Longitudinal sets of 52,982 facial photographs of 20 children previously diagnosed with an eye disorder (test children) and 20 children without an eye disorder (control children) were donated to researchers by parents in response to solicitations in mass media. To ensure that parents did not engage in the biased collection of photographs (at a particular angle, setting, or rate of collection), the researchers requested that parents donate their entire, unsorted, digital library of photographs that had been collected up to the time of enrollment. Parents of test children reported the date of diagnosis of the eye disorder, the disorder that was diagnosed, the laterality of the disorder (right, left, or bilateral), the treatment regimen, and in some cases, provided electronic copies of medical records (e.g., corrective lens prescription and fundus photographs). Test children were previously diagnosed with unilateral retinoblastoma (four males and four females), bilateral retinoblastoma (three males and four females), unilateral Coats’ disease (two males), bilateral pediatric cataract (one male), bilateral hyperopia (one female), and anisometropic amblyopia (one male).

Children with retinoblastoma were clinically diverse and exhibited the full range of disease severity according to both the International Classification for Intraocular Retinoblastoma Grouping (i.e., groups A to E) and Reese-Ellsworth Staging (i.e., stages I to V) (48). Children received a wide range of different therapies including proton beam radiation, intra-arterial chemotherapy, subtenon chemotherapy, systemic chemotherapy, laser photoablation therapy, cryotherapy, and eye enucleation. The two children with Coats’ disease were diagnosed at stages 2 and 3.

The age of clinical diagnoses for test children (table S7 and the Supplementary Materials) mirrored the typical range of dates of diagnosis for children in highly developed nations. For example, in highly developed nations, retinoblastoma is typically diagnosed in the first 2 years of life (bilateral retinoblastoma at 9 to 12 months and unilateral retinoblastoma at ~24 months) (13) and Coats’ disease at ~5 years (12). The average reported age of diagnosis for pediatric cataract ranges from birth to <3 months old (49) [amblyopia, 1.2 years; (50)]; the emergence of hyperopia is uncertain and ranges from months to years (51). Control children did not exhibit and had not been diagnosed with any type of eye condition, including common conditions such as refractive error, amblyopia, or strabismus (according to parents). This study was determined to be exempt from review by an Institutional Review Board at the Baylor University. The parents of children whose photographs were used in this study had given written consent to use and, in some cases, publish photographs of their children. Additional details of study methodology can be found in the Supplementary Materials.

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