Ruttum M S, Nelson D B, Wamser M J, Balliff M
Pediatrics. 1987 May;79(5):814-7.
Congenital cataracts and other ocular media opacities are a leading cause of preventable childhood blindness. Because of the importance of early recognition and treatment of congenital media opacities in newborn infants, we designed a study to determine the ability of relatively inexperienced examiners to detect such ocular abnormalities with either of two instruments. Eight third-year medical students examined eight children and young adults with ocular media opacities and eight age-matched normal subjects with an ophthalmoscope or a retinoscope. With respect to detection of abnormalities requiring referral to an ophthalmologist, there was an underreferral rate of 7% and overreferral rate of 5%. There was no significant difference between instruments. Based on an estimated incidence of congenital cataracts of 0.4%, the positive predictive value of this screening in the population of newborn infants is 18.7% and the negative predictive value is 99.96%. Therefore, overreferral is unavoidable in the effort to detect infants with congenital media opacities. We conclude that this examination can be easily taught and accurately performed with the readily available ophthalmoscope. The importance and technique of examining the red reflex should be stressed in the training of those caring for newborns.
先天性白内障及其他眼内介质混浊是儿童可预防失明的主要原因。鉴于尽早识别和治疗新生儿先天性眼内介质混浊的重要性，我们设计了一项研究，以确定经验相对不足的检查者使用两种仪器中的任何一种检测此类眼部异常的能力。八名三年级医学生使用检眼镜或视网膜镜对八名患有眼内介质混浊的儿童和年轻人以及八名年龄匹配的正常受试者进行了检查。对于需要转诊至眼科医生的异常检测，转诊不足率为7%，转诊过度率为5%。两种仪器之间没有显著差异。基于估计的先天性白内障发病率为0.4%，这种筛查在新生儿群体中的阳性预测值为18.7%，阴性预测值为99.96%。因此，在检测患有先天性眼内介质混浊的婴儿时，转诊过度是不可避免的。我们得出结论，可以轻松教授这种检查方法，并且使用现成的检眼镜就能准确进行。在照顾新生儿人员的培训中，应强调检查红光反射的重要性和技术。
