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Pediatría (Asunción)

On-line version ISSN 1683-9803


CARDOZO-SARUBBI, Olivia; GARCIA-GARCIA, Susana  and  MESQUITA-RAMIREZ, Mirta. Red reflex sensitivity in infants, performed by pediatricians using images taken with a smartphone. Pediatr. (Asunción) [online]. 2021, vol.48, n.2, pp.99-106. ISSN 1683-9803.


The first ocular evaluation is performed in the neonatal period observing the red reflex (RR).


To determine the sensitivity and specificity of the red reflex obtained with images taken by pediatricians using a smartphone, in children under 24 months.

Materials and Methods:

This was an observational study of diagnostic testing. We included infants aged 24 months and under. The study had two stages, The first stage involved searching for the red reflex using images obtained with a smartphone with a 1280 x720 screen and a pixel density of 267 ppp, with a 13 MP rear camera and LED Flash, which was carried out by a pediatrician operator, in a darkened office, with the child held by the mother 6 meters away from the camera. Presence of the red reflex in both eyes was considered normal and a unilateral or bilateral absence was abnormal. The second stage was an ophthalmological examination, which was blinded in relation to the first pediatric evaluation. Data analysis was performed with SPSS, using descriptive statistics. The institutional ethics committee approved the protocol, and informed consent was obtained.


228 infants with a median age of 7 months were included (interquartile ranges from 5 to 11 months). The red reflex with the cell phone was normal in 206/228 and abnormal in 21/228. On examination by pediatric ophthalmology, the exam was normal in 219 / 228 and abnormal in 9/228. The sensitivity of the test with the smartphone was 88% and the specificity 94%. Visual pathologies were detected in 4%.


The detection of the red reflex by pediatricians with a smartphone had a sensitivity of 88% and a specificity of 94%. Ocular pathologies were detected in 4% of subjects.

Keywords : Infants; primary care; red reflex test; smart phone; ophthalmopathies.

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