Red Reflex Study: East Africa

Late presentation is a key barrier to good outcomes for congenital cataract and retinoblastoma (Rb) in sub-Saharan Africa, leading to needless blindness for cataract, and death for retinoblastoma. For instance Rb survival in Kenya has been estimated at 23% compared to 97% in developed countries. For cataract, average lag time before operation is measured in years in Africa whereas babies are operated before 8 weeks of age in developed countries. This is the reason why cataract has become the leading cause of childhood blindness in Africa. Increased public understanding of these problems and appropriate screening strategies are two important methods for addressing this problem.Primary health workers have a good opportunity to screen for these conditions; 90% of children are seen by them during their first year of life as part of successful immunization programmes. They are not currently trained / equipped to do red reflex screening which would diagnose cataract and Rb. New technologies are making red reflex screening simpler and more reliable for the non-specialist. We therefore have a well-described public health problem and an opportunity with new technology to address it.Study Objective: To measure and compare 2 devices for nurse led red reflex screening in terms of case detection rates and PPV regarding numbers of children referred with serious treatable eye conditions, specifically cataract and retinoblastoma.SECURE: Saving Eyes and Children Using Red reflex Examination