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When a diagnosis of retinoblastoma is considered, your child will come to the operating room for an examination under anesthesia (EUA) and the beginning of treatment. An unusual feature of
retinoblastoma is that both eyes can be separately involved with this cancer, although the tumors can not spread from one eye to the other. If both eyes are involved, usually but not always, one eye is more severely affected than the other one. During the initial exam in the doctor's office, it might appear as though
only one eye has tumors, but closer examination of the child asleep in the operating room may reveal tumor involvement in the second eye.

If you are scheduled for your child's first EUA at the Hospital for Sick Children in Toronto, a nurse will give you a tour of the ward and then carry out the Day admission routine. This includes a nursing history, temperature, heart rate, blood pressure and urine sample. A technician will take a routine blood sample
from a finger prick. A doctor will take a medical history and examine your child. The doctors will explain the disease and the possible treatment options. You will be asked to sign a consent form for the EUA and any treatment that may be needed.

IMPORTANT:

For 12 hours before any anesthetic your child can have no solid food with the exception of children under the age of two years who are allowed breast milk or formula up to 6 hours before the anesthetic. Clear fluids (not milk) are permitted up to 3 hours before surgery, but then the child can have nothing more since food or liquid in the stomach is dangerous during an anesthetic. If the child vomits while under anaesthesia, the fluid could be breathed into the lungs and he could choke. If these guidelines are not followed strictly, the EUA may have to be canceled and the childs treatment may be delayed. These guidelines must be followed each time your child comes to the hospital and is given an anaesthetic.

A nurse will go with your child to the operating room and you will be asked to wait in the parents post-operative waiting area. When the EUA and any treatment is finished, your child will be taken to the Recovery Room. He will remain there for 1 to 2 hours until he is fully awake. While it is not common, occasionally a child may return from the Recovery Room with a red flush to the face. The flush is a reaction to one of the pre-operative medications, Atropine and it will disappear within a few hours.

The doctor will speak to you in the waiting area during (if necessary) and after the procedure. She will discuss the projected long-term treatment plan with you, explaining the treatments involved and the rationale behind them. After the diagnosis has been confirmed and your child has had his first EUA, he will continue to be seen at the hospital for ongoing treatment sessions or follow-up visits.

During the next few visits to the hospital, you will meet many individuals involved in the care of your child. These people may include the clinic coordinator, the genetic counselor, the social worker, the residents (doctors training to be ophthalmologists), fellows (doctors specializing in pediatric and tumor ophthalmology), one or more ophthalmologist and an oncologist. These people work together as a Team to ensure the best care for your child and to provide you and your family with the appropriate information and resources.