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Looking for the red reflex

Examining for the red reflex is part of the new-born screening exam and is often used in older infants to check for any anterior or posterior chamber eye pathology. All medical students are taught this and it is part of the daily screening life on a new-born unit. Subhi S et al [JAMA Ophthalmol 2020. doi:10.1001/jamaophthalmol.2020.4854] published an interesting systematic review and meta-analysis. They have asked the question, what is the diagnostic accuracy of the red reflex test for detecting ocular pathologies in infants? Data have been examined from 5 studies with 8713 patients. The bottom line is that eliciting the red reflex has a low sensitivity but a high specificity for detecting ocular pathologies. In other words an abnormal red reflex test result is highly indicative of an ocular pathology, but a normal red reflex result does not rule out ocular pathologies. Simple. Their eligibility criteria were defined according to population (studies of consecutively screened infants), exposure (red reflex or Brückner test (Lucina had not heard this name for the test) as the index test), comparator (any ophthalmological examination), and study type (any study with diagnostic test accuracy data). All studies used the red reflex test without pupillary dilation and were compared with a reference test performed with pupillary …

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