Comparative study of use of Brückner test with eye testing for refractive error
Comparative study of use of Brckner test with eye testing for refractive error
INTRODUCTION
Health screening of school going children is performed in almost every school as a part of Sarva shiksha Abiyan (SSA) under National Ruler health Mission (NRHM).Ophthalmic screening for estimation of visual acuity & refractive error is a very difficult task. Many times such programmes are not carried out by vision care specialists or trained school teachers. Such testing can not be performed in preverbal or mentally retarded children.
Different study shows that the prevalence of refractive error in India for school going children is 3 to 5 %. Uncorrected refractive error cause amblyopia, strabismus (Squint ) & many more ophthalmic complications. Early detection of refractive error is most important in the management of eye health.
To overcome this difficulty a test has been developed to find out refractive error of the patients. This test enables the investigator to find out subjects with normal eyes and those who are affected so that only affected subjects can be screened meticulously.
Brckner test is a simple and objective method that relies on comparison of brightness and pattern of transpupillary reflex by a trained examiner using a direct ophthalmoscope. It is an ultra-rapid test useful in detecting significant refractive error, strabismus > 4 prism diopter, anisometropia > 1D, media opacity and afferent pupillary defect. In this study we have compared Brckner test with conventional vision screening method to detect refractive errors in school children.
Aim
To compare efficacy of Brckner test with conventional visual eye testing for finding the refractive error in school going age.
Objectives
To find out efficacy of Brckner test.
To find out rapid method for detection of Refractive error in school going age.
To find out objective method for Refractive error in school going age.
To find out sensitivity of Brckner test over visual eye testing.
Materials and Methods
This prospective, single masked, observational, study was performed on children of 2 different schools from Navi Mumbai. Brckner test was performed for 524 children (1048 eyes). The test was performed in a closed room with the room lights off. Children with obvious ocular co-morbidity viz. squint, nystagmus, cataract, glaucoma, corneal opacities etc. were excluded.
An examiner with a good amount of training with the Brckner test performed all the examinations and noted the test as positive or negative based on size and location of the transpupillary crescent. Subsequently a class teacher trained for estimation of visual acuity & who does not know (masked) the observations of the Brckner test performed vision testing of same students. The child was declared Pass if presenting vision measured by Snellen's vision chart at 3 meter distance in each eye was > 6/9.
Result
Table-Comparison of Brckner test with vision estimation
N= 524
Vision Estimation
Brckner test
Emmetropia (Pass)
> 6/9
Ametropia (Fail)
< 6/9
Total
Emmetropia (Negative)
441
1 *
442
Ametropia (Positive)
3
79
82
Total
444
80
524
Statistical Analysis
We examined 1048 eyes of 524 children, Time taken to perform Brckner test was less than 30 seconds per child. 524 students of primary school age were subjected to Brckner test, out of which 442 were marked negative where as 82 were stamped as Brckner test positive Out of So called affected children 3 (3.65%) were found Emmetropic & 1 (1.21%) from Brckner negative was found Ametropic after they were subjected to manual eye examination
Conclusion
In this study Brckner test was found to have excellent sensitivity only 0.19 % failures in form of the1 ametropic in 524 subjects. Where as these were only 3 failures in 82 positive subjects. i.e. 3.65%
Bibliography
l PK Mukherjee's Clinical Examination In Ophthalmology, ISBN 9788131203354 Elesevier 2006
l Parsons' Diseases of the eye 12th edition ISBN 9788131203378 Elesevier 2007
l Kothari MT. Can the Brckner test be used as a rapid screening test to detect significant refractive errors in children? Indian J Ophthalmol 2007;55:213-5.
l Kothari M, Turakhia J, Vijayalakshmi P. Can Brckner test be used as a Rapid Screening Test for the detection of amblyogenic factors in developing countries? Am Orthop J 2003;23:112-6.
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Comparative study of use of Brückner test with eye testing for refractive error