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The '''red reflex''' refers to the reddish-orange reflection of light from the [[eye]]'s [[Fundus (eye)|fundus]] observed when using an [[ophthalmoscope]] or [[retinoscope]]. The reflex relies on the transparency of optical media (tear film, [[cornea]], [[Aqueous humour|aqueous humor]], [[Lens (anatomy)|crystalline lens]], [[Vitreous body|vitreous humor]]) and reflects off the fundus back through media into the aperture of the opthalmoscope<ref name=":0">{{Cite journal|last=Pediatrics|first=American Academy Of|last2=Ophthalmology|first2=Section on|last3=Strabismus|first3=American Association for Pediatric Ophthalmology And|last4=Ophthalmology|first4=American Academy Of|last5=Orthoptists|first5=American Association of Certified|date=2008-12-01|title=Red Reflex Examination in Neonates, Infants, and Children|url=http://pediatrics.aappublications.org/content/122/6/1401|journal=Pediatrics|language=en|volume=122|issue=6|pages=1401–1404|doi=10.1542/peds.2008-2624|issn=0031-4005|pmid=19047263}}</ref>. The red reflex is considered abnormal if there is any asymmetry between the eyes, dark sports, or white reflex ([[Leukocoria]]).
The '''red reflex''' (also called the fundal reflex) refers to the reddish-orange reflection of light from the back of the [[eye]], or [[Fundus (eye)|fundus]], observed when using an [[ophthalmoscope]] or [[retinoscope]]. The red reflex may be absent or poorly visible in people with dark eyes, and may even appear yellow in Asians or green/blue in Africans. <ref>{{Cite web |title=PhotoRED Technique |url=https://wechope.org/retinoblastoma/white-eye-reflex/photo-red-technique/ |access-date=2024-05-21 |website=WE C Hope |language=en-GB}}</ref>


The reflex relies on the transparency of optical media (tear film, [[cornea]], [[Aqueous humour|aqueous humor]], [[Lens (anatomy)|crystalline lens]], [[Vitreous body|vitreous humor]]) and reflects off the fundus back through media into the aperture of the ophthalmoscope.<ref name=":0">{{Cite journal|title=Red Reflex Examination in Neonates, Infants, and Children |journal=Pediatrics |year=2008 |volume=122 |issue=6 |pages=1401–1404 |doi=10.1542/peds.2008-2624 |doi-access=free |pmid=19047263|author1=American Association for Pediatric Ophthalmology and Strabismus |author2=American Academy of Ophthalmology |author3=American Association of Certified Orthoptists }}</ref> The red reflex is considered abnormal if there is any asymmetry between the eyes, dark spots, or white reflex ([[Leukocoria]]).
⚫
Generally it is a physical exam done on [[neonates]] and children by healthcare providers but occasionally occurs in flash photography seen when the [[pupil]] does not have enough time to constrict and reflects the fundus known as the [[red-eye effect]].


⚫
Generally, it is a physical exam done on [[neonates]] and children by healthcare providers but occasionally occurs in flash photography seen when the [[pupil]] does not have enough time to constrict and reflects the fundus known as the [[red-eye effect]].
⚫
This is a '''recommended screening''' by the [[American Academy of Pediatrics]] and [[American Academy of Family Physicians]] for neonates and children at every office visit to detect ocular pathology that needs early intervention and ophthalmology referral to prevent visual abnormalities and more serious, but rarely, death. 


⚫
This is a '''recommended screening''' by the [[American Academy of Pediatrics]] and [[American Academy of Family Physicians]] for neonates and children at every office visit. The objective is to detect ocular pathology that needs early intervention and ophthalmology referral to prevent visual abnormalities and more serious, but rarely, death.
It is difficult to assess the '''effectiveness''' of the technique due to the low incidence of some of the pathology it is used to detect. <ref>Li J., D.K. Coats, D. Fung, E.O. Smith, E. Paysse'''The detection of simulated retinoblastoma by using red-reflex testing'''


