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Red Reflex Examination in Reproductive and Child Health Clinics for Early Detection of Paediatric Cataract/ Ocular Media Disorders:  Evidence from Kilimanjaro Tanzania

Furahini G. Mndeme, MD; Evarista Mgaya; Louise Allen; Richard Bowman
London School of Hygien and Tropical Medicine
London , United Kingdom

Introduction: Cataract is the leading cause of childhood blindness in sub Saharan Africa (1,2), due in large part to late presentation and absence of any screening programmes (3) or appropriate screening technology. We aim to determine the most suitable screening test for ocular media disorders in under-five reproductive and child health clinical setting.

Methods:  Study 1. We compared reflex test with torchlight examination in 1152 children less than 5 years old attending Reproductive and Child Health clinics, using pen torch, direct and indirect ophthalmoscopy.  Study 2. We evaluated the sensitivity and specificity of 4 screening tools (Arclight, I-Cam, Portable Eye Examination Kit (PEEK) and Torchlight) in detecting media opacities by ophthalmic nurses in an enriched sample of 41 cases and 60 controls in the hospital setting. Study 3. We then evaluated the feasibility of 2 new screening technologies (Arclight and I Cam) by trained non- ophthalmic nurses in Reproductive and Child Health clinical setting.

Results:  Study1. Red reflex testing was more sensitive (p=0.0005) than torchlight detecting 18 out of 19 (94.7%) ocular media disorders (cataract, retinoblastoma and corneal scar) compared to 8 out of 19 (42%) by torchlight.
Study 2. The sensitivities of the 4 techniques were, I-Cam (97.56%), Arclight (92.68%), Portable Eye Examination Kit (90.2%) and torchlight (7.3%).
Study 3. Trained non-ophthalmic nurses screened a total of 2728 children.  24 children were referred and 7 were true positive (6 cataracts &1 retinoblastoma). Nurses reported I-cam initially easier to use but after learning curve, Arclight was easier.

Discussion:  Our study shows that,Red reflex testing was more sensitive  than torchlight. The study also show that I-Cam had higher  sensitivity than Arclight , Portable Eye Examination Kit,  and torchlight. In addition, Nurses reported I-cam initially easier to use but after learning curve, Arclight was easier.

Conclusion:  I-cam and Arclight offer exciting potential to reduce blindness from cataract in African children.


  1. Muhit, M.A., et al., Causes of severe visual impairment and blindness in Bangladesh: a study of 1935 children. British journal of ophthalmology, 2007. 91(8): p. 1000-1004.
  2. Gilbert, C., Changing challenges in the control of blindness in children. Eye, 2007. 21(10): p. 1338-1343.
  3. Mafwiri, M.M., R. Kisenge, and C.E. Gilbert, A pilot study to evaluate incorporating eye care for children into reproductive and child health services in Dar-es-Salaam, Tanzania: a historical comparison study. BMC nursing, 2014. 13(1): p. 1.
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