What is the red light reflex in newborn assessment, also known as ophthalmoscopy (eye examination)?

From the Guidelines

The red light reflex is a crucial component of newborn assessment, where a healthcare provider shines a light into both eyes to detect symmetrical reddish-orange glow, indicating normal eye function, and any asymmetry or absence can signal serious eye conditions, as noted in the most recent study 1. The red light reflex, also known as the Bruckner reflex, is used to detect eye abnormalities in newborns. During this examination, a healthcare provider shines a light from an ophthalmoscope or penlight directly into both of the infant's eyes simultaneously from about 18 to 30 inches away, as recommended in the 2023 study 1.

Key Points to Consider

• In a normal response, both pupils should show a symmetrical reddish-orange glow (reflex) caused by light reflecting off the retina.
• The red reflex test is used to detect opacities in the visual axis, abnormalities of the back of the eye, and amblyogenic conditions, as stated in the study 1.
• Any asymmetry in color, brightness, or size is indicative of a problem, and the red reflex should be observed from both eyes for them to be considered normal, as noted in the study 1.
• The red reflex varies based on retinal pigmentation and, thus, varies by race/ethnicity, as mentioned in the study 1.

Importance of Red Light Reflex

The red light reflex is important because it can indicate serious eye conditions such as cataracts, retinoblastoma (eye cancer), retinal detachment, or other ocular disorders, as highlighted in the study 1.

• Early detection of abnormalities through this simple, non-invasive test allows for prompt intervention, potentially preserving vision and, in some cases like retinoblastoma, saving lives, as emphasized in the study 1.
• Parents should ensure this assessment is completed during regular pediatric check-ups, as recommended in the study 1.

From the Research

Red Light Reflex in Newborn Assessment

• The red reflex test is a simple, non-invasive method that can be performed easily by pediatricians during the clinical examination in the neonatal period, infancy, and childhood 2.
• The test can detect a variety of ocular pathologies, including cataracts and retinal abnormalities, and can lead to prompt diagnosis of several ocular disorders, with potentially severe consequences on patient's vision, cognitive function, and even life 2, 3.
• The American Academy of Pediatrics recommends 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 3.
• Red reflex testing has been shown to have high sensitivity and specificity for detecting congenital cataract and retinoblastoma, with studies suggesting that it should be recommended in WHO guidelines instead of torchlight examination 4.

Implementation and Feasibility

• The implementation of red reflex testing should be encouraged in all neonatal/pediatric departments, and prompt education of pediatricians should be empowered to achieve careful vision screening, according to current guidelines 2.
• Red reflex testing can be performed by non-specialist community nurses, and has been shown to be feasible and effective in community-based settings 4.
• The use of red reflex screening tools, such as Catcam and Arclight, has been shown to have higher sensitivity than torchlight examination, and are easy to learn and use by primary health care nurses 4.

Diagnostic Accuracy

• The diagnostic accuracy of red reflex testing has been shown to be high, with estimated sensitivities ranging from 90.2% to 97.6% for different screening tools 4.
• The specificity of red reflex testing has also been shown to be high, with estimated specificities ranging from 87% to above 90% for different screening tools 4.