It is difficult to assess the '''effectiveness''' of the technique due to the low incidence of some of the pathology the red reflex is used to detect.<ref>{{Cite journal |doi = 10.1542/peds.2009-0882|title = The Detection of Simulated Retinoblastoma by Using Red-Reflex Testing|year = 2010|last1 = Li|first1 = J.|last2 = Coats|first2 = D. K.|last3 = Fung|first3 = D.|last4 = Smith|first4 = E. O.|last5 = Paysse|first5 = E.|journal = Pediatrics|volume = 126|issue = 1|pages = e202–e207|pmid = 20587677| s2cid=7071311 }}</ref> For example, retinoblastoma, a neuroblastic tumor that can cause a dampened or even white reflex, occurs in 1 in every 20,000 children.<ref>{{Cite journal | doi=10.3126/kumj.v10i2.7338| title=Bruckner Red Light Reflex Test in a Hospital Setting| year=2013| last1=Shrestha| first1=UD| last2=Shrestha| first2=MK| last3=Yoon| first3=PD| last4=Yun| first4=S.| last5=Saiju| first5=R.| journal=Kathmandu University Medical Journal| volume=10| issue=2| pages=23–26| pmid=23132470| doi-access=free}}</ref> Regardless of the effectiveness, it is a ''fast,'' ''inexpensive'', and ''noninvasive'' exam that could identify ocular pathology which with early identification can alter the course of the disease.
Pediatrics, 126 (2010)


==Red reflex technique==
e202-7</ref>For example, retinoblastoma, a neuroblastic tumor that can cause a dampened or even white reflex, occurs in 1 in every 20,000 children<ref>R. Saiju, Yun S., P.D. Yoon, M.K. Shrestha, U.D. Shrestha'''Brückner red light reflex test in a hospital setting'''
⚫
There are two techniques used to assess the red reflex listed below. Both are noninvasive, inexpensive, and quick. Dilation of the eyes is unnecessary and not recommended due to the theoretical but rarely seen risks of [[sympathomimetics]] and [[antimuscarinic]] systemic effects – tachycardia (fast heart rate), hypertension (high blood pressure), and arrhythmia (abnormal heart rhythm).<ref>{{Cite journal |pmid = 8823596|year = 1996|last1 = Oğüt|first1 = M. S.|last2 = Bozkurt|first2 = N.|last3 = Ozek|first3 = E.|last4 = Birgen|first4 = H.|last5 = Kazokoğlú|first5 = H.|last6 = Oğüt|first6 = M.|title = Effects and side effects of mydriatic eyedrops in neonates|journal = European Journal of Ophthalmology|volume = 6|issue = 2|pages = 192–6|doi = 10.1177/112067219600600218| s2cid=42351069 }}</ref><ref>{{cite journal | author = Gaynes BI | year = 1998 | title = Monitoring drug safety: cardiac events in routine mydriasis | journal = Optom Vis Sci | volume = 75 | issue = 4| pages = 245–246 | doi = 10.1097/00006324-199804000-00019 | pmid = 9586747 }}</ref>


=== Red reflex or individual reflex ===
Kathmandu Univ Med J (KUMJ), 10 (2012), pp. 23-26</ref>. Regardless of the effectiveness, it is a ''fast,'' ''inexpensive'', and ''noninvasive'' exam that could identify ocular pathology which with early identification can alter the course of the disease.


⚫
The traditional red reflex refers to visualizing each eye individually. The American Academy of Pediatrics describes using a direct ophthalmoscope with a lens at 0, approximately 18 inches away in a dimly lit room on each eye.<ref name=":0" />
==Red Reflex Technique==
⚫
There are two techniques used to assess the red reflex listed below. Both are noninvasive, inexpensive, and quick. It should be noted that dilation of the eyes is unnecessary and not recommended due to the theoretical but rarely seen risks of [[Sympathomimetics|sympathmimetics]] and [[antimuscarinic]] systemic effects – tachycardia (fast heart rate), hypertension (high blood pressure), and arrhythmia (abnormal heart rhythm).<ref>Oğüt MS, Bozkurt N, Ozek E, Birgen H, Kazokoğlú H, Oğüt M. Effects and side effects of mydriatic eyedrops in neonates. ''Eur J Ophthalmol.''1996;6 (2):192– 196</ref><ref>Gaynes BI. Monitoring drug safety: cardiac events in routine mydriasis. ''Optom Vis Sci.''1998;75(4):245– 246</ref>


