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Toli A, Perente A, Labiris G. Evaluation of the red reflex: An overview for the pediatrician. World J Methodol 2021; 11:263-277. [PMID: 34631483 PMCID: PMC8472546 DOI: 10.5662/wjm.v11.i5.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Red reflex test (RRT) is a simple, non-invasive method that can be performed easily by pediatricians during the clinical examination in neonatal period, infancy and childhood. Abnormal reflexes can lead to prompt diagnosis of several ocular disorders, with potentially severe consequences on patient's vision, cognitive function and even life. AIM To underline the contribution of pediatricians to early detection of vision and life threatening diseases by using RRT effectively. METHODS For the present systematic review, PubMed searches were performed using the key words "red reflex and newborn"; "red reflex and neonate"; "red reflex and complications"; "red reflex and necessity"; "red reflex and retinoblastoma"; "red reflex and congenital cataract"; "red reflex and glaucoma"; "red reflex and prematurity"; "red reflex and leukocoria"; "red reflex and blindness"; "red reflex sensitivity and specificity"; "red reflex and differential diagnosis"; "red reflex and guidelines". The relevant articles were selected without language restrictions. When a full-text publication was not available, their English abstracts were used. In some cases, studies from the reference lists of the selected articles provided useful information. The research took place in September 2020, in the Ophthalmology Department of University Hospital of Alexandroupolis. RESULTS A total of 45 articles were selected according to the used key words. After reviewing data from these articles, it is supported that red reflex remains an effective tool of undeniable importance for early detection of severe eye conditions, such as cataract, retinoblastoma, retinopathy of prematurity and glaucoma. Although literature reports some limitations of RRT, including a notable percentage of false positive tests, the inability to detect small, peripheral retinoblastomas and the lower sensitivity for posterior segment pathology, it is widely accepted that the benefits from the regular evaluation of the test on public health are significant. Therefore, RRT has been established by international guidelines and should be an essential component of pediatricians clinical practice. Red reflex implementation should be incorporated in pediatricians educational programs, so that they would be able to provide quality services and safe diagnoses. CONCLUSION The implementation of RRT should be encouraged in all neonatal/pediatric departments. Prompt education of pediatricians should be empowered in order to achieve careful vision screening, according to current guidelines.
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Affiliation(s)
- Aspasia Toli
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Asli Perente
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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2
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Mehner LC, Singh JK. Ocular Disorders in the Newborn. Neoreviews 2021; 22:e461-e469. [PMID: 34210810 DOI: 10.1542/neo.22-7-e461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Visual development begins at birth and continues throughout childhood. Ocular pathology can lead to permanent visual impairment and subsequent problems in overall development and school performance as well as signify serious systemic disease or even life-threatening malignancies. Prompt identification of congenital or early acquired ocular pathology via regular bedside ocular examinations and assessments of visual behaviors by neonatal clinicians is a critical component of newborn care. The goal of this article is to review the components of the newborn eye examination, describe key ocular findings and diagnoses that are common or critical to identify in the newborn period, and offer guidance on necessity and timing of ophthalmology referral.
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Affiliation(s)
- Lauren C Mehner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
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3
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Fundus Examination of 23,861 Newborns by Digital Imaging in Ningbo. J Ophthalmol 2021; 2021:6620412. [PMID: 34012681 PMCID: PMC8102127 DOI: 10.1155/2021/6620412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To perform fundus examinations of full-term and premature infants to identify common congenital ocular diseases and determine the incidence and additional risk factors in Ningbo, China. Methods Fundus examinations were performed on newborns between January 2017 and July 2020 in Ningbo using a RetCam3 or PanoCam LT wide-field digital imaging system. The neonates' birth weight, gestational age, gender, delivery mode, oxygen intake, and other conditions were recorded. We compared the incidence of ocular abnormalities in both full-term newborns and premature infants. Results There were 23,861 newborns in this study comprising 12,605 (52.8%) male and 11,256 (47.2%) female infants, 20,938 full-term babies, and 2,923 premature babies. The average gestational age was 37.9 ± 5.6 weeks, and the average birth weight was 3,189 ± 417 g. Overall, we found ocular abnormalities in 6,645 (27.8%). The most common abnormality in full-term newborns was retinal hemorrhage (RH), which we found in 3,827 (18.3%) cases. Other diseases identified included familial exudative vitreoretinopathy (FEVR), retinoblastoma (RB), and congenital cataracts. The delivery method had a significant impact on the incidence of neonatal RH (P < 0.001). Retinopathy of prematurity (ROP) was observed in 617 newborns accounting for 21.1% of all screened premature infants. Logistic analysis showed that gestational age and birth weight were important risk factors for ROP (P < 0.001). For treatable diseases, such as ROP, FEVR, congenital cataract, glaucoma, and RB, early identification allows for active treatment or referral to a specialized hospital for further treatment. Conclusion Early examination and prompt treatment of ocular disorders in newborns are important to avoid lifelong visual impairment. Eye examinations should be performed during the neonatal period and at regular follow-up visits.
