The role of education in the promotion of red reflex assessments

OBJECTIVES: To assess the impact of an information poster on rate and accuracy of referrals of abnormal red reflex from general practioners (GP) and hospital doctors involved in the care of children. DESIGN: A retrospective audit of all referrals for abnormal red reflex received between the periods September 2005 to September 2006 was carried out. Posters were sent to 200 GP practices in East London as well as our local hospital. Pathways for referrals were given, and a prospective re-audit was conducted from October 2006 to March 2008. SETTING: The Royal London Hospital and practices serving the East End of London. PARTICIPANTS: GPs serving the East End of London and hospital doctors involved in child care. MAIN OUTCOME MEASURES: (1) Increase in the referral rate for abnormal red reflex finding; and (2) accuracy of referral for abnormal red reflex. RESULTS: Prior to posters being sent, there were no referrals of abnormal red reflexes to our department. Following the posters being sent, 21 abnormal red reflex referrals were made over a period of 18 months; 18 from GPs and three from neonatologists. Thirteen were detected at 6 weeks of age (routine screening). Three patients had a positive finding (two with bilateral cataracts and one with hypermetropic astigmatism). CONCLUSIONS: Although an increase in referrals suggests that the assessment of the red reflex is being performed and public awareness has increased, the sensitivity of this test remains low. Management strategies need to be in place to deal with an influx of patients who may have normal assessments and a strategy in East London will be discussed.