=== Red Reflex or individual reflex ===
=== Bruckner test ===


⚫
The Bruckner test differs in that one will visualize both eyes simultaneously. Unlike the red reflex, this can help determine if the patient has normal ocular alignment. In order to perform this test the patient and physician are normally approximately 2 to 3 feet away from each other.<ref>Pediatric eye exam and disease states, Mara Hover, DO. A T still University school of osteopathic medicine. November 2012.</ref>
⚫
The traditional red reflex refers to visualizing individually each eye. The American Pediatric Association describes using a direct opthalmoscope with a lens at 0, approximately 18 inches away in a dimly lit room on each eye. <ref name=":0" />


It is also used to detect opacities in the visual axis, such as a cataract or corneal abnormality. The inequality of red reflection in both the eyes indicates unequal refraction, indicating a refractive error.<ref>Procedures for the Evaluation of the Visual System by Pediatricians. Sean P. Donahue, MD, PhD, FAAP, Cynthia N Baker, MD, FAAP, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON OPHTHALMOLOGY, AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS, AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS, AMERICAN ACADEMY OF OPHTHALMOLOGY. https://pediatrics.aappublications.org/content/pediatrics/early/2015/12/07/peds.2015-3597.full-text.pdf</ref>
=== Bruckner Test ===

⚫
The Bruckner test differs in that one will visualize both eyes simultaneously. Unlike the red reflex, this can help determine if the patient has normal ocular alignment. In order to perform this test the patient and physician are normally approximately 2 to 3 feet away from each other.<ref>Pediatric eye exam and disease states, Mara Hover, DO. A T still University school of osteopathic medicine. November 2012.</ref>


=== Limitations ===
=== Limitations ===
*  Pupil of a sleeping newborn may not dilate in a darkened room to allow for full assessment.
* Pupil of a sleeping newborn may not dilate in a darkened room to allow for full assessment.
*  The area of the retina reflected in the test is very small but rather it shows summation of the area. <ref>A.O. Khan, S. Al-Mesfer'''Lack of efficacy of dilated screening for retinoblastoma'''
* The area of the retina reflected in the test is very small and rather than showing part of the retina it shows summation of the area.<ref>{{Cite journal |pmid = 16121549|year = 2005|last1 = Khan|first1 = A. O.|last2 = Al-Mesfer|first2 = S.|title = Lack of efficacy of dilated screening for retinoblastoma|journal = Journal of Pediatric Ophthalmology and Strabismus|volume = 42|issue = 4|pages = 205–10; quiz 233–4|doi = 10.3928/01913913-20050701-01}}</ref>


⚫
== Differential diagnosis ==
J Pediatr Ophthalmol Strabismus, 42 (2005), pp. 205-210
⚫
The differential diagnosis for what could be causing an abnormal reflex ranges in severity from causes that will resolve on their own to pathology that can be life-threatening, which is why expert evaluation is essential. Below are a few of the most referenced pathologies.

quiz 33-4</ref>
⚫
== Differential Diagnosis ==
⚫
The differential diagnosis for what could be causing an abnormal reflex ranges in severity from causes that will resolve on their own to pathology that can be life threatening which is why expert evaluation is essential. Below is a few of the most referenced pathologies.

⚫
=== Needs Intervention ===
⚫
* [[Congenital cataract]], [[refractive error]], ocular alignment, retinal abnormalities<ref>American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred practice pattern guidelines. Pediatric eye evaluations. San Francisco, Calif.: American Academy of Ophthalmology; 2007.</ref>
* Strabismus, amblyopia<ref>A.C. Tongue, G.W. Cibis'''Brückner test'''

Ophthalmology, 88 (1981), pp. 1041-1044</ref><ref>E.A. Paysse, G.C. Williams, D.K. Coats, E.A. Williams'''Detection of red reflex asymmetry by pediatric residents using the Brückner reflex versus the MTI photoscreener'''

