title: Detection of red reflex asymmetry by pediatric residents using the Brückner reflex versus the MTI photoscreener.
abstract: OBJECTIVE
  To compare the ability of pediatric residents to differentiate an asymmetric from a symmetric red reflex in patients with anisometropia and microstrabismus using the Brückner reflex and the Medical Technology Innovations (MTI) photoscreener.
  
  
  METHODS
  A prospective, masked, case-control study was performed. Twelve pediatric residents evaluated 10 study patients and 6 control subjects in a masked manner in 2 separate sessions, using the Brückner reflex or the MTI photoscreener, evaluating for asymmetric (abnormal) or symmetric (normal) red reflexes between the 2 eyes. Each study patient had asymmetric red reflexes and the amblyogenic risk factor of anisometropia or microstrabismus. Each control subject had symmetric red reflexes.
  
  
  RESULTS
  The pediatric residents had a mean correct score of 82% (69%-100%) using the MTI photoscreener versus a mean correct score of 65% (44%-81%) using the Brückner reflex (McNemar test: alpha < 0.01). The sensitivity of the MTI photoscreener evaluation was 89% in comparison to 61% for the Brückner reflex. The specificities for the MTI photoscreener versus the Brückner reflex were similar at 69% and 71%, respectively.
  
  
  CONCLUSIONS
  Pediatric residents were better at detecting asymmetric red reflexes in patients with anisometropia and microstrabismus when evaluating MTI photoscreener photographs than when evaluating the red reflexes by the Brückner reflex. The MTI photoscreener may be a more sensitive method than the Brückner reflex to screen for the common amblyogenic risk factors of anisometropia and microstrabismus by easier detection of red reflex asymmetry.
authors.affiliation: Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA. epaysse@bcm.tmc.edu
authors.forename: E A
authors.initials: EA
authors.lastname: Paysse
authors.forename: G C
authors.initials: GC
authors.lastname: Williams
authors.forename: D K
authors.initials: DK
authors.lastname: Coats
authors.forename: E A
authors.initials: EA
authors.lastname: Williams
mesh_terms: D000328:Adult; D000550:Amblyopia / Q000175:diagnosis; D015858:Anisometropia / Q000175:diagnosis*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003116:Color; D005260:Female; D006801:Humans; D007223:Infant; D007396:Internship and Residency / Q000592:standards; D008297:Male; D009887:Ophthalmoscopy / Q000379:methods; D010372:Pediatrics / Q000193:education* / Q000592:standards; D010775:Photic Stimulation / Q000379:methods; D010781:Photography / Q000379:methods; D011446:Prospective Studies; D012025:Reflex, Pupillary / Q000502:physiology; D012680:Sensitivity and Specificity; D013285:Strabismus / Q000175:diagnosis*; D015351:Vision Screening / Q000295:instrumentation / Q000379:methods / Q000592:standards; D014787:Vision Tests / Q000295:instrumentation / Q000379:methods* / Q000592:standards