July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Accuracy of the Red Reflex Test to Detect Unequal Refractive Error
Author Affiliations & Notes
  • Aldo Vagge
    DiNOGMI, University Eye Clinic of Genoa, Genoa, Italy
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Kara La Mattina
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Leonard Nelson
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Aldo Vagge, None; Kara La Mattina, None; Leonard Nelson, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4418. doi:
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      Aldo Vagge, Kara La Mattina, Leonard Nelson; Accuracy of the Red Reflex Test to Detect Unequal Refractive Error. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4418.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Anisometropia is a significant cause of amblyopia, and may be difficult to detect in the absence of strabismus. We sought to determine the accuracy of the red reflex test in the detection of anisometropia.

Methods : Prospective, single-masked study which included new patients under the age of 18 who had not undergone pharmacologic pupillary dilation. A fellow who was masked to all clinical information illuminated both eyes with a direct ophthalmoscope in a darkened room from a distance of one meter, assessing whether the red reflex between the two eyes was symmetric or asymmetric. The patient was then cyclopleged and refraction was performed by an attending pediatric ophthalmologist. Exclusion criteria included the presence of strabismus, anisocoria, prior intraocular surgery, media opacity, leukocoria, and nystagmus. Sensitivity was compared to a null hypothesized value of 50% using a one-sided binomial test.

Results : Ninety-two patients with a mean age of 7.3 years (range 3 months - 16 years) were enrolled in the study. Anisometropia greater than 1.5 diopters in spherical equivalent (4 patients, range -10.625 to -2.625) or cylinder (3 patients, range 1.75 to 2.25) was accurately detected by red reflex testing in each case.

Conclusions : The red reflex test can be an accurate screening tool to detect anisometropia when performed by an ophthalmologist and pediatrician as well.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.


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