Pediatrics, 108 (2001), p. E74</ref> or amblyogenic disorder
* Retinoblastoma<ref>Wan M.J., D.K. VanderVeen'''Eye disorders in newborn infants (excluding retinopathy of prematurity)'''

Arch Dis Child Fetal Neonatal Ed, 100 (2015)

F264-9</ref><ref>American Academy of Pediatrics'''Section on Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children'''

Pediatrics, 122 (2008), pp. 1401-1404</ref> - a neuroblastic tumor, most common primary intraocular malignancy, and seventh most common malignancy – 1in 20,000 children.<ref>Hered RW. Effective vision screening of young children in the pediatric office. ''Pediatr Ann''. 2011;40(2):76–82.</ref><ref>Melamud A, Palekar R, Singh A. Retinoblastoma [published correction appears in ''Am Fam Physician''. 2007;75(7):980]. ''Am Fam Physician''. 2006;73(6):1039–1044.</ref>
⚫
** Of note other signs of retinoblastoma include [[strabismus]], tearing red eye, iris discoloration


⚫
=== Needs intervention ===
⚫
* [[Congenital cataract]], [[refractive error]], ocular alignment, retinal abnormalities.<ref>American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred practice pattern guidelines. Pediatric eye evaluations. San Francisco, Calif.: American Academy of Ophthalmology; 2007.</ref>
* Strabismus, amblyopia<ref>{{Cite journal | doi=10.1016/S0161-6420(81)80034-6| title=Brückner Test| year=1981| last1=Tongue| first1=Andrea Cibis| last2=Cibis| first2=Gerhard W.| journal=Ophthalmology| volume=88| issue=10| pages=1041–1044| pmid=7335307}}</ref><ref>{{Cite journal |doi = 10.1542/peds.108.4.e74|title = Detection of Red Reflex Asymmetry by Pediatric Residents Using the Bruckner Reflex Versus the MTI Photoscreener|year = 2001|last1 = Paysse|first1 = E. A.|last2 = Williams|first2 = G. C.|last3 = Coats|first3 = D. K.|last4 = Williams|first4 = E. A.|journal = Pediatrics|volume = 108|issue = 4|pages = e74|pmid = 11581482|doi-access = free}}</ref> or amblyogenic disorder.
* Retinoblastoma<ref>{{Cite journal | doi=10.1136/archdischild-2014-306215| title=Eye disorders in newborn infants (Excluding retinopathy of prematurity)| year=2015| last1=Wan| first1=Michael J.| last2=Vanderveen| first2=Deborah K.| journal=Archives of Disease in Childhood - Fetal and Neonatal Edition| volume=100| issue=3| pages=F264–F269| pmid=25395469| s2cid=36687619}}</ref><ref name=":0"/> – a neuroblastic tumor, the most common primary intraocular malignancy, and the seventh most common malignancy – 1 in 20,000 children.<ref>{{cite journal | author = Hered RW | year = 2011 | title = Effective vision screening of young children in the pediatric office | journal = Pediatr Ann | volume = 40 | issue = 2| pages = 76–82 | doi = 10.3928/00904481-20110117-06 | pmid = 21323203 }}</ref><ref>{{cite journal | author = Melamud A, Palekar R, Singh A | year = 2006 | title = Retinoblastoma [published correction appears in ''Am Fam Physician''. 2007;75(7) 980] | journal = Am Fam Physician | volume = 73 | issue = 6| pages = 1039–1044 }}</ref>
⚫
** Of note other signs of retinoblastoma include [[strabismus]], tearing red eye and iris discoloration.
* According to ''Bates' Guide to Physical Exams,'' [[retinal detachment]] would result in the absence of red reflex in the affected eye.
* According to ''Bates' Guide to Physical Exams,'' [[retinal detachment]] would result in the absence of red reflex in the affected eye.


