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Afghanistan–Pakistan retinoblastoma “Silk Road” referral pathway

Eye volume 39, pages 2164–2168 (2025) Cite this article

Subjects

Abstract

Background/Objectives

There is no specialist retinoblastoma (Rb) treatment centre in Afghanistan. We aimed to describe the first-year experience and outcome of referring Afghani children with Rb to Pakistan for treatment via the Afghanistan-Pakistan Rb “Silk-Road” referral pathway.

Methods

A 12-month prospective analysis (January 2023–January 2024) was conducted on children with suspected Rb presenting at National Organisation for Ophthalmic Rehabilitation (NOOR) eye care centres. Online consultations with specialists from the Rb-NET were used to confirm Rb diagnoses, and eligible patients were identified for referral to Rb treatment centres in Pakistan. Data on clinical presentation and outcomes were recorded using a structured Microsoft Excel spreadsheet, which was monitored by the entire team to ensure accuracy and completeness. The primary outcomes included successful transfer to Rb treatment centres in Pakistan and child survival at 1-year follow-up. Secondary outcomes focused on identifying barriers to successful patient transfer.

Results

Of the 23 children included in the study, 12/23 (52%) were referred due to leukocoria, 11/23 (48%) were female, 7/23 (30%) presented with bilateral Rb, and none had familial Rb. Overall, 5/23 (22%) children were diagnosed with extraocular disease, and 6/23 (26%) had distant metastases at the time of diagnosis. Only 9/23 (39%) children successfully reached Rb treatment centres in Pakistan. At the last follow-up, 5/23 (22%) children had died, 6/23 (26%) were confirmed alive, and 12/23 (52%) were lost to follow-up. The most common obstacles to patient transfer included difficulty crossing the Afghani/Pakistani border (12/23; 52%) and economic barriers (11/23; 48%) throughout the referral process.

Conclusions

This report highlights the immense difficulties in improving child survival from a treatable childhood cancer in a country with poor health care systems. The first-year experience of this referral pathway offers valuable lessons, which can guide the creation of a dedicated Rb treatment centre within Afghanistan.

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Fig. 1: Geographic map of the “Silk Road” Retinoblastoma referral pathway between Afghanistan and Pakistan.
The alternative text for this image may have been generated using AI.
Fig. 2: A 4-year-old child with suspected retinoblastoma presenting to the National Organization for Ophthalmic Rehabilitation (NOOR) centre in Afghanistan for referral to Pakistan via “Silk Road” pathway referral.
The alternative text for this image may have been generated using AI.

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Data availability

Will be made available upon request from corresponding author.

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Author information

Authors and Affiliations

  1. Rb-NET, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom

    Mattan Arazi, Jonathan Kfir, Alona Baum, Allen Foster & Ido Didi Fabian

  2. Medicine faculty, Kabul University of Medical Sciences (KUMS), Kabul, Afghanistan

    Sayed Mansoor Sediqi

  3. International Assistance Mission, NOOR Eye Care Programme, Kabul, Afghanistan

    Sayed Mansoor Sediqi, Abdul Rahim Majeed & Samina Behjat

  4. Paediatric Ophthalmology Department, Children Hospital & University of Child Health Sciences (CH & UCHS) Lahore, Lahore, Pakistan

    Shabana Chaudhry

  5. Indus Hospital, Karachi, Pakistan

    Syed Ahmer Hamid

Authors
  1. Mattan Arazi
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  2. Jonathan Kfir
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  3. Sayed Mansoor Sediqi
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  4. Abdul Rahim Majeed
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  6. Alona Baum
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  7. Samina Behjat
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  8. Syed Ahmer Hamid
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  9. Allen Foster
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  10. Ido Didi Fabian
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Contributions

MA and IDF were responsible for designing the study; all authors were responsible for overlooking the study, all authors were responsible for collecting the data; MA, AB and IDF analysed the data; MA wrote the preliminary draft; all authors reviewed and approval the final draft; IDF was responsible for overlooking the study.

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Correspondence to Ido Didi Fabian.

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Arazi, M., Kfir, J., Sediqi, S.M. et al. Afghanistan–Pakistan retinoblastoma “Silk Road” referral pathway. Eye 39, 2164–2168 (2025). https://doi.org/10.1038/s41433-025-03823-0

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