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The effect of ethnicity on the accuracy of fundal reflex referrals

Eye (2025)Cite this article

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We read with great interest Kelly et al.’s work regarding the importance of the language used to describe the retinal fundal reflex [1]. The retinal fundal reflex test (“red reflex”) screens for sight threatening eye conditions in newborns. Classically described as the “red reflex”, as this is the normal appearance in Caucasians, Kelly et al. have proposed changing the terminology to the “fundal reflex test” to counter the false implication that a ‘normal’ reflex must be red in colour [1].

Anecdotally, it is described that a number of false positive referrals for abnormal fundal reflexes occur when the reflex is ‘normal’ but not ‘red’ due to the ethnicity of the patient. A common scenario is General Practitioners unnecessarily referring Black and minority ethnic children whose normal fundal reflexes appear yellow or white instead of red [2]. This prompted us to investigate further.

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All data generated or analysed during this study are included in this published article.

References

  1. Kelly C, Anderson M, Smith H, Kousha O, Hitchcott N, Reddy MA, et al. Decolonising the ‘red’ reflex test: transitioning from terminology based on colour to anatomy. Eye (Lond). 2025;39:379–81.

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  2. Shafiq A. Seeing red in young children: the importance of the red reflex. Br J Gen Pr. 2015;65:209–10.

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  3. Baldino VMCL, Eckert GU, Rossatto J, Wagner MB. Red reflex test at the maternity hospital: results from a tertiary hospital and variables associated with inconclusive test results. J Pediatr (Rio J). 2020;96(Nov-Dec):748–54.

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  4. NHS Lothian, Lothian public health survey 2023 [Internet]. NHS Lothian; [cited 2025 Feb 03].

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This was not supported by any sponsor or funder.

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Authors and Affiliations

  1. School of Medicine, University of Edinburgh, Chancellor’s Building, Edinburgh, UK

    Yutao Du & James E. Hazelwood

  2. Princess Alexandra Eye Pavilion, Chalmers St, Edinburgh, UK

    James E. Hazelwood & Frederick R. Burgess

  3. School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, UK

    Frederick R. Burgess

Authors
  1. Yutao Du
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  2. James E. Hazelwood
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  3. Frederick R. Burgess
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Contributions

YD contributed to data collection, statistical analysis and writing of the manuscript. JH and FB contributed writing of the manuscript.

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Correspondence to Yutao Du.

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Du, Y., Hazelwood, J.E. & Burgess, F.R. The effect of ethnicity on the accuracy of fundal reflex referrals. Eye (2025). https://doi.org/10.1038/s41433-025-04070-z

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