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Falsaperla R, Saporito MAN, Pisani F, Mailo J, Pavone P, Ruggieri M, Suppiej A, Corsello G. Ocular Motor Paroxysmal Events in Neonates and Infants: A Review of the Literature. Pediatr Neurol 2021; 117:4-9. [PMID: 33581391 DOI: 10.1016/j.pediatrneurol.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ocular paroxysmal events can accompany a variety of neurological disorders. Particularly in infants, ocular paroxysmal events often represent a diagnostic challenge. Distinguishing between epileptic and nonepileptic events or between physiological and pathologic paroxysmal events can be challenging at this age because the clinical evaluation and physical examination are often limited. Continuous polygraphic video-electroencephalography (EEG) monitoring can be helpful in these situations. METHODS We review ocular paroxysmal events in newborns and infants. The aim is to improve clinical recognition of ocular paroxysmal events and provide a guide to further management. Using the PubMed database, we identified studies focused on all ocular motor paroxysmal events in neonates and infants. RESULTS Fifty-eight articles were selected on the topic. We summarized and divided these studies into those describing nonepileptic and epileptic ocular paroxysmal events. CONCLUSIONS The diagnosis of ocular paroxysmal events can be difficult, but their recognition is important because of the variety of underlying etiologies. The distinction between epileptic versus nonepileptic ocular paroxysmal events often often requires polygraphic video-EEG to identify the epileptic events. For nonepileptic events, further testing can characterize pathologic ocular movements. To determine the etiology and prognosis of ocular paroxysmal events, a multimodal approach is required, including a thorough full history and clinical examination, polygraphic video-EEG monitoring, neuroimaging, and a careful follow-up plan.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, AOU Policlinico, PO San Marco, University of Catania, Catania, Italy; Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Catania, Italy
| | | | - Francesco Pisani
- Unit of Child Neuropsychiatry, Department of Neuroscience, University of Parma, Parma, Italy
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Piero Pavone
- Unit of Rare Diseases of the Nervous System, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Maternal and Child Health, University of Palermo, Palermo, Italy
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Lin SY, Yen KG, Zhu H, Moisiuc A, Chilakapati M. Abnormal Red Reflex: Etiologies in a Pediatric Ophthalmology Population. Clin Pediatr (Phila) 2020; 59:760-765. [PMID: 32503396 DOI: 10.1177/0009922820916892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children who present with an abnormal red reflex (ARR) are often referred to ophthalmology due to concern for retinoblastoma. However, an ARR can indicate a wide variety of pathologies, all of which have the potential to develop amblyopia and irreversible vision loss. In this retrospective cohort study, we demonstrate that children who presented with an ARR had a mean age of 22.0 ± 32.5 months and were more frequently referred by their pediatricians (74.5%). The majority of these patients (61.8%) had a normal examination on further evaluation, followed by refractive error (20.4%). Amblyopia was diagnosed in 83.9% of patients with refractive error, with a mean age of 50.3 ± 49.2 months. Because many ARR-associated pathologies require time-sensitive treatment to prevent vision loss, proper screening is critical for diagnosis. Pediatricians play a key role in screening, so education on more common ARR pathologies can better facilitate referrals and improve outcomes.
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Affiliation(s)
| | - Kimberly G Yen
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | | | | | - Madhuri Chilakapati
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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Tang H, Li N, Li Z, Zhang M, Wei M, Huang C, Wang J, Li F, Wang H, Liu Z, He L, Cheng Y, Chen W, Jin L, Gong L, Lu J, Xue Y, Su M, Wang Y, Mo H, Chen Z, Guo W, Li Y, Pan H, Zhang W, Ma X, Jin X, Wang B. Fundus examination of 199 851 newborns by digital imaging in China: a multicentre cross-sectional study. Br J Ophthalmol 2018; 102:1742-1746. [DOI: 10.1136/bjophthalmol-2018-312366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
Abstract
BackgroundThe prevalence of ocular abnormalities of newborn in China has seldom been reported. To report the implementation of digital imaging in ocular screening of all newborns in multiple centres in China and to describe the abnormal findings of fundus examination, we did the cross-sectional study.MethodsFundus examinations were performed on newborns within the 42 days after birth using a RetCam wide-field digital imaging system. Digital images of the posterior pole, superior, nasal and temporal retinal fields of each participant were taken. All newborns were from eights centres across China from January 2009 to July 2017.ResultsA total of 199 851 newborns were included in the study. We detected 18 198 (9.11%) abnormal cases. The most frequent abnormality was severe retinal haemorrhage (RH) found in 12 810 cases (6.41%). The other anomalies included familial exudative vitreoretinopathy, retinopathy of prematurity, abnormal fundus pigmentation, subconjunctival haemorrhage, choroidal coloboma, idiopathic retinal venous tortuosity, exudative changes and other anomalies with uncertain identities.ConclusionThis large-scale study of newborn fundus examination showed a relatively high prevalence of ocular abnormalities. Hundreds of neonates with rare disorders that severely impair ocular health were also detected at an early age. The long-term impact of other anomalies including RHs on the ocular system should be investigated by a perspective study. Our study suggested that fundus examination of newborns can play a beneficial role in ocular health.
