Consumer Digital Cameras: A Feasible Strategy for the Early Detection of Childhood Blindness

Abstract

Purpose: : There is a need for earlier identification of childhood eye diseases. Red-reflex screening with a direct ophthalmoscope can allow the detection of eye abnormalities in infancy, but may not be ideal in India. We have developed a protocol to photograph the red reflex (PhotoRED) which may be better-suited. This study assessed its efficacy in detecting sight-threatening eye disease in pre-verbal children.

Methods: : 188 preschool children were screened with distant direct ophthalmoscopy(DDO) and photographed with the PhotoRED protocol. Patients’ recordswere reviewed retrospectively to confirm ophthalmological findings anddiagnosis. Examination sensitivities, specificities and the proportionof cooperative children were calculated.

Results: : Sensitivity and specificity for vision-threatening disease was 58% and 82% for PhotoRED and 79% and 90% for DDO. PhotoRED detected media opacities (80%) and retinoblastoma (100%) with sensitivities similar to DDO (86%; 100%). Under six months of age 28% and over six months 82% cooperated adequately during PhotoRED screening.

Conclusions: : PhotoRED is suitable for infants after 6 months and demonstrates an ability to detect several sight-threatening conditions, including important causes of childhood blindness. This simple test creates a record which can be remotely assessed and may mean better eye care in areas where access to care is difficult.

Keywords: clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology • clinical (human) or epidemiologic studies: prevalence/incidence • screening for ambylopia and strabismus