Retinoblastoma patient Sol Mendoza Corrales, 13 months, typifies the challenges and successes of pediatric ophthalmology in Costa Rica. Sol just had surgery to remove her left eye, which contained a large, malignant tumor. But the fact that she survived her cancer, and that she will be continually monitored to ensure her remaining eye is cancer-free, is good news and cause for celebration.

Sol’s journey begins with mysterious white reflection in eye 

Sol’s father, Jose Luis Mendoza Duarte, was the first to notice something wrong with Sol’s eye. At times the pupil

Sol Mendoza Corrales

appeared white — something he had never seen before in anybody else. Sol was 4 months old at the time and appeared to be in perfect health, but the white reflection in her pupil bothered him.

Sol’s mother, Maricela Corrales Vargas, noticed that their daughter’s eyes didn’t line up correctly (strabismus), but nothing more. She had had other relatives with misaligned eyes and they had all grown out of it, so she saw no need to take Sol to the doctor.

It wasn’t until nine months later that Maricela noticed the white reflection in Sol’s pupil and took Sol to a local clinic. The doctor immediately diagnosed retinoblastoma — an abnormal pupil reflex caused by a tumor and the misalignment of her eyes. He had Sol rushed to the National Children’s Hospital in San Jose. There the diagnosis was confirmed and Sol was scheduled immediately for surgery.

Retinoblastoma: A leading childhood cancer

Retinoblastoma is a cancerous tumor of the eye. The tumor is located within the retina — the light-sensitive tissue in the back of the eye.

Retinoblastoma is usually apparent in children by the time they’re 18 months old. In Costa Rica, an estimated 1 out of 12,000 children are born with retinoblastoma. It can affect only one eye, although nearly half the time it affects both.

Although retinoblastoma is relatively rare, comprising 2 percent of all childhood cancers, it is the most common eye cancer in children and is nearly always fatal if not diagnosed early and treated effectively.

Delay in diagnosis allows cancer to spread

Why did Sol’s father see the white reflection in his daughter’s pupil, but not her mother? It turns out that Sol’s mother watched over her daughter during the day, while Sol’s father was at work. Sol’s father would check on her after dark, when he came home. Since it was nighttime when he saw her, Sol’s pupils had expanded to let in more light. The white appearance was more visible with her pupils enlarged.

Dr. Mariana Vargas

Dr. Mariana Vargas, director of the pediatric ophthalmology unit of the National Children’s Hospital in San Jose, examined Sol when she arrived from San Pablo de Heredia. Dr. Vargas regrets that Sol’s mother didn’t understand the urgency of seeking treatment right away. This is a common problem in developing countries. If the cancer had been caught earlier, it’s possible that Sol’s eye could have been saved. But Dr. Vargas is pleased that the hospital’s efforts to improve the country’s referral system did result in Sol’s being sent immediately to the National Children’s Hospital for diagnosis and treatment.

"Through ORBIS and the Ronald McDonald House Charities’ ‘Hand-in-Hand Saving Sight’ project, we’ve been able to educate doctors at the local level as to which patients should be referred to the National Children’s Hospital versus those who should be treated locally,” Dr. Vargas said. “We may not have been able to save Sol’s left eye, but we were at least able to remove the cancer before it had spread.”

Donated equipment and training cover all areas of Sol’s treatment

A retinal camera, right, was used during Sol's eye surgery.

Equipment donated by ORBIS and Ronald McDonald House Charities is being used in many areas of Sol’s treatment.

A donated digital retinal camera helped determine the extent of Sol’s cancer and will be used in monthly examinations to learn whether the cancer has spread to the remaining eye. If cancer cells are spotted, depending on the location of the cancer, an ORBIS-donated laser could be used to destroy the cancer.

Sol’s surgery was performed by Dr. Raquel Benavides, the National Children’s Hospital’s only eye oncologist. With ORBIS’s support, Dr. Benavides was able to attend the American Academy of Ophthalmology meeting last year in the United States and this year the World Ocular Tumor meeting in Italy. She also received additional pediatric oncology training in Costa Rica, through ORBIS volunteer medical faculty Dr. A. Linn Murphree. CAJA, the Costa Rican social security system, paid for Sol's treatment, and will pay for Sol’s follow-up care and a basic prosthetic eye.

One day later, Sol is doing well

One day post-surgery, Sol is nestled comfortably in her mother’s arms, calm and content. Her eyelid is sutured closed, securing the tiny silicon implant that’s replacing the eye that was removed. Dr. Benavides will place a cosmetic prosthesis over the implant in about a month, after the orbit has had time to heal.  

Sol laughs. Her hair is fixed up in pigtails that seem to sprout from the top of her head. Her mother coos at the little girl, overjoyed that the surgery went well and that her daughter’s remaining eye received a clean bill of health. Sol's prognosis is particularly good news for her parents because Sol is their only child, and they are unable to have more children. 

You can help

Your financial contribution can help other pediatric ophthalmology patients like Sol benefit from sight-saving — even lifesaving — eye surgery. Donations to ORBIS help fund advanced ophthalmic training, the purchase of needed equipment and development of an eye care infrastructure designed to streamline and maximize ophthalmic care. Please give generously so that others may see.