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This is a prospective study documenting a series of children with RB treated at Ruharo Eye Centre between December 2009 and November 2019. Survival by stage of RB, number of eyes affected, and visual acuity were assessed. The study found that among 665 children with RB, 18.2 % (121 children) presented with metastatic (Stage 4) RB, the five-year survival was 60.2 % among all children with RB rising to 93.3 % and 87.2 % for children with unilateral and bilateral Stage 1 disease, respectively. In addition, among 184 children with bilateral disease, 130 (70.7 %) retained some level of sight following primary treatment with 91 of those (49.5 % of all bilateral children) retaining vision up to their death or to the end of follow-up. The study demonstrates that many children in Uganda present with advanced RB and curative treatment is not possible in this setting. In addition, children diagnosed and treated early have good prospects of survival, and retention of sight among many bilaterally affected children is achievable. Therefore, the strategic priorities for improving survival are changing community perceptions so that children with eye problems are brought without delay and widening access to modern treatment by using genereal health workers with standard drugs, backed by financial, social, and peer support.