Validity of the Bruckner reflex in the detection of amblyopia

Abstract

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.