=== Benign ===
=== Benign ===
* [[Pupillary membranes|Pupillary membrane]] which will resolve spontaneously.
* [[Pupillary membranes|Pupillary membrane]] which will resolve spontaneously.
* Mucus in the tear film which will be mobile and resolves with blinking.<ref name=":1">American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred practice pattern guidelines. Pediatric eye evaluations. San Francisco, Calif.: American Academy of Ophthalmology; 2012.</ref><ref>American Academy of Pediatrics, Section on Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology; American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children. ''Pediatrics''. 2008;122(6):1401–1404.</ref>
* Mucus in the tear film which will be mobile and resolves with blinking.<ref name=":1">American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred practice pattern guidelines. Pediatric eye evaluations. San Francisco, Calif.: American Academy of Ophthalmology; 2012.</ref><ref name=":0"/>
* Can have different shades of reflex dependent on race and pigmentation of the fundus.<ref name=":0" />
* Can have different shades of reflex dependent on race and pigmentation of the fundus.<ref name=":0" />
⚫
*


⚫
*
== Recommendations ==
== Recommendations ==
Both the pediatric and family physician associations encourage newborn screening and continued assessment at all visits because some diseases only develop later in life. Two examples include: [[Familial exudative vitreoretinopathy]] and polar cataracts. This is considered an urgent referral that needs a "hot hand-off" or direct communication between the physician that found an abnormality and the ophtalmologist receiving the referral to discuss the patients history and current exam.
Both the pediatric and family physician associations encourage newborn screening and continued assessment at all visits because some diseases only develop later in life. Two examples include: [[Familial exudative vitreoretinopathy]] and polar cataracts. This is considered an urgent referral that needs a "hot hand-off" or direct communication between the physician that found an abnormality and the ophthalmologist receiving the referral to discuss the patients history and current exam.


=== When to refer to children's ophthalmology? ===
=== When to refer to children's ophthalmology? ===
For any of the reasons below a newborn or child should be seen by a physician that specializes in eye disease (see [[opthalmologist]]).
For any of the reasons below a newborn or child should be seen by a physician that specializes in eye disease (see [[ophthalmologist]]).
* Any abnormal exam
* Any abnormal exam.
* Patient history or personal history of:
* Patient history or personal history of:
** High risk patients: premature birth, down syndrome, or cerebral palsy.
** High risk patients: premature birth, down syndrome, or cerebral palsy.
** History or presence of leukocoria.<ref name=":0" />
** History or presence of leukocoria.<ref name=":0" />
* Family history or any person blood related to the patient of:
* Family history or any person blood related to the patient of:
** Strabismus, amblyopia, retinoblastoma, childhood glaucoma, childhood cataracts, general ocular disease<ref name=":1" />, or retinal dysplasia.<ref name=":0" />
** Strabismus, amblyopia, retinoblastoma, childhood glaucoma, childhood cataracts, general ocular disease,<ref name=":1" /> or retinal dysplasia.<ref name=":0" />


==See also==
==See also==
Line 80: Line 64:


==External links==
==External links==
* {{cite journal | pmid = 11986467 |doi=10.1542/peds.109.5.980 |title=Red Reflex Examination in Infants |journal=Pediatrics |year=2002 |volume=109 |issue=5 |pages=980–981 |doi-access=free }}
*[http://aappolicy.aappublications.org/cgi/content/full/pediatrics;109/5/980 "Red reflex examination in infants. Section on Ophthalmology. American Academy of Pediatrics."] ''Pediatrics.'' 2002 May;109(5):980-1. {{PMID|11986467}}.


⚫
[[Category:Ophthalmology]]

{{eye-stub}}
{{Appearance phenomena}}
{{Appearance phenomena}}

⚫
[[Category:Ophthalmology]]

Latest revision as of 21:12, 18 November 2024

The red reflex (also called the fundal reflex) refers to the reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope. The red reflex may be absent or poorly visible in people with dark eyes, and may even appear yellow in Asians or green/blue in Africans. [1]

The reflex relies on the transparency of optical media (tear film, cornea, aqueous humor, crystalline lens, vitreous humor) and reflects off the fundus back through media into the aperture of the ophthalmoscope.[2] The red reflex is considered abnormal if there is any asymmetry between the eyes, dark spots, or white reflex (Leukocoria).

Generally, it is a physical exam done on neonates and children by healthcare providers but occasionally occurs in flash photography seen when the pupil does not have enough time to constrict and reflects the fundus known as the red-eye effect.

