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Updated: Jul 15, 2026
Neurodevelopmental Reflex Testing in Neonatal Rat Pups
Published on: April 24, 2017
Have we stopped looking for a red reflex in newborn screening?
O Sotomi1, C A Ryan, G O'Connor
1Unified Maternity and Neonatal Services, and Department of Paediatrics & Child Health, Cork University Hospital.
Insights
Early diagnosis of congenital cataracts within 3 months of birth is crucial for optimal vision. Delays in diagnosis, often due to parental concerns rather than screening, significantly worsen visual outcomes in infants.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Public Health
Background:
- Congenital cataracts require early surgical intervention for best visual outcomes.
- Timely diagnosis and treatment are critical for preventing long-term visual impairment in infants.
Purpose of the Study:
- To review the timing and source of congenital cataract diagnoses in a specific region.
- To evaluate the visual outcomes at 2 years or more in relation to diagnostic timing.
Main Methods:
- Retrospective study of children under 15 diagnosed with congenital cataracts over 10 years (1991-2002).
- Data collected from a Regional Ophthalmology Centre serving 546,000 population.
- Inclusion criteria: congenital or infantile cataracts, presenting in infancy or with early clinical features.
Main Results:
- 27 cases identified; 17 (63%) diagnosed after parental concerns, only 2 before 3 months.
- General practitioners diagnosed 24%, pediatricians 12%, ophthalmologists 9%. No diagnoses via newborn screening.
- Infants diagnosed before 3 months had better visual outcomes (6/8 good) compared to those diagnosed later (3/19 good).
Conclusions:
- Congenital cataracts must be diagnosed and treated within the first 3 months of life.
- Newborn screening and 6-8 week checks by general practitioners are vital for early detection.
- Parental concerns about vision, like squint, warrant red light reflex examination and prompt ophthalmological referral.
Abstract:
Best medical evidence indicates that surgical treatment of significant congenital cataracts is required within the first 3 months of life for optimal visual outcome. The aim of the present study was to review when the diagnosis of congenital cataracts was made in our region, by whom it was made, and the visual outcome at 2 years of age or more. This was a retrospective study in a region with a population of 546,000 and approximately 8500 births per annum, served by a single Regional Ophthalmology centre. All children under 15 years, diagnosed with Congenital Cataract over a 10-year period (1991-2002), were identified using the Hospital In-Patient Enquiry [HIPE] database. Children with cataract(s) from infancy from a congenital cause and those first presenting outside infancy but with salient clinical features indicating early cataract were included in the study. 27 cases of congenital and infantile cataract 15 (56%) males, 12 (44%) females were retrieved. 17 infants (63%) were diagnosed with bilateral disease, while the remainder were unilateral 10 (37%). Most of the cases 17 (63%) were diagnosed following presentation with parental/carer concerns about visual function (usually a squint). However only 2 of these 17 cases presented before 3 months of age. The remaining cases of congenital cataracts were diagnosed by general practitioners 8 (24%), paediatricians 4 (12%), ophthalmologists 3 (9%) or School Medical Officer (1, 3%). No case of congenital cataract was diagnosed by newborn screening examination. Six of 8 infants diagnosed with congenital cataracts before three months of age had a good visual outcome, (visual acuity < 6/24 at 2 years or more). In contrast only 3 of 19 cases who were diagnosed after 3 months of age had good visual outcomes. Despite their relative rarity, it is imperative that congenital cataracts are diagnosed and treated within 3 months of birth. The onus of diagnosis rests with newborn screening examiners at birth and with general practitioners at the 6-8 week checks. Parental concerns about a possible squint should be addressed by performing a red light reflex examination and urgent specialist ophthalmological referral if a flaw is detected.
