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Validity of the Bruckner reflex in the detection of amblyopia
1Department of Ophthalmology, Royal Children's Hospital, Herston Road, Brisbane 4029, Queensland.
Purpose:
To establish the sensitivity and specificity of the Bruckner reflex (comparison of the fundus red reflexes) in the detection of amblyopia or its risk factors.
Methods:
A single masked study using a medical student's diagnostic ability against the gold standard of a full clinical examination by a paediatric ophthalmologist.
Setting:
A university teaching hospital outpatient facility.
Patients:
Three hundred and one patients consecutively referred for ophthalmic assessment.
Results:
The sensitivity of the test for the detection of children with amblyopia risk factors was 86% and the specificity was 65%. Of 70 children with a definite diagnosis of amblyopia, the sensitivity of the test was 95%.
Conclusions:
The Bruckner reflex is a useful screening test for primary eye care personnel. However, there is a significant false-positive rate which will result in unnecessary referrals. We recommend that it form part of a battery of tests, including, for example, the modified base down prism test, which are useful in assessing the vision of preverbal children.