The opportunistic screening of refractive

errors in school-going children by

pediatrician using enhanced Brückner test
Okta Kurniawan Saputra*

Consultants:
dr. Ani, SpM(K)

Department of Ophthalmology
Mohammad Hoesin Hospital Palembang
2019
Background

Prevalence of refractive errors,

especially myopia, in urban
India is high and demonstrates
an increasing trend

The magnitude as well as the

prevalence of myopia
increases with age.
Background

Enhanced Brückner test (EBT) can

be performed by transilluminating
the pupil using a direct
ophthalmoscope from an arm
length distance while the patient
fixates at the ophthalmoscope
light.
Background
EBT :
Simple, Rapid,
Reliable, And
Objective
(Experienced Pediatric
Ophthalmologist) However, its
reliability is not
compared when used
by a pediatrician.
Method
Pediatric
Community
Ophthalmologist
of Tertiary
Teaching Pediatric
Prospective Eye Centre of
Two masked
observational urban India
investigators
study

Performed
A pediatrician
EBT in a
and a
semi-darkene
pediatric
d room of a
ophthalmolog
municipal
ist
school
 Method
The EBT was performed from a distance of 1 m from the
subject. Both eyes of the subject were simultaneously
illuminated using a direct ophthalmoscope with the subject
looking directly into the ophthalmoscope light.

Ametropic :
Emetropic :
Inferior crescent or
≤2 mm superior well
decentered crescent
centered to 12
or >2 mm size
o’clock position
superior crescent
Results
Discusion
High prevalence of significant refractive errors using a
screening test that was reported to have high negative
predictive value and specificity

This is particularly important when a pharmacological and

environmental modification can potentially prevent or slow
down the progression of myopia
Training in performing the EBT should be included as a part
of the curriculum in the pediatric residency program and
should be considered a mandatory examination in the
pediatrician’s office.

One of the methods for detection of refractive errors in

preverbal children is to perform an EBT during a routine
comprehensive pediatric examination

The sole purpose of this study was to compare the

screening of children with EBT by a pediatrician with a
trained pediatric ophthalmologist who was very well
versed with the EBT
Conclusion

Opportunistic screening of
refractive errors using EBT by
pediatrician can be an important
approach in the detection of
ametropia in children.
Critical Appraisal
Is the background of the study clearly stated?

Yes, It is.
Myopia is the most common refractive error
in school-going children in India
The Brückner test is a simple and objective
method that relies on comparison of
brightness and pattern of transpupillary refl
ex by a trained examiner using a direct
ophthalmoscope
What is the main problem of this study?

Reliability is not compared when used by a

pediatrician.
What is the objective of this study?

To compare the results of enhanced Brückner test

(EBT) performed by a pediatrician and an experienced
pediatric ophthalmologist

What is • Prospective
the type of observational
the study? study
What is conclusion of this study?

• EBT by pediatrician can be an important approach in

the detection of ametropia in children.
• In this study, the Brückner test was found to have
excellent sensitivity and negative predictive value
for detecting refractive errors in school children
 Perkembangan Postnatal
Ukuran bola mata dan panjang aksial:

Berubah secara dramatis (brp th I kehidupan).

Segmen anterior (neonatus); 75% - 80% dewasa.
Segmen posterior (saat lahir); < ½ ukuran dewasa
Volume mata neonatus; 2,8 cm3,dewasa; 6,8–7,5 cm3
Area permukaan sklera neonatus; 812 mm2 ,dewasa; 2450
mm2
Perubahan ukuran bola mata  perluasan permukaan sklera
pada segmen posterior (sampai umur 13 th, perubahan
dramatis pd 6 bln I kehidupan)
 Perkembangan Postnatal
Ukuran bola mata dan panjang aksial:

Sklera pada bayi lebih banyak seluler dari pada dewasa 

pertumbuhan.
Tebal sklera di equator; 0,45 mm pada anak (dewasa; 1,09
mm)
Sklera neonatus lebis elastis dan lebih mudah dilipat dari pada
dewasa.
Panjang aksial mata neonatus; 16 mm, pertumbuhan
longitudinal panjang aksial terjadi sampai umur 13 th
 Perkembangan Postnatal
Ukuran bola mata dan panjang aksial:
Perubahan panjang aksial dibagi dalam 3 periode
pertumbuhan;
1. Phase pertumbuhan postnatal;
cepat, 18 bln I kehidupan, panjang aksial m
4,3 mm (dari 16,0 mm menjadi 20,3 mm)
2. Phase pertumbuhan infantil;
antara umur 2 & 5 th, panjang aksial m 1,1 mm
3. Phase juvenil;
lambat, dari umur 3 sampai 13 tahun, panjang
aksial m 1,3 mm
Panjang aksial; laki-laki 0,3 – 0,4 mm > perempuan.