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Invited Commentary
November 12, 2020

The Enduring Value of Newborn Red Reflex Testing as a Screening Tool

Author Affiliations
  • 1Pediatric and Strabismus Ophthalmic Surgery, Moorfields Eye Hospital, London, United Kingdom
JAMA Ophthalmol. Published online November 12, 2020. doi:10.1001/jamaophthalmol.2020.4853

A red reflex screening examination of the eyes of newborn infants is undertaken in most high-income countries. It aims to identify potentially blinding but treatable disorders, in particular congenital cataract, for which early diagnosis and surgery give better visual acuity outcomes. The examination involves observation of the infant and assessment of the red reflexes through undilated pupils using a direct ophthalmoscope; in some countries, usually those with fewer resources, the examination is performed with a flashlight or penlight rather than an ophthalmoscope. A flashlight examination is less sensitive than a direct ophthalmoscope test in identifying cataract.1 Testing can be performed by pediatricians, nurses, or midwives. Red reflex testing is an essential component of the physical examination of newborn infants, and it is important to know the accuracy and limitations of the test in identifying ophthalmic disease.

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