Universal neonatal screening for eye anomalies is recommended. This should be accompanied by diagnostic and treatment services for infants in whom an abnormality is detected.
An estimated 1.14 million children aged 0-15 years are blind or have severe visual impairment due to eye conditions. The main causes of blindness are congenital and developmental cataracts, corneal scarring, congenital ocular anomalies, retinal dystrophies, glaucoma, and retinopathy of prematurity.
Screening during the neonatal period allows detection of those newborns with conditions that are present at birth for timely referral for treatment (cataract, glaucoma and retinoblastoma surgery; long-term follow-up or referral for general health evaluation or visual rehabilitation). Ocular evaluation is usually performed with a flashlight to examine the external structures of the eye and with red reflex testing, with direct ophthalmoscopy or a suitable alternative. The direct ophthalmoscopic red reflex has high specificity for anterior and posterior eye segment conditions, and for combined conditions, although its sensitivity is lower, especially for posterior segment conditions.
Universal screening for ocular anomalies in newborns should be performed prior to discharge after a facility-based delivery, or at the first postnatal care visit in an outpatient setting after home birth. Whenever possible, screening should be done within the first six weeks after birth.
External eye examination and red reflex testing should be performed by appropriately trained health care team personnel using standard equipment (e.g., direct ophthalmoscope). Systematic screening, referral, diagnosis and treatment systems should be established or strengthened to ensure appropriate follow-up and management of those with a positive result.