This is a recommended screening by the American Academy of Pediatrics and American Academy of Family Physicians for neonates and children at every office visit. The objective is to detect ocular pathology that needs early intervention and ophthalmology referral to prevent visual abnormalities and more serious, but rarely, death.

It is difficult to assess the effectiveness of the technique due to the low incidence of some of the pathology the red reflex is used to detect.[3] For example, retinoblastoma, a neuroblastic tumor that can cause a dampened or even white reflex, occurs in 1 in every 20,000 children.[4] Regardless of the effectiveness, it is a fast, inexpensive, and noninvasive exam that could identify ocular pathology which with early identification can alter the course of the disease.

Red reflex technique

[edit]

There are two techniques used to assess the red reflex listed below. Both are noninvasive, inexpensive, and quick. Dilation of the eyes is unnecessary and not recommended due to the theoretical but rarely seen risks of sympathomimetics and antimuscarinic systemic effects – tachycardia (fast heart rate), hypertension (high blood pressure), and arrhythmia (abnormal heart rhythm).[5][6]

Red reflex or individual reflex

[edit]

The traditional red reflex refers to visualizing each eye individually. The American Academy of Pediatrics describes using a direct ophthalmoscope with a lens at 0, approximately 18 inches away in a dimly lit room on each eye.[2]

Bruckner test

[edit]

The Bruckner test differs in that one will visualize both eyes simultaneously. Unlike the red reflex, this can help determine if the patient has normal ocular alignment. In order to perform this test the patient and physician are normally approximately 2 to 3 feet away from each other.[7]

It is also used to detect opacities in the visual axis, such as a cataract or corneal abnormality. The inequality of red reflection in both the eyes indicates unequal refraction, indicating a refractive error.[8]

Limitations

[edit]
  • Pupil of a sleeping newborn may not dilate in a darkened room to allow for full assessment.
  • The area of the retina reflected in the test is very small and rather than showing part of the retina it shows summation of the area.[9]

Differential diagnosis

[edit]

The differential diagnosis for what could be causing an abnormal reflex ranges in severity from causes that will resolve on their own to pathology that can be life-threatening, which is why expert evaluation is essential. Below are a few of the most referenced pathologies.

Needs intervention

[edit]
  • Congenital cataract, refractive error, ocular alignment, retinal abnormalities.[10]
  • Strabismus, amblyopia[11][12] or amblyogenic disorder.
  • Retinoblastoma[13][2] – a neuroblastic tumor, the most common primary intraocular malignancy, and the seventh most common malignancy – 1 in 20,000 children.[14][15]
    • Of note other signs of retinoblastoma include strabismus, tearing red eye and iris discoloration.
  • According to Bates' Guide to Physical Exams, retinal detachment would result in the absence of red reflex in the affected eye.

Benign

[edit]
  • Pupillary membrane which will resolve spontaneously.
  • Mucus in the tear film which will be mobile and resolves with blinking.[16][2]
  • Can have different shades of reflex dependent on race and pigmentation of the fundus.[2]

Recommendations

[edit]

Both the pediatric and family physician associations encourage newborn screening and continued assessment at all visits because some diseases only develop later in life. Two examples include: Familial exudative vitreoretinopathy and polar cataracts. This is considered an urgent referral that needs a "hot hand-off" or direct communication between the physician that found an abnormality and the ophthalmologist receiving the referral to discuss the patients history and current exam.

When to refer to children's ophthalmology?

[edit]

For any of the reasons below a newborn or child should be seen by a physician that specializes in eye disease (see ophthalmologist).

