Accessible eye health technology shows large advantages over current method for detecting childhood problems in lower and middle-income countries

A nurse trained in red reflex testing giving health education to mothers attending a child health clinic. Photograph: Furahini Mndeme

A new study from ICEH has revealed that an existing, easily accessible method of detecting causes of avoidable blindness would be more beneficial in lower and middle-income countries than the current standard.

The research, carried out in Tanzania, tested four different screening tools for cataract and retinoblastoma, common causes of blindness. The methods included simple torchlight, which is currently recommended by the World Health Organisation (WHO) for primary eye care, and three more advanced methods: Arclight™, CatCam and PEEK Retina.

Torchlight, Arclight and CatCam can all perform red reflex testing, a method whereby light is projected through the pupil into the eye. The resulting reflection can reveal a number of potential abnormalities of vision. The final method, PEEK Retina, captures pictures of the retina directly through a smartphone attachment.

Devices designed specifically for testing the red reflex are more commonly used in higher-income countries, which may contribute to better outcomes in those countries. Lower-income countries such as Tanzania have a much higher burden of poor health linked to vision and are more likely to use torchlight to assess eye problems.

This study, published in Eye, had ophthalmic nurses at a paediatric ophthalmic clinic in Kilimanjaro use the four different methods on children who had already been assessed by an ophthalmologist to have either cataract or retinoblastoma. This was the first time these methods have been compared.

Nurses performing red reflex test using Arclight during training. Photograph: Furahini Mndeme

The results showed a significant advantage for the newer three methods, with the ability to accurately detect the right disease at 97.6% for CatCam, 92.7% for Arclight, 90.2% for PEEK retina and 7.3% for torchlight.

Following these results, the investigators looked to determine if the newer methods were feasible within a primary healthcare setting in Tanzania. Reproductive and Child Health (RCH) Nurses, who normally carry out child services such as immunisation but not eye screening, were trained to use the three newer methods of detection.

Despite CatCam performing best in the previous study, the devices have limited availability. In contrast, the Arclight is relatively affordable and available.  Therefore, after training, nurses who would regularly assess children at 12 local Reproductive and Child Health clinics were provided with Arclights to use in their normal practice.

After three months of using the Arclight, the nurses completed a questionnaire which revealed that the majority found the devices easy to use and they were able to integrate screening into their normal practice. The nurses had also detected several children with causes of blindness during the trial. The combined results from the two trials have led to the authors suggesting that red reflex testing should be recommended by WHO instead of torchlight examination to help detect potential causes of blinding, which could lead to improvements in eye health in countries that need it most.



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