow” before the age of nine. Know that early identification and action may lead to diagnosis of an entirely curable condition. If you are seeing “The Glow” in multiple photos, we recommend that you have your child checked by your pediatrician and ask for a Red Reflex Screening.
“The Glow” is present in several of my child’s photos. What should I do next?
If you see it once, be alert. If you see it often, be active. Know The Glow members are not doctors, most are mothers, who recommend you trust your intuition.
If you’ve seen the glow in multiple photographs contact your pediatrician or local pediatric ophthalmologist. Take copies of the photos with glowing eyes to the doctor’s office.
During the appointment, ask the doctor to perform the Red Eye Reflex Screening. This test is not difficult for pediatricians to perform nor is it painful for the child. The Red Eye Reflex Screening allows the doctor to test for the presence of glow-related diseases and conditions.
My child exhibits “The Glow” but doesn’t seem to be complaining about any eye issues ... should I still be concerned?
There are no pain receptors within the eye. Several glow-related eye conditions develop slowly and without other symptoms. It is always best to seek professional medical care if your child is exhibiting “The Glow” on multiple photographs.
My cellphone/iPhone keeps showing glowing eyes in all of my children ... should I be alarmed?
“Pseudo Leukocoria” tends to occur sporadically with smartphones. The issue is being investigated by smartphone developers, but for now the recommendation is to check for “The Glow” on multiple occasions, straight on and in the same eye, to help avoid these “false positive” camera glows.
Why is it important that “The Glow” photo be straight on?
Differences in camera angles can sometimes show “The Glow” when reflecting light. It is more likely to be true Leukocoria if the subject with the glow is looking directly at the camera.
Can I stage a photo shoot to test for “The Glow?”
There is currently no photo test with 100% accuracy.
Why does “The Glow” occur most often in photos with red-eye?
Typically photographs reflect back the healthy red blood vessels in the back of the eye, but when there is a foreign matter present like lipids, fats or a mass such as a tumor, the reflection will be of that foreign matter.
Why can’t I see “The Glow” by looking closely into my child’s eye?
The retina typically absorbs most light which comes into the eye. When properly dilated and with the aid of an ophthalmoscope, a physician is in a better position to accurately screen for “The Glow.”
Diagnosing "The Glow"
What diseases are associated with “The Glow”?
“The Glow” is an indicator of as many as 16 devastating childhood eye diseases, as well as the leading preventable cause of Amblyopia – monocular childhood blindness.
Some of the diseases, such as nearsightedness, are correctable. Others are much more devastating but still preventable.
The list of glow-related diseases includes:
- Amblyopia, monocular childhood blindness
- Cataract, clouding of the eye lens
- Congenital Cataract, clouding of the eye’s lens present at birth
- Choroidal Melanoma, cancer of the choroidal blood vessel layer underneath the retina
- Coats’ Disease, A rare eye disorder involving abnormal development of the blood vessels of the retina, which lines the back wall of the eye. As various components of blood leak into the retina, fluid accumulates under the retina. The result may be loss of vision, particularly central vision, and detachment of the retina from other layers of the eye.
- Coloboma, a hole or other defect in the iris
- Norrie’s Disease
- Retinoblastoma, A childhood cancer arising from immature retinal cells in one or both eyes and can strike from the time a child is in the womb up to 8 years of age; the cancer is most commonly diagnosed between 12 and 24 months. This cancer is curable if caught early.
- Retinal Detachment
- Retinal Dysplasia
- Retinopathy of Prematurity
How important is the Red Reflex Test, and how should it be performed?
Newborn children are not born with 20/20 vision. There is a brief window of time during the first year of life where the retina and visual cortex learn to work together to produce the perception of formed vision. Should anything interfere with creating a sharply focused retinal image, the results can be dense and permanent amblyopia.
Assessing visual function in a newborn and pre-verbal child can be very challenging. The most effective way to detect ocular pathology in this population is the red reflex test, which can identify cataracts, retinal detachments and anisometropia.
In 2008, the American Academy of Pediatrics (AAP) revised its policy statement on performing red reflex tests. It recommends that:
- All newborn children have testing done prior to discharge from the nursery and on ALL subsequent exams.
- The results must be documented as to whether the reflexes in both eyes were equivalent in color, intensity and clarity.
- Children with an abnormal reflex should be referred immediately to an ophthalmologist for further evaluation.
- The pediatrician must receive confirmation back from the ophthalmologist that the consultation was performed.
- Children with a family history of hereditary eye diseases need to be referred to an ophthalmologist for evaluation.
- If the parents describe a history consistent with leukocoria,the pediatrician should refer the patient to an ophthalmologist to evaluate for possible retinoblastoma.*
(*This last recommendation is particularly important especially in an era where the parents may notice an unequal red reflex with digital flash photography.)
Even in those children with ocular pathology, the red reflex test can be challenging to perform. In 2003, a study (Abramson et al, Pediatrics) reviewed 1632 patients with retinoblastoma but no family history, and found that family members made the initial observation 80% of the time while the pediatricians were the first to recognize the abnormality only 8% of the time.
Much of this is now attributed to the frequency of parents taking flash photography using digital cameras. Since the red reflex test evaluates primarily the retina within the macula, it may miss a retinoblastoma lesion that is off in the peripheral retina, whereas a flash photograph taken at an angle may identify a tumor in the periphery. Because of these statistics, it is very important for the pediatrician to follow the AAP recommendation for referral to an ophthalmologist should the parents comment on an abnormal reflex even in the setting of a normal test in the office.
There are several simple ways to increase the accuracy of the red eye reflex test. The first is to make the assessment in a dimly lit or dark room. It can take 10 seconds from the time the lights go down to the time the pupil reaches maximal dilation. The second is to stand 4-6 feet away from the child and look through the direct ophthalmoscope so that the entire face is in clear focus. Then use a large enough aperture size so that both eyes are illuminated. By using simultaneous illumination, it is much easier to compare the reflex.
An absent reflex in one eye may result from a cataract. Conversely a white reflex can occur in a child with retinoblastoma or a retinal detachment due to Coats’ disease. In those cases where both eyes have a red reflex, but one is brighter than the other, the child may have different refractions resulting in anisometropic amblyopia.
All pediatricians need to be comfortable performing this simple yet powerful test. In many cases, pathology detected by an abnormal red reflex can be treated and in some cases may save a child’s eye or life.
What happens in the Red Reflex Test?
The physician dilates your child’s eyes and shines a light in the back of the eye using an ophthalmoscope. A white reflection indicates Leukocoria while an orange reflection is normal.
What should I expect if the ophthalmologist identifies “The Glow” in my child’s eye?
Upon positive identification of Leukocoria, the physician will look to treat the underlying cause of its existence. In 80% of cases early detection of blinding childhood diseases and disorders are preventable and/or correctable. Because there are 16 different associated disorders, the exact treatment will depend on which disorder is creating “The Glow.”