What is the Red Reflex & why do we check for it?
Vision screening is a huge part of each well-child visit!
Apart from reviewing relevant family history and identifying risk factors that may require referral to a doctor who specializes in eyes (an ophthalmologist!), vision testing is also performed to recognize any eye conditions that may require glasses and to ensure your kid’s eyes are properly aligned and point in the right direction.
You may have noticed that your pediatrician or family doc dims the lights when shining a light towards your kid’s eyes and examining them closely with a strange looking device (an ophthalmoscope). In that case they are looking for the red reflex. You know, when you take pictures of your children with the flash on and their eyes seem to reflect a red light? That is exactly what your doctor is looking for!
The parents of this 18-month-old child noticed a difference between the two eyes in a family photograph and alerted their pediatrician. The child was subsequently referred to an ophthalmologist and diagnosed with retinoblastoma in the left eye, which is directly visible through the pupil as an abnormal white reflex (leukocoria).
Courtesy of Paul L Kaufman, MD and Richard A Saunders, MD.
© 2022 UpToDate, Inc. and/or its affiliates. All Rights Reserved.
When looking for the red reflex, your doctor is basically looking for its presence or absence, the color, brightness and, most importantly, symmetry between the eyes.
Adapted with permission from: Alfred G. Smith, MD. As printed in: Red Reflex Examination in Neonates, Infants, and Children. Pediatrics 2008; 122:1401.
© 2022 UpToDate, Inc. and/or its affiliates. All Rights Reserved.
Red reflex testing is super important for early detection of vision- and potentially life-threatening abnormalities, including:
Cataracts - clouding of the lens.
Glaucoma - optic nerve damage, usually due to increased eye pressure.
Strabismus - eyes that are turned in different directions from one another.
Retinoblastoma - cancer that starts in the very back of the eye (the retina).
High refractive errors - when the shape of your eye prevents you from seeing clearly.
Because of the serious nature of some of those findings, the AAP recommends that red reflex testing should be performed starting in the newborn period and during all upcoming well child appointments.
If you think your child may have an abnormal test, consult your pediatrician.
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