Can the Brückner Test Be Used as a Rapid Screening Test to Detect Amblyogenic Factors in Developing Countries?
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 papillary 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 81.2% and specificity 81.6%; the positive (PPV) and negative (NPV) predictive values were 66.7% and 90.3%. The false positive and false negative rates were 18.8%.
Conclusion: Although imperfect, the Brückner test may be a low cost alternative to either screening with a photo screener or to no screening for amblyogenic factors in developing countries.