Determination of Refractive Error Using Direct Ophthalmoscopy in Children

Abstract

Purpose

Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test.

Patients and Methods

This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed.

Results

The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021).

Conclusion

The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.

Keywords:

• visual impairment
• pediatric refraction
• hypermetropia
• myopia
• Brückner test
• refractive error

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical Statement

This research was reviewed and approved by the institutional review board of Kasturba Medical College Manipal, Manipal Academy of Higher Education (registration number ECR/146/Inst/KA/2013/RR-19). Informed consent was obtained from the parents or legal guardians of all the participants. The trial was registered prospectively with Clinical Trials Registry- India (registration number: CTRI/2021/05/033615, registered on 13/05/2021).

Acknowledgments

We would like to thank the Department of Optometry, Manipal College of Health Professions, Manipal Academy of higher Education, Manipal for allowing the usage of Plusoptix autorefractor during the conduct of this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Yogish S Kamath and Neetha Kuzhuppilly report grants from Indian Council of Medical Research (ICMR). The authors report no other conflicts of interest in this work.

Additional information

Funding

No funding was received for this work.