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Can the Brückner Test Be Used as a Rapid Screening Test to Detect Amblyogenic Factors in Developing Countries?

Correspondence: Requests for reprints should be addressed to: Dr. Mihir T. Kothari, Department of Paediatric Ophthalmology, Aravind Eye Care Center System, 1 Anna Nagar, Madurai 625 020, India. email: drmihirkothari{at}yahoo.com

Purpose: To determine the usefulness of the Brückner test as a screening tool for detection of amblyogenic factors in developing countries.

Methods: A double blind prospective study of 101 children aged 1 to 16 years attending the pediatric ophthalmology department of a tertiary eye care center. A trained optometrist masked to clinical findings of the subject performed the Brückner test in a dark room using a direct ophthalmoscope and compared differences in brightness of the pupillary reflex of both eyes. Subsequently, subjects underwent a complete ophthalmic examination by a pediatric ophthalmologist masked to the results of the Brückner test.

Results: The optometrist identified 39 subjects as Brückner test positive and 62 as Brückner test negative. On clinical examination, 12 subjects had anisometropia of 1D and 20 subjects had manifest deviation of >4. The sensitivity of the Brückner test was 87.5% and specificity 84.1%; the positive (PPV) and negative predictive (NPV) value was 71.8% and 93.6%. The false positive and false negative rates were 28.2% and 6.5%.

Conclusion: Although imperfect, the Brückner test may be a low cost alternative to either screening with photo screener or to no screening for amblyogenic factors in developing countries.

Key words: Brückner test, vision screening, amblyopia, strabismus, aniso-metropia