Red reflex testing is a mainstay of efforts to screen infants for ocular pathology and eye doctors worldwide rely on it. A study recently reported that an abnormal red reflex finding most likely reflects an underlying ocular pathology; however, a normal red reflex finding does not necessarily exclude ocular disease.

The team conducted a meta-analysis of 8,713 infants from five studies. All studies used the red reflex test without pupillary dilation and were compared with a reference test performed with pupillary dilation.

For any ocular pathology, the researchers observed an estimated sensitivity of 7.5% and specificity of 97.5%. Focusing on ocular pathologies requiring a medical or surgical intervention, sensitivity improved to 17.5% and specificity remained high at 97.6%.

Subhi Y, Schmidt DC, Al-Bakri M, et al. Diagnostic test accuracy of the red reflex test for ocular pathology in infants. JAMA Ophthalmol. November 12, 2020. [Epub ahead of print].