Red reflex

Abstract: Appropriate visual assessments help identify children who may benefit from early interventions to correct or improve vision. Examination of the eyes and visual system should begin in the nursery and continue throughout both childhood and adolescence during routine well-child visits in the medical home. Newborn infants should be examined using inspection and red reflex testing to detect structural ocular abnormalities, such as cataract, corneal opacity, and ptosis. Instrument-based screening, if available, should be first attempted between 12 months and 3 years of age and at annual well-child visits until acuity can be tested directly. Direct testing of visual acuity can often begin by 4 years of age, using age-appropriate symbols (optotypes). Children found to have an ocular abnormality or who fail a vision assessment should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients.

Abstract: According to the general principles of screening, detection of visual impairment in children is worthwhile, since the condition is a serious health problem, reliable diagnostic tests are available and effective treatment is possible in most instances of ocular and visual dysfunction. However, an evaluation of the screening procedures has not been properly done and the cost-benefit of screening has not been studied. The aim of the present study is to perform a systematic analysis of the screening programs for detection of visual dysfunction. In the screening two parts can be separated, one that concerns the more serious ocular and visual conditions which have to be discovered by general survey methods very early in life, and one that involves detection of less serious conditions, mainly amblyopia, which can be diagnosed by testing for monocular reduction of visual acuity at about 3-4 years of age. The performance characteristics of the screening programs used in Sweden and Canada were evaluated and found to be very favourable. Based on the analysis and the evaluation, recommendations are made on programs for vision screening in children that could be applied more widely. The program could involve all or parts of the following: 1) A careful inspection of the eyes in the neonatal period and preferably also examination of the red reflex with the ophthalmoscope. 2) Children at high risk for ocular and visual disorder, i.e. those born prematurely before 32 weeks of age, or with genetic disease, hearing deficit and/or neurological and mental disorder, should be examined at the proper age by an ophthalmologist. 3) All staff at pediatric departments and child health care centers should be familiar with the visual development of the normal baby and should be alerted to the various symptoms and signs which first warn parents that there may be a visual defect. An inspection of the eyes to detect squint should be part of all pediatric examinations. 4) A screening test of monocular visual acuity in 4 year-old children can be reliably performed by non-ophthalmic personnel after proper training. The screening test should be repeated by school nurses during the first grade of school, and at regular intervals during the school years. 5) The children that screen positively should be seen by ophthalmologists, and in some cases by orthoptists, without undue delay for diagnosis and treatment.

Abstract: A rapid method of grading clinically important central lens opacities has been developed for use in eye surveys and in epidemiological studies of cataract and has been field-tested in a specifically designed observer agreement study in a survey of a rural community in Central India. The grading method is based on simple measurement of the area of lens opacity that obscures the red reflex relative to the area of clear red reflex, as visualised through the undilated normal pupil. Good to almost perfect agreements were attained between two ophthalmologists and two trained ophthalmic assistants for overall grades of central lens opacity. Most disagreements were trivial in nature and were concerned with difficulties in distinguishing grade 0 from grade 1, and with hazy appearance of the red reflex in high myopes and in cases of early nuclear sclerosis. Teaching materials including video tape and slides for training survey teams and other workers are in preparation.

Abstract: Background The American Academy of Pediatrics recently published recommendations for the red reflex assessment in the newborn period to detect and treat ocular disorders as early as possible, and to prevent lifelong visual impairment and even save lives. The test is technically simple to perform, non-invasive, requires minimal equipment and can detect a variety of ocular pathologies including cataracts and retinal abnormalities. No specific national guidelines exist on this issue. Objectives To document the implementation of red reflex examination in routine neonatal care and present the findings. Methods Our clinical experience following inclusion of the red reflex test into the newborn physical examination in a single center was reviewed. In addition, an electronic mail questionnaire was sent to all neonatology departments in Israel regarding performance of the red reflex test. Results During 2007-2008, five infants were identified with congenital cataracts at days 2-6 of life prior to discharge from hospital. Surgery was performed in one infant at age 2 months and all infants underwent a thorough follow-up. The incidence of congenital cataract in our center was 1:2300. Less than half the neonatology departments have endorsed the AAP recommendation and perform the red reflex test routinely. Conclusions Abnormal red reflex test after delivery enables a rapid ophthalmologic diagnosis, intervention and close followup. We recommend that red reflex screening be performed as part of the newborn physical examination; if abnormal, an urgent ophthalmologic referral should be made.