The Brückner Transillumination Test

Infrared photographs with a selective wavelength filter to diagnose small-angle esotropia in young children

PURPOSE

To validate the effectiveness of the selective wavelength filter analysis with infrared photographs for diagnosing small-angle esotropia in children under age 4.

METHODS

This is a retrospective, observational, case-control study. A total of 83 esotropes with an esodeviation of ≤ 16 prism diopters (PD) and 75 orthotropic controls under 4 years of age were included. Full-face infrared photographs were taken with a selective wavelength filter in front of either eye. The angles of esodeviation on photographs were measured with the three-dimensional Strabismus Photo Analyzer. The alternate prism and cover test or the Krimsky test were repeatedly performed to measure ocular alignment.

RESULTS

The testability of infrared photographs using selective wavelength filters in children under 4 years of age was 85.6%. The mean angle of esodeviation was 11.3 ± 4.0 PD by manual measurements and 11.5 ± 4.4 PD by the infrared photograph analysis. Manual measurements and the infrared photograph analysis showed a strong positive correlation (R = 0.815, P < 0.001). The sensitivity and specificity of the infrared photograph analysis for detecting small-angle esotropia were 95.2% and 77.9%, respectively, with a cutoff value of 4.0 PD.

CONCLUSIONS

The automated infrared photograph analysis was simple and effective for diagnosing small-angle esotropia in young children.

Tests for detecting strabismus in children aged 1 to 6 years in the community

BACKGROUND

Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect strabismus by trained professionals is the cover‒uncover test.

OBJECTIVES

To assess and compare the accuracy of tests, alone or in combination, for detection of strabismus in children aged 1 to 6 years, in a community setting by non-expert screeners or primary care professionals to inform healthcare commissioners setting up childhood screening programmes.Secondary objectives were to investigate sources of heterogeneity of diagnostic accuracy.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library, the Health Technology Assessment Database (HTAD) in the Cochrane Library (2016, Issue 4), MEDLINE Ovid (1946 to 5 January 2017), Embase Ovid (1947 to 5 January 2017), CINAHL (January 1937 to 5 January 2017), Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1990 to 5 January 2017), BIOSIS Previews (January 1969 to 5 January 2017), MEDION (to 18 August 2014), the Aggressive Research Intelligence Facility database (ARIF) (to 5 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 5 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 5 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 5 January 2017. We did not use any date or language restrictions in the electronic searches for trials. In addition, orthoptic journals and conference proceedings without electronic listings were searched.

SELECTION CRITERIA

All prospective or retrospective population-based test accuracy studies of consecutive participants were included. Studies compared a single or combination of index tests with the reference test. Only those studies with sufficient data for analysis were included specifically to calculate sensitivity and specificity and determine diagnostic accuracy.Participants were aged 1 to 6 years. Studies reporting participants outside this range were included if subgroup data were available.Permitted settings included population-based vision screening programmes or opportunistic screening programmes, such as those performed in schools.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. In brief, two review authors independently assessed titles and abstracts for eligibility and extracted the data, with a third senior author resolving any disagreement. We analysed data primarily for specificity and sensitivity.

MAIN RESULTS

One study from a total of 1236 papers, abstracts and trials was eligible for inclusion with a total number of participants of 335 of which 271 completed both the screening test and the gold standard test. The screening test using an automated photoscreener had a sensitivity of 0.46 (95% confidence interval (CI) 0.19 to 0.75) and specificity of 0.97 (CI 0.94 to 0.99). The overall number affected by strabismus was low at 13 (4.8%).

AUTHORS' CONCLUSIONS

There is very limited data in the literature to ascertain the accuracy of tests for detecting strabismus in the community as performed by non-expert screeners. A large prospective study to compare methods would be required to determine which tests have the greatest accuracy.

Sensitivity and Specificity of Red Reflex Test in Newborn Eye Screening

OBJECTIVES

To validate the sensitivity of an isolated red reflex test in detection of ocular abnormalities of the anterior and posterior segments in newborns.

STUDY DESIGN

Red reflex test and comprehensive eye examinations including external inspection, pupil examination, hand-held slit lamp examination, and RetCam fundus imaging (Clarity Medical Systems, Pleasanton, California) were performed in 7641 newborns. All results were documented as negative or positive. Sensitivity and specificity of red reflex test were calculated by the use of comprehensive eye examinations as the reference standard. Anterior abnormalities were separated from posterior abnormalities, and the sensitivity of red reflex test for each group was calculated.

RESULTS

The proportion of abnormalities that were correctly classified by red reflex test was greater in anterior segment group (sensitivity = 99.6%, 95% CI 97.1%-100%) than in the posterior group (sensitivity = 4.1%, 95% CI 3.3%-5.1%, χ² = 1521.382, φ = 0.836, P < .001).

CONCLUSIONS

The red reflex test was a useful universal screening tool in detection of anterior abnormalities; however, the test has limitations in detection of posterior abnormalities. The generalization of these results to infants and children and observers with varying levels of expertise may need to be established further.