A CLINICAL STUDY ON THE DETECTION OF STRABISMUS, ANISOMETROPIA OR AMETROPIA OF CHILDREN BY SIMULTANEOUS PHOTOGRAPHY OF THE CORNEAL AND THE FUNDUS REFLEXES

Abstract

Strabismus [22] and normal, straight-eyed patients [106] were photographed with a conventional camera equipped with a weak 100 mm teleobjective and coaxial flashlight and then examined clinically. The possibility of detecting strabismus, anisometropias and ametropias in the photographs by noting the localization of the corneal reflexes and the appearance and lightness of the fundus reflexes and their possible asymmetry were tested in a double-blind study. Even small-angled strabismus cases were detected because of the asymmetrical localization of the corneal reflexes. In 18 of the 22 strabismus cases (82%) the asymmetrical lightness of the fundus reflexes and the fundus reflex of the deviating eye were lighter than the fixating eye. All the straight-eyed anisometropias of .gtoreq. 3.0 diopter (5 cases) were observed in the photographs because of the asymmetrical appearance of the fundus reflexes. In straight-eyed anisometropias of < 3.0 diopters the fundus reflexes were symmetrical in 90 cases and asymmetrical in 11 cases (11%). Only 3 of 8 hyperopias of +4.5 to +6.0 diopters were found because of the light crescent in the low part of the pupil. All myopias of > -4.0 diopters (14 cases) were observed because of the light crescent appearance in the upper part of the pupil. No pupillary crescents appeared with refractions of < -1.75 diopter myopia or < +4.5 diopter hyperopia; 172 eyes were within this range. This rapid and simple screening can be performed by a technician without using premedication to detect strabismus and straight-eyed anisometropias of .gtoreq. 3.0 diopters in small children or other patients who do not cooperate well in normal clinical examination. Over -4.0 diopter myopias were diagnosable. Hyperopias were not reliably predicted, presumably because no cycloplegic drops were used.