Skip to main content
Log in

Red reflex examination in neonates: evaluation of 3 years of screening

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Red reflex is a test that can detect potentially life-threatening ocular abnormalities. In 2012, a red reflex screening campaign was started in Umbria, central Italy. In this study, we report the results of the first 3 years (2012–2014) of screening.

Methods

Red reflex screening was carried out in the 11 regional birth centres. On the first level, the test was performed on all newborns within the third day of life. A pathologic test was an indication for referral to the nearest Ophthalmology Hospital Department (II level). Patients were referred to the Perugia University Ophthalmology Hospital Department if an ulterior evaluation or if treatment was necessary (III level).

Results

Between 1 January 2012 and 31 December 2014, 22,884 children were born in Umbria and of these, 22,272 (97.3%) were tested with the red reflex. Four hundred and sixty-one (4.83%) neonates resulted having a positive or equivocal test and were sent to II level. Three of these cases (0.01%) were affected by an important eye disease, in particular two patients (0.009%) presented congenital cataract and one patient (0.005%) presented retinoblastoma.

Conclusion

Our results are consistent with the previous findings, although reports on red reflex screening are sporadic in the literature. Despite the high number of false positives, the red reflex test has proven to be a useful, easy to perform and low cost test for the early detection of congenital low vision diseases, and our data confirm that it must become part of normal neonatal assessments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lambert SR, Drack AV (1996) Infantile cataracts. Surv Ophthalmol 40:427–458

    Article  CAS  PubMed  Google Scholar 

  2. World Health Organization (1977) Global initiative for the elimination of avoidance blindness. WHO, Geneva

    Google Scholar 

  3. American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology (2003) Eye examination in infants, children, and young adults by pediatricians. Pediatrics 111:902–907

    Article  Google Scholar 

  4. American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology (2003) Eye examination in infants, children, and young adults by pediatricians: organizational principles to guide and define the child health care system and/or improve the health of all children. Ophthalmology 110:860–865

    Article  Google Scholar 

  5. American Academy of Pediatrics (2008) Red reflex examination in neonates, infants, and children. Pediatrics 122:1401–1404

    Article  Google Scholar 

  6. Magnusson G, Bizjajeva S, Haargaard B, Lundström M, Nyström A, Tornqvist K (2013) Congenital cataract screening in maternity wards is effective: evaluation of the Pediatric Cataract Register of Sweden. Acta Pediatr 102(3):263–267

    Article  Google Scholar 

  7. Eventov-Friedman S, Leiba H, Flidel-Rimon O, Juster-Reicher A, Shinwell ES (2010) The red reflex examination in neonates: an efficient tool for early diagnosis of congenital ocular diseases. Isr Med Assoc J 12(5):259–261

    PubMed  Google Scholar 

  8. Clopper CJ, Pearson ES (1934) The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 26:404–413

    Article  Google Scholar 

  9. Cornfield J (1956) A statistical problem arising from retrospective studies. In: Neyman J (ed) Proceedings of the Third Berkeley Symposium, Vol. 4. University of California Press, Berkeley, p 135–148

  10. Nelson LB (1984) Diagnosis and management of cataracts in infancy and childhood. Ophthalmic Surg 15:688–697

    CAS  PubMed  Google Scholar 

  11. Francis PJ, Berry V, Bhattacharya SS, Moore AT (2000) The genetics of childhood cataract. J Med Genet 37:481–488

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Litmanovitz I, Dolfin T (2010) Red reflex examination in neonates: the need for early screening. Isr Med Assoc J 12(5):301–302

    PubMed  Google Scholar 

  13. Rahi JS, Dezateux C (2001) British Congenital Cataract Interest Group. Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a national study of congenital cataract in the UK. Invest Ophthalmol Vis Sci 42(7):1444–1448

    CAS  PubMed  Google Scholar 

  14. Mussavi M, Asadollahi K, Janbaz F, Mansoori E, Abbasi N (2014) The evaluation of red reflex sensitivity and specificity test among neonates in different conditions. Iran J Pediatr 24(6):697–702

    PubMed  PubMed Central  Google Scholar 

  15. Haargaard B, Nyström A, Rosensvärd A, Tornqvist K, Magnusson G (2015) The Pediatric Cataract Register (PECARE): analysis of age at detection of congenital cataract. Acta Ophthalmol 93(1):24–26

    Article  PubMed  Google Scholar 

  16. Bhatti TR, Dott M, Yoon PW, Moore CA, Gambrell D, Rasmussen SA (2003) Descriptive epidemiology of infantile cataracts in metropolitan Atlanta, GA, 19681998. Arch Pediatr Adolesc Med 157:341–347

    Article  PubMed  Google Scholar 

  17. Rahi JS, Lynn R (1998) A survey of pediatricians’ practice and training in routine infant eye examination. Arch Dis Child 78:364–366

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Fry M, Wilson GA (2005) Scope for improving congenital cataract blindness prevention by screening of infants (red reflex screening) in a New Zealand setting. J Pediatr Child Health 41:344–346

    Article  Google Scholar 

  19. Sotomi O, Ryan CA, O’Connor G, Murphy BP (2007) Have we stopped looking for a red reflex in newborn screening? Ir Med J 100(3):398–400

    CAS  PubMed  Google Scholar 

  20. Chak M, Wade A, Rahi JS (2006) British Congenital Cataract Interest Group. Long-term visual acuity and its predictors after surgery for congenital cataract: findings of the British congenital cataract study. Invest Ophthalmol Vis Sci 47:4262–4269

    Article  PubMed  Google Scholar 

  21. Birch EE, Stager DR (1996) The critical period for surgical of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci 37(8):1532–1538

    CAS  PubMed  Google Scholar 

  22. Rogers GL, Tishler CL, Tsou BH, Hertle RW, Fellows RR (1981) Visual acuities in infants with congenital cataracts operated on prior to 6 months of age. Arch Ophthalmol 99:999–1003

    Article  CAS  PubMed  Google Scholar 

  23. Gelbart SS, Hoyt CS, Jastrebski G, Marg E (1982) Long-term visual results in bilateral congenital cataracts. Am J Ophthalmol 93:615–621

    Article  CAS  PubMed  Google Scholar 

  24. Kugelberg U (1992) Visual acuity following treatment of bilateral congenital cataracts. Doc Ophthalmol 82:211–215

    Article  CAS  PubMed  Google Scholar 

  25. Magli A, Forte R, Rombetto L (2013) Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract. Graefes Arch Clin Exp Ophthalmol 251(1):309–314

    Article  PubMed  Google Scholar 

  26. You C, Wu X, Zhang Y, Dai Y, Huang Y, Xie L (2011) Visual impairment and delay in presentation for surgery in Chinese pediatric patients with cataract. Ophthalmology 118:17–23

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlo Cagini.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual patients caregivers included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cagini, C., Tosi, G., Stracci, F. et al. Red reflex examination in neonates: evaluation of 3 years of screening. Int Ophthalmol 37, 1199–1204 (2017). https://doi.org/10.1007/s10792-016-0393-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-016-0393-2

Keywords

Navigation