Lack of efficacy of dilated screening for retinoblastoma

J Pediatr Ophthalmol Strabismus. Jul-Aug 2005;42(4):205-10; quiz 233-4. doi: 10.3928/01913913-20050701-01.


Purpose: To assess red reflex testing of the pharmacologically dilated pupil in screening for retinoblastoma.

Patients and methods: Children with a family history of retinoblastoma or a history of treated retinoblastoma who were admitted to our institution for examination using anesthesia during a 3-month period underwent red reflex testing of the pharmacologically dilated pupil in a masked fashion. Red reflexes were classified as normal (unremarkable), abnormal (in brightness or color), or absent (no reflex, black pupil). The results of the screenings were later compared with actual retinal findings.

Results: Red reflex testing of the dilated pupil failed to identify all 13 eyes that harbored retinoblastoma lesions (all 13 were classified as normal). The 3 eyes that were identified as having abnormal red reflexes had neither disease nor significant refractive error.

Conclusion: Red reflex testing of the dilated pupil is a poor screening technique for retinoblastoma.

MeSH terms

  • Child, Preschool
  • Cyclopentolate / administration & dosage
  • Diagnostic Techniques, Ophthalmological*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infant
  • Male
  • Mydriatics / administration & dosage*
  • Phenylephrine / administration & dosage
  • Pupil / drug effects*
  • Reproducibility of Results
  • Retinal Neoplasms / diagnosis*
  • Retinoblastoma / diagnosis*
  • Sensitivity and Specificity


  • Mydriatics
  • Phenylephrine
  • Cyclopentolate