Pediatrician recommends red reflex vision test for all newborns

Children's Hospital Los AngelesNov 7 2009

With the number of premature births and medically fragile infants now increasing in the U.S., a basic eye exam, including a red reflex test, should be given to all children shortly after birth, reports Angela Buffenn, M.D., M.P.H., Director of the Orbit and Eye Movement Institute at The Vision Center of Childrens Hospital Los Angeles.

"Advances in medicine have enabled many medically fragile infants to survive. Unfortunately, many of them grow up with compromised visual systems. With a basic eye exam soon after birth, the visual problems of these children can be identified and treated in a timely manner. Unfortunately, studies show that some 75 percent of all children under five in the U.S. have never had a comprehensive eye exam," Dr. Buffenn notes.

Dr. Buffenn and a colleague, Diana Dennis, M.A. of the Therapeutic Living Center for the Blind, reported on the problem of inadequate childhood vision screenings in the Fall 2009 issue of Pediatric News, a publication of California Chapter 2 of the American Academy of Pediatrics.

The red reflex test involves looking at the infant's eyes through an ophthalmoscope in a dimly lit room to see if there are any abnormalities in the back of the eye or white spots in the eyeball. The test is used to screen for abnormalities in the eye itself as well as ocular misalignment. If the red reflex is found to be abnormal, the child should be examined by a pediatric ophthalmologist in order to test for strabismus (crossed eyes), cataracts, glaucoma, retinoblastoma, retinal abnormalities, and high refractive errors.

Oftentimes, the test is first administered by a pediatrician or family physician. The red reflex test has been endorsed as an important part of a well child visit by the American Academy of Pediatrics and the American Academy for Pediatric Ophthalmology and Strabismus.

"Too often we see children with developmental delay whose visual system has not been properly evaluated. Sometimes, parents also think that vision loss is less important than treating the seizure disorder or developmental disability, when the truth is we can address both at the same time," said Dr. Buffenn.