The detection of simulated retinoblastoma by using red-reflex testing

Jennifer Li, David K. Coats, Derrick Fung, E. O Brian Smith, Evelyn Paysse

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE: To determine the ability to detect simulated retinoblastoma by using the red-reflex test. METHODS: Discs that simulated retinoblastoma lesions were affixed to the retina of model eyes with an 8- or 3-mm pupil. The diameter, height, and location of the discs varied. Five examiners evaluated the red reflex with direct ophthalmoscopy by using straight-on and oblique viewing. The generalized estimating equation was used to assess the effects of pupil dilation and observer viewing orientation on tumor detection. RESULTS: Significant 3-way interactions between pupil dilation, observer orientation, and tumor diameter (P < .004) or height (P < .02) were detected; these relationships depended on tumor diameter and height. A similar 3-way interaction was found between pupil dilation, observer orientation, and tumor location in degrees from the fovea (P < .001). Oblique viewing and pupillary dilation improved the tumordetection rate. With straight-on viewing, the degree of detection was <48% (95% confidence interval [CI]: 39%-57%) for even the largest lesions, compared with 96% (95% CI: 93%-98%) for oblique viewing. For peripheral lesions, the percentage detection for straight-on viewing was 35% (95% CI: 21%-50%) for 30° from the fovea and 16% (95% CI: 2%-31%) for 60° from the fovea; these detection rates significantly improved with oblique viewing to 70% or higher (P < .001). CONCLUSIONS: Detection of simulated retinoblastoma was better when lesions were large and when oblique viewing and dilation were used. Peripheral location was negatively associated with detection. Red-reflex testing to detect leukocoria may be improved with oblique viewing and pharmacologic dilation.

Original languageEnglish (US)
JournalPediatrics
Volume126
Issue number1
DOIs
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Retinoblastoma
Reflex
Dilatation
Pupil
Confidence Intervals
Neoplasms
Ophthalmoscopy
Aptitude
Retina

Keywords

  • Detection
  • Leukocoria
  • Red-reflex testing
  • Retinoblastoma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

The detection of simulated retinoblastoma by using red-reflex testing. / Li, Jennifer; Coats, David K.; Fung, Derrick; Smith, E. O Brian; Paysse, Evelyn.

In: Pediatrics, Vol. 126, No. 1, 07.2010.

Research output: Contribution to journalArticle

Li, Jennifer ; Coats, David K. ; Fung, Derrick ; Smith, E. O Brian ; Paysse, Evelyn. / The detection of simulated retinoblastoma by using red-reflex testing. In: Pediatrics. 2010 ; Vol. 126, No. 1.
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abstract = "OBJECTIVE: To determine the ability to detect simulated retinoblastoma by using the red-reflex test. METHODS: Discs that simulated retinoblastoma lesions were affixed to the retina of model eyes with an 8- or 3-mm pupil. The diameter, height, and location of the discs varied. Five examiners evaluated the red reflex with direct ophthalmoscopy by using straight-on and oblique viewing. The generalized estimating equation was used to assess the effects of pupil dilation and observer viewing orientation on tumor detection. RESULTS: Significant 3-way interactions between pupil dilation, observer orientation, and tumor diameter (P < .004) or height (P < .02) were detected; these relationships depended on tumor diameter and height. A similar 3-way interaction was found between pupil dilation, observer orientation, and tumor location in degrees from the fovea (P < .001). Oblique viewing and pupillary dilation improved the tumordetection rate. With straight-on viewing, the degree of detection was <48{\%} (95{\%} confidence interval [CI]: 39{\%}-57{\%}) for even the largest lesions, compared with 96{\%} (95{\%} CI: 93{\%}-98{\%}) for oblique viewing. For peripheral lesions, the percentage detection for straight-on viewing was 35{\%} (95{\%} CI: 21{\%}-50{\%}) for 30° from the fovea and 16{\%} (95{\%} CI: 2{\%}-31{\%}) for 60° from the fovea; these detection rates significantly improved with oblique viewing to 70{\%} or higher (P < .001). CONCLUSIONS: Detection of simulated retinoblastoma was better when lesions were large and when oblique viewing and dilation were used. Peripheral location was negatively associated with detection. Red-reflex testing to detect leukocoria may be improved with oblique viewing and pharmacologic dilation.",
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N2 - OBJECTIVE: To determine the ability to detect simulated retinoblastoma by using the red-reflex test. METHODS: Discs that simulated retinoblastoma lesions were affixed to the retina of model eyes with an 8- or 3-mm pupil. The diameter, height, and location of the discs varied. Five examiners evaluated the red reflex with direct ophthalmoscopy by using straight-on and oblique viewing. The generalized estimating equation was used to assess the effects of pupil dilation and observer viewing orientation on tumor detection. RESULTS: Significant 3-way interactions between pupil dilation, observer orientation, and tumor diameter (P < .004) or height (P < .02) were detected; these relationships depended on tumor diameter and height. A similar 3-way interaction was found between pupil dilation, observer orientation, and tumor location in degrees from the fovea (P < .001). Oblique viewing and pupillary dilation improved the tumordetection rate. With straight-on viewing, the degree of detection was <48% (95% confidence interval [CI]: 39%-57%) for even the largest lesions, compared with 96% (95% CI: 93%-98%) for oblique viewing. For peripheral lesions, the percentage detection for straight-on viewing was 35% (95% CI: 21%-50%) for 30° from the fovea and 16% (95% CI: 2%-31%) for 60° from the fovea; these detection rates significantly improved with oblique viewing to 70% or higher (P < .001). CONCLUSIONS: Detection of simulated retinoblastoma was better when lesions were large and when oblique viewing and dilation were used. Peripheral location was negatively associated with detection. Red-reflex testing to detect leukocoria may be improved with oblique viewing and pharmacologic dilation.

AB - OBJECTIVE: To determine the ability to detect simulated retinoblastoma by using the red-reflex test. METHODS: Discs that simulated retinoblastoma lesions were affixed to the retina of model eyes with an 8- or 3-mm pupil. The diameter, height, and location of the discs varied. Five examiners evaluated the red reflex with direct ophthalmoscopy by using straight-on and oblique viewing. The generalized estimating equation was used to assess the effects of pupil dilation and observer viewing orientation on tumor detection. RESULTS: Significant 3-way interactions between pupil dilation, observer orientation, and tumor diameter (P < .004) or height (P < .02) were detected; these relationships depended on tumor diameter and height. A similar 3-way interaction was found between pupil dilation, observer orientation, and tumor location in degrees from the fovea (P < .001). Oblique viewing and pupillary dilation improved the tumordetection rate. With straight-on viewing, the degree of detection was <48% (95% confidence interval [CI]: 39%-57%) for even the largest lesions, compared with 96% (95% CI: 93%-98%) for oblique viewing. For peripheral lesions, the percentage detection for straight-on viewing was 35% (95% CI: 21%-50%) for 30° from the fovea and 16% (95% CI: 2%-31%) for 60° from the fovea; these detection rates significantly improved with oblique viewing to 70% or higher (P < .001). CONCLUSIONS: Detection of simulated retinoblastoma was better when lesions were large and when oblique viewing and dilation were used. Peripheral location was negatively associated with detection. Red-reflex testing to detect leukocoria may be improved with oblique viewing and pharmacologic dilation.

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