Global retinoblastoma service availability in 2024 and equity trends since 2017

BACKGROUND/AIMS: To assess the global availability of retinoblastoma (Rb) diagnostic and treatment services in 2024 and examine changes in their income-related distribution since 2017. METHODS: We conducted an international cross-sectional study with a longitudinal comparison. In 2024, 438 Rb treatment centres from 145 countries participated; 49 countries had no identified Rb centres, and four were unconfirmed. Longitudinal analyses included 246 centres from 124 countries that participated in both the 2017 and 2024 assessments. Centres reported availability of key diagnostic services (CT, MRI, pathology and genetic testing) and treatment modalities (intravenous, intravitreal and intra-arterial chemotherapy; focal therapies and radiotherapy). Service availability was assessed using country-level binary availability and proportional availability across centres. Income-related distribution was evaluated using concentration curves and concentration indices. RESULTS: In 2024, pathology services were available in 143 of 145 countries (98.6%), MRI in 128 (88.3%) and genetic testing in 74 (51.0%). Intravenous chemotherapy was available in 139 countries (95.9%), intravitreal chemotherapy in 101 (69.7%) and intra-arterial chemotherapy in 69 (47.6%). Among centres participating in both study years, proportional availability increased across all modalities between 2017 and 2024, with the largest gains observed for genetic testing, intravitreal chemotherapy and cryotherapy. Except for pathology and intravenous chemotherapy, service availability remained concentrated in higher-income settings. Sensitivity analyses indicated that observed reductions in income-related inequality were not explained by income reclassification. CONCLUSION: Between 2017 and 2024, global availability of Rb services increased and income-related inequality narrowed. However, advanced diagnostic and eye-preserving treatments remain predominantly available in higher-income settings.