  • Any abnormal exam.
  • Patient history or personal history of:
    • High risk patients: premature birth, down syndrome, or cerebral palsy.
    • History or presence of leukocoria.[2]
  • Family history or any person blood related to the patient of:
    • Strabismus, amblyopia, retinoblastoma, childhood glaucoma, childhood cataracts, general ocular disease,[16] or retinal dysplasia.[2]

See also

[edit]

References

[edit]
  1. ^ "PhotoRED Technique". WE C Hope. Retrieved 2024-05-21.
  2. ^ a b c d e f g American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology; American Association of Certified Orthoptists (2008). "Red Reflex Examination in Neonates, Infants, and Children". Pediatrics. 122 (6): 1401–1404. doi:10.1542/peds.2008-2624. PMID 19047263.
  3. ^ Li, J.; Coats, D. K.; Fung, D.; Smith, E. O.; Paysse, E. (2010). "The Detection of Simulated Retinoblastoma by Using Red-Reflex Testing". Pediatrics. 126 (1): e202 – e207. doi:10.1542/peds.2009-0882. PMID 20587677. S2CID 7071311.
  4. ^ Shrestha, UD; Shrestha, MK; Yoon, PD; Yun, S.; Saiju, R. (2013). "Bruckner Red Light Reflex Test in a Hospital Setting". Kathmandu University Medical Journal. 10 (2): 23–26. doi:10.3126/kumj.v10i2.7338. PMID 23132470.
  5. ^ Oğüt, M. S.; Bozkurt, N.; Ozek, E.; Birgen, H.; Kazokoğlú, H.; Oğüt, M. (1996). "Effects and side effects of mydriatic eyedrops in neonates". European Journal of Ophthalmology. 6 (2): 192–6. doi:10.1177/112067219600600218. PMID 8823596. S2CID 42351069.
  6. ^ Gaynes BI (1998). "Monitoring drug safety: cardiac events in routine mydriasis". Optom Vis Sci. 75 (4): 245–246. doi:10.1097/00006324-199804000-00019. PMID 9586747.
  7. ^ Pediatric eye exam and disease states, Mara Hover, DO. A T still University school of osteopathic medicine. November 2012.
  8. ^ Procedures for the Evaluation of the Visual System by Pediatricians. Sean P. Donahue, MD, PhD, FAAP, Cynthia N Baker, MD, FAAP, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON OPHTHALMOLOGY, AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS, AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS, AMERICAN ACADEMY OF OPHTHALMOLOGY. https://pediatrics.aappublications.org/content/pediatrics/early/2015/12/07/peds.2015-3597.full-text.pdf
  9. ^ Khan, A. O.; Al-Mesfer, S. (2005). "Lack of efficacy of dilated screening for retinoblastoma". Journal of Pediatric Ophthalmology and Strabismus. 42 (4): 205–10, quiz 233–4. doi:10.3928/01913913-20050701-01. PMID 16121549.
  10. ^ American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred practice pattern guidelines. Pediatric eye evaluations. San Francisco, Calif.: American Academy of Ophthalmology; 2007.
  11. ^ Tongue, Andrea Cibis; Cibis, Gerhard W. (1981). "Brückner Test". Ophthalmology. 88 (10): 1041–1044. doi:10.1016/S0161-6420(81)80034-6. PMID 7335307.
  12. ^ Paysse, E. A.; Williams, G. C.; Coats, D. K.; Williams, E. A. (2001). "Detection of Red Reflex Asymmetry by Pediatric Residents Using the Bruckner Reflex Versus the MTI Photoscreener". Pediatrics. 108 (4): e74. doi:10.1542/peds.108.4.e74. PMID 11581482.
  13. ^ Wan, Michael J.; Vanderveen, Deborah K. (2015). "Eye disorders in newborn infants (Excluding retinopathy of prematurity)". Archives of Disease in Childhood - Fetal and Neonatal Edition. 100 (3): F264 – F269. doi:10.1136/archdischild-2014-306215. PMID 25395469. S2CID 36687619.
  14. ^ Hered RW (2011). "Effective vision screening of young children in the pediatric office". Pediatr Ann. 40 (2): 76–82. doi:10.3928/00904481-20110117-06. PMID 21323203.
  15. ^ Melamud A, Palekar R, Singh A (2006). "Retinoblastoma [published correction appears in Am Fam Physician. 2007;75(7) 980]". Am Fam Physician. 73 (6): 1039–1044.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ a b American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred practice pattern guidelines. Pediatric eye evaluations. San Francisco, Calif.: American Academy of Ophthalmology; 2012.
[edit]
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