Did you know that a photograph could provide valuable and potentially life-saving information about the health of a child's eyes?

When Tara Taylor posted a photograph of her 3-year-old daughter on Facebook, friends in her social network informed her that the glow in the girl's eye could indicate something wrong. As a result, Rylee Taylor was diagnosed with a rare eye disease that can cause vision loss, but thanks to early detection was able to save her sight.

We are taking more pictures than ever, and sharing them with a growing audience of people using social and other digital media. Paying close attention to photos of children can actually clue us in to both common and rare eye problems signaled by the reflection of the camera flash off the retina, also known as the "red reflex."

Examples of white reflex, asymmetrical red reflex, and yellow reflex as seen in photographs of children. White, yellow and missing reflex can be signs of serious, potentially blinding, eye problems. Asymmetrical red reflex can be a sign of misalignment of eyes, which is also very serious and can result in reduction of a child’s vision.

The Rainbow of Reflexes

A red reflex is produced when the flash of a camera lights up the blood-rich retina. If the eyes are looking directly at the camera lens and the color of the reflex in both eyes is red, in most cases that's a good indication that the retinas of both eyes are unobstructed and healthy.

An "abnormal red reflex" is a white, yellow or black reflection in one or both eyes. This can be a warning sign for the presence of an eye condition, which can be diagnosed by a pediatric ophthalmologist.

Dr. Jane Edmond, MD, Baylor College of Medicine and Texas Children's Hospital, points out that it's important to note whether a photo has been taken under optimal conditions to present a true abnormal red reflex. Be sure that:

  • the child is looking directly at the camera lens
  • the camera flash is on and the background is dimly lit
  • red-eye reduction is turned off

If you do spot an abnormal red reflex, bring the photo to your child's pediatrician or a pediatric ophthalmologist.

Very often, a white reflex may not actually signal anything abnormal. "Instead, the child is probably looking off to the right of the camera, and the white reflection occurs in the left eye because the optic nerve is lined up perfectly with the camera and the flash."

"Overwhelmingly, the most common cause of an abnormal red reflex is refractive error," said Dr. Michael Repka, MD, Johns Hopkins Hospital. A refractive error means that due to its shape, your eye doesn't refract the light properly, so the image you see is blurred. Myopia (nearsightedness), hyperopia (farsightedness) and astigmatism are types of refractive error.  

"Most of the time, this is a problem fixed with glasses," Dr. Repka said.

White, Yellow and Black Flags for Serious Eye Disorders

On rare occasions, abnormal red reflexes can signal more dangerous eye conditions.

An asymmetrical red reflex, when only one eye reflex appears red, or one eye's red reflex is dimmer than the other, may be an indicator of strabismus, or misalignment of the eyes, a condition in which both eyes do not look at the same place at the same time. Treatment for strabismus may include eyeglasses, prisms, patching or blurring the strong eye, or eye muscle surgery. If detected and treated early, strabismus often can be corrected with excellent results.

A white reflex that covers most of the pupil, also known as leukocoria, can be a red flag for several serious eye disorders including cataracts, retinal detachments and infections inside the eye. It can also be a warning sign of retinoblastoma, an extremely rare and very serious childhood cancer of the eye. When caught and treated early, retinoblastoma is curable 95 percent of the time.

A yellow reflex can be a sign of Coats' disease, when blood vessels inside the eye that provide blood and oxygen to the retina become twisted and leaky, creating a blockage in the retina that can cause vision loss or retinal detachment. It occurs mostly in boys under age 10, and usually affects only one eye. Treatment can include laser surgery, cryotherapy or, in later stages of the disease, more invasive surgery.

Coats' disease can be difficult to distinguish from a retinoblastoma through photographs because the white and yellow reflexes look similar, Dr. Edmond said.

A Picture Is Worth a Thousand Words

Pediatricians should check for red reflex at every wellness visit using an ophthalmoscope. But it's important to know that even the most serious eye conditions don't typically cause children pain or visual impairment in early stages. In most cases, one of the child's eyes is working normally, so complaints are rare – even when something is wrong.

"A young child isn't going to tell you 'By the way when I cover one of my eyes I can't see.' They just go on with life," Dr. Repka said.

Research is underway to develop software that can automatically detect leukocoria and other abnormal red reflexes in photographs. Meanwhile, screening and sharing pictures, both online and printed, may lead to early detection that could save vision or a life.

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