Assessment of a modification of Brückner′s test as a screening modality for anisometropia and strabismus

Abstract

Background:Current amblyopia screening methods are not cost effective.Aim:To evaluate the diagnostic capability of a modified Brückner test (MBT) for amblyopiogenic risk factors.Materials and Methods:We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination.Statisitics:Data were analyzed by 2 × 2 tables for diagnostic test parameters (95% CI).Results:From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ≥ 90% (95%CI 89% to 97%) over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 (0.48, 0.64), 0.97 (0.95, 0.98), 0.92 (0.90, 0.93) and 18 (9.7, 35); for 1D: 0.74(0.60, 0.82), 0.95 (0.94, 0.97), 0.97 (0.95, 0.98) and 16 (9.3, 28); and for strabismus: 0.5 (0.32, 0.66), 0.98 (0.97, 0.98), 0.97 (0.96, 0.98) and 20 (9.1, 42).Conclusion:Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice.

The 4 meters Bruckner test: An important tool in amblyopia screening of children with intellectual disability

“…Amitava et al tried to simplify and reduce the Bruckner test costs by using retinoscopy. They obtained similar results to the classic test, with above 90% accuracy [15].…”

Assessment of a modification of Bruckner′s test as a screening modality for anisometropia and strabismus

“…[1] It is heartening to note that he agrees with our opinion that the MBT may prove to be a good screening test to detect amblyopiogenic conditions. Our study was not undertaken to analyze the cost-effectiveness of the MBT and hence are unable to comment further than pointing out that because the retinoscope is such simple and affordable equipment with universal applicability, if it were to perform as well as costlier equipment like the MTI photoscreeners in detecting amblyopia, then it might offer a cost-effective alternative.…”

Testul Bruckner la 4 metri: Un instrument important în screening-ul ambliopiei la copiii cu dizabilități intelectuale

“…Amitava și colaboratorii au încercat să simplifice și să reducă costurile testului Bruckner utilizând retinoscopia și obținând rezultate similare testului clasic cu o acuratețe mai mare de 90% [15].…”

“…O altă modalitate de screening rapid și eficient a fost elaborată de Bani S și colaboratorii prin utilizarea unei camere digitale pentru detecția anizometropiei și a strabismului, prin analiza reflexului Bruckner, oferind o alternativă utilă pentru screening-ul ambliopiei în țările în curs de dezvoltare, cu o acuratețe similară cu cea din studiul lui Amitava [15,16].…”