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Staffieri SE, Kearns LS, Sanfilippo PG, Craig JE, Mackey DA, Hewitt AW. Crowd-sourced Ontology for Photoleukocoria: Identifying Common Internet Search Terms for a Potentially Important Pediatric Ophthalmic Sign. Transl Vis Sci Technol 2018; 7:18. [PMID: 29464132 PMCID: PMC5815559 DOI: 10.1167/tvst.7.1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose Leukocoria is the most common presenting sign for pediatric eye disease including retinoblastoma and cataract, with worse outcomes if diagnosis is delayed. We investigated whether individuals could identify leukocoria in photographs (photoleukocoria) and examined their subsequent Internet search behavior. Methods Using a web-based questionnaire, in this cross-sectional study we invited adults aged over 18 years to view two photographs of a child with photoleukocoria, and then search the Internet to determine a possible diagnosis and action plan. The most commonly used search terms and websites accessed were recorded. Results The questionnaire was completed by 1639 individuals. Facebook advertisement was the most effective recruitment strategy. The mean age of all respondents was 38.95 ± 14.59 years (range, 18-83), 94% were female, and 59.3% had children. An abnormality in the images presented was identified by 1613 (98.4%) participants. The most commonly used search terms were: "white," "pupil," "photo," and "eye" reaching a variety of appropriate websites or links to print or social media articles. Conclusions Different words or phrases were used to describe the same observation of photoleukocoria leading to a range of websites. Variations in the description of observed signs and search words influenced the sites reached, information obtained, and subsequent help-seeking intentions. Translational Relevance Identifying the most commonly used search terms for photoleukocoria is an important step for search engine optimization. Being directed to the most appropriate websites informing of the significance of photoleukocoria and the appropriate actions to take could improve delays in diagnosis of important pediatric eye disease such as retinoblastoma or cataract.
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Affiliation(s)
- Sandra E Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Lisa S Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, SA, Australia
| | - David A Mackey
- Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Lion's Eye Institute, Centre for Ophthalmology and Visual Sciences, University of Western Australia, Perth, WA, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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8
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The analysis of posterior segment findings in term and premature infants using RetCam images. Int Ophthalmol 2017; 38:1879-1886. [DOI: 10.1007/s10792-017-0670-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022]
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9
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Mansoor N, Mansoor T, Ahmed M. Eye pathologies in neonates. Int J Ophthalmol 2016; 9:1832-1838. [PMID: 28003988 DOI: 10.18240/ijo.2016.12.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/15/2016] [Indexed: 12/25/2022] Open
Abstract
In the United Kingdom, newborn assessment incorporates a screening eye examination for any structural abnormalities, observation of neonate's visual behaviour and direct ophthalmoscopy examination looking for red reflex. Early identification and immediate management of eye related pathologies should commence soon after birth as early diagnosis and prompt intervention may have significant impact on the prognosis for many potentially blinding but treatable disorders such as congenital cataracts and retinoblastoma. If left undetected and untreated, such problems may potentially lead to irreversible damage to the vision which persists into adulthood resulting in lack of self-confidence together with difficulties in educational attainment and job opportunities.
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Affiliation(s)
- Nyaish Mansoor
- Leeds School of Medicine, University of Leeds, LS2 9JT, United Kingdom
| | - Tihami Mansoor
- Leeds School of Medicine, University of Leeds, LS2 9JT, United Kingdom
| | - Mansoor Ahmed
- Queen's Hospital, Burton Upon Trent, DE13 0RB, United Kingdom
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Sun M, Ma A, Li F, Cheng K, Zhang M, Yang H, Nie W, Zhao B. Sensitivity and Specificity of Red Reflex Test in Newborn Eye Screening. J Pediatr 2016; 179:192-196.e4. [PMID: 27640356 DOI: 10.1016/j.jpeds.2016.08.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/26/2016] [Accepted: 08/15/2016] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Ming Sun
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China; Department of Ophthalmology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Aihua Ma
- Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Fengjiao Li
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Kai Cheng
- Department of Ophthalmology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Min Zhang
- Department of Ophthalmology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Haixia Yang
- Department of Ophthalmology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Wenying Nie
- Department of Ophthalmology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.
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