Abstract

DO.18.04

Brückner test by experienced and unexperienced observers

Jung A., Gräf M.
Department of Ophthalmology, University of Gießen

Objective: The Brückner reflex is an easy and quick method to detect amblyogenic factors by an abnormal pupillary red reflex. In this study, experienced and unexperienced observers were compared regarding the sensitivity of the Brückner reflex to detect unilateral spherical ametropia.
Methods: Five experienced and 25 unexperienced observers performed the transillumination test in emmetropic subjects at distances of 1 m and 4 m. Unilateral hypermetropia was simulated by sperical lenses of -1, -2, -3, -4 diopters which were placed in front of both the right and the left eye in an unpredictable order. Additionally, there were control conditions in each subject with a plano lens in front of both eyes. The same procedure was repeated inducing unilateral myopia with lenses of +1, +2, +3 und +4 diopters. In total, the experienced/unexperienced observers performed 50/25 tests for each individual ametropia situation both at 1 m and 4 m distance and 225/200 tests in emmetropic control conditions. The test was defined to be positive, if there was a difference between the red reflexes of both eyes.
Results: At a test distance of 1 m, the experienced (in parenthesis, the unexperienced) observers detected unilateral hypermetropia of 1, 2, 3, and 4 diopters in 34% (8%), 58% (40%), 76% (56%), and 80% (64%). Myopia of 1, 2, 3, and 4 diopters was detected in 60% (32%), 80% (28%), 74% (40%), and 82% (36%). At 4 m detection rates were 52% (60%), 94% (100%), 96% (100%), 98% (100%) and 100% (64%), 100% (100%), 98% (100%), 100% (96%), respectively. The rates of false positive findings were 3.1% (1.5%) at 1 m and 4.0% (3.0%) at 4 m.
Conclusions: Extending the test distance significantly improves the sensitivity of the transillumination test to detect anisometropia and reduces observer bias. At a distance of 4 m, findings of experienced and unexperienced observers were nearly equal, while they differed significantly at the traditional distance of 1 m.

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