Can the Brückner Test be Used as a Rapid Screening Test to Detect Amblyogenic Factors in Developing Countries?

Kothari, Mihir; Turakhia, Jinesh K.; Vijayalakshmi, P; Karthika, Arumugam; Nirmalan, Praveen K

doi:10.3368/aoj.53.1.121

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Photorefraction devices capture images of the light crescent generated on the pupillary red reflex. Results have been comparable to the Brückner test [23,27]. However, unlike the Brückner test, which relies on a live, moving subject, photoscreener images permit an unlimited amount of time for interpretation [20].…”

Section: Photoscreenersmentioning

confidence: 65%

Automatic Refractive Error Estimation Using Deep Learning-Based Analysis of Red Reflex Images

Linde,

Chalakkal,

Zhou

et al. 2023

Diagnostics

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Purpose/Background: We evaluate how a deep learning model can be applied to extract refractive error metrics from pupillary red reflex images taken by a low-cost handheld fundus camera. This could potentially provide a rapid and economical vision-screening method, allowing for early intervention to prevent myopic progression and reduce the socioeconomic burden associated with vision impairment in the later stages of life. Methods: Infrared and color images of pupillary crescents were extracted from eccentric photorefraction images of participants from Choithram Hospital in India and Dargaville Medical Center in New Zealand. The pre-processed images were then used to train different convolutional neural networks to predict refractive error in terms of spherical power and cylindrical power metrics. Results: The best-performing trained model achieved an overall accuracy of 75% for predicting spherical power using infrared images and a multiclass classifier. Conclusions: Even though the model’s performance is not superior, the proposed method showed good usability of using red reflex images in estimating refractive error. Such an approach has never been experimented with before and can help guide researchers, especially when the future of eye care is moving towards highly portable and smartphone-based devices.

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Section: Photoscreenersmentioning

confidence: 65%

Automatic Refractive Error Estimation Using Deep Learning-Based Analysis of Red Reflex Images

Linde,

Chalakkal,

Zhou

et al. 2023

Diagnostics

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“…The idea to screen for ocular morbidities using Bruckner’s reflex is not new and various studies have attempted to study its efficacy [ 19 , 20 , 21 ]. Photographic analysis of Bruckner’s reflex was attempted by Kakkinen K et al way back in 1981 [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Reliability of Smart Phone Photographs for School Eye Screening

et al. 2022

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Smartphone photographs capturing Bruckner’s reflex have demonstrated reliability in identifying amblyogenic conditions in children. Assessing visual acuity for screening has been the traditional method since the inception of school screening. The present study aims to assess the reliability of smartphone photographs in detecting ocular morbidities in school children and to compare it with traditional vision screening. Two thousand five hundred and twenty school children underwent vision screening and smartphone cameraphotography by a trained research assistant followed by a comprehensive eye examination of all children by an ophthalmologist. Children with unaided visual acuity less than 6/12 in either of the eyes were graded as abnormal. Based upon the characteristics of the Bruckner’s reflex, the photographs were graded as normal or abnormal by two investigators blinded to the clinical findings. Statistical analysis was performed to compare the sensitivity and specificity of traditional vision screening and photograph based screening, considering comprehensive eye examination as the gold standard. The sensitivity and specificity of vision screening was 81.88% and 97.35% whereas for photographs it was 94.69% and 98.85% respectively. When the two methods were compared, the p value was <0.05. We conclude that smartphone photography is better than traditional vision screening for detecting ocular morbidities in school children.

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“…84.1%. [7] Amitava evaluating the modified Brückner test (MBT) using the streak retinoscope,[5] (on children who failed 6/9 Snellen) has reported the sensitivity and specificity as follows: 57% and 97% for anisometropia of 0.5 D; 74% and 95% for anisometropia of 1 D, and 50% and 98% for strabismus and concluded that MBT is accurate and useful for ruling them. Considering the high specificity obtained in our study, it is likely that the CDC method is equally effective.…”

Section: Discussionmentioning

confidence: 99%

“…Such advantages accrue by utilizing the Bruckner's reflex, with the retinoscope and the consumer digital cameras (CDC). [5678] The enhanced Bruckner reflex, visible from the top or side of the ophthalmoscope,[9] generates a light crescent in the pupil of an ametropic eye, while an uniformly brighter reflex is seen from the strabismic eye. The child friendly CDC records this, permitting both anisometropia and strabismus to be identified.…”

Section: Introductionmentioning

confidence: 99%

Beyond photography: Evaluation of the consumer digital camera to identify strabismus and anisometropia by analyzing the Bruckner′s reflex

Bani

Amitava

Sharma

et al. 2013

Indian J Ophthalmol

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Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1) digital camera as an efficient screener for amblyogenic risk factors (ARF). We included 138 subjects: 84-amblyopes and 54-normal. With the red-eye-reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA), 36 had anisometropia alone (AA) while six were mixed amblyopes (MA). Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83-0.89) and specificity 0.85 (95% CI: 0.77-0.93). Sub-group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen's Kappa was 0.66 (95% CI: 0.62-0.71). The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.

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Can the Brückner Test be Used as a Rapid Screening Test to Detect Amblyogenic Factors in Developing Countries?

Abstract: Although imperfect, the Brückner test may be a low cost alternative to either screening with photo screener or to no screening for amblyogenic factors in developing countries.

Cited by 8 publications

References 15 publications

Automatic Refractive Error Estimation Using Deep Learning-Based Analysis of Red Reflex Images

Automatic Refractive Error Estimation Using Deep Learning-Based Analysis of Red Reflex Images

Reliability of Smart Phone Photographs for School Eye Screening

Beyond photography: Evaluation of the consumer digital camera to identify strabismus and anisometropia by analyzing the Bruckner′s reflex

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