Detection of red reflex asymmetry by pediatric residents using the Bruckner reflex versus the MTI photoscreener

Objective. To compare the ability of pediatric residents to differentiate a n asymmetric from a symmetric red reflex in patients with anisometropia and microstrabismus using the Bruckner reflex and the Medical Technology Innov ations (MTI) photoscreener. Methods. A prospective, masked, case-control study was performed. Twelve pe diatric residents evaluated 10 study patients and 6 control subjects in a m asked manner in 2 separate sessions, using the Bruckner reflex or the MTI p hotoscreener, evaluating for asymmetric (abnormal) or symmetric (normal) re d reflexes between the 2 eyes. Each study patient had asymmetric red reflex es and the amblyogenic risk factor of anisometropia or microstrabismus. Eac h control subject had symmetric red reflexes. Results. The pediatric residents had a mean correct score of 82% (69%-100%) using the MTI photoscreener versus a mean correct score of 65% (44%-81%) u sing the Bruckner reflex (McNemar test: alpha <0.01). The sensitivity of th e MTI photoscreener evaluation was 89% in comparison to 61% for the Bruckne r reflex. The specificities for the MTI photoscreener versus the Bruckner r eflex were similar at 69% and 71%, respectively. Conclusions. Pediatric residents were better at detecting asymmetric red re flexes in patients with anisometropia and microstrabismus when evaluating M TI photoscreener photographs than when evaluating the red reflexes by the B ruckner reflex. The MTI photoscreener may be a more sensitive method than t he Bruckner reflex to screen for the common amblyogenic risk factors of ani sometropia and microstrabismus by easier detection of red reflex asymmetry.