6-week old baby - no red reflex seen

[esgill]

My daughter was seen by my GP today as part of our 6-week postpartum review. Everything was okay except the GP said she couldn't see baby's red reflex. She said it wasn't anything to worry about but referred my daughter for an urgent ophthalmologist appointment.

Of course now I'm worried sick reading about possible causes, including congenital cataracts, cancer and other life-threatening or sight-threatening conditions.

Our daughter is half-East Asian so I wondered if this could affect how visible the red reflex is? I read somewhere that it looks different in different ethnicities/can be harder to see. Wondering if there's anything to do while we wait/if a trip to Sick Kids would yield any quicker answers...

(I should note, she can see well it seems -- she has looked into my eyes and my husband's eyes since birth, smiles and follows us around the room with her gaze).

They can be paler in different ethnicities but you can still see them. It’s odd that the dr couldn’t see them at all? In cateracts they are usually quite white or opaque but still viable.
Try no to stress. I assume all was well with the initial check as a newborn?

@UpUpUpU thanks for replying. yes everything was ok when she was born, at least I assume so, they never said anything about her eyes.

Yeah the doctor didn't say she saw anything white -- just that she couldn't see it. I wish I could stop worrying...

The red reflex can be paler in darker skinned ethnicities. So that may be a factor. Does your DD look at you?

What is Sick Kids? You say she's been referred urgently to the ophthalmology team, did they say how long to expect to wait?

Hopefully they will be able to give you some answers and any treatment if needed.

My dd had this and my husband has some quite serious eye problems so I was like you and full of panic. Wait on the ophthalmology appointment as they are the best suited to check baby. I will warn you they sometimes give drops and have to use little sticks to prop open the eye which looks distressing but baby will be fine. In my case it turned out to be nothing just the initial doctor couldn't see anything, hopefully you will be the same!

My daughter had no red reflex in her eye and she had a cataract, she was born with it. She's a teenager now, has had 2 lense replacements and laser treatment for additional growth and wears glasses/contact lenses.

@nocoolnamesleft yes our DD looks at us and smiles.

@xxmyheartxx sorry to hear that. Does she have it in both eyes or one? How is her sight?

@onemoretine oh I really hope this is what we get told. How long did you have to wait? I'm worried sick and can't think of anything else...

I think it was maybe 2/3 weeks until the appointment came through

Well that's a very reassuring sign that she can see.

@nocoolnamesleft true. I'm just so anxious. I love her so much and can't bear the thought of her having a problem so early on. Hoping the Gp just didn't have much experience with this or something...

The red reflex is a reflection coming back from the retina which is pinky/red in people with lighter coloured eyes, in very dark eyes the retina is much darker and you may not see the reflex from the retina. Babies with very dark eyes do sometimes get referred to ophthalmology as the GP cannot see a reflex as you need to exclude anything obstructing the view to the retina but most often the eye exam is normal and it is just due to the amount of retinal pigment. Hope all is well

@Rodders92 thank you, how do you know this? Went for a second opinion at my GP practice today and they said both reflexes are white. I was super anxious about this but also had read that Asian people tend to have lighter/more yellowy reflexes. They checked my husband's to reassure and his are the same colour as our baby's. We have a private consultation with an ophthalmologist tomorrow -- hopefully we'll get more reassurance. I'm surprised there isn't much about this online. The doctor we spoke with today said doctors tend to refer for a low threshold of worry just to rule out anything scary.

I’m an orthoptist and work in a lot of paediatric ophthalmology clinics so have come across this situation many times

Here is an example

@Rodders92 thank you for sharing. I wish there was more information about this. The doctor we saw today said it's probable it's just an example of colour variation but they always like to investigate these things to be safe. She said the reassuring thing for her is that the eyes are symmetrical. Is it very common then for doctors to refer but for things to be okay? Glad we have the private appointment but nervous all the same. Forking out £250 sounds like a lot when we have the NHS appointment in a week, but I'm so anxious...

Yes it is reasonably common for very dark eyed babies to be referred for this and the majority are fine, but occasionally there can be a problem such as cataract or other abnormality in the eye but these are much rarer, hope all goes well tomorrow and it is probably money well spent for peace of mind

It's particularly common for darker skinned babies to be referred for this if they live in a predominantly white area, where the doctors are less accustomed the natural variation in red reflex. Years ago I worked in Blackburn, so saw lots of Asian babies, and was very confident with how their eyes looked. Very few babies were referred onwards. In less multicultural areas, most of the baby checks are being done by doctors predominantly seeing white babies, so there can be uncertainty. And definitely better to refer babies who are fine than to risk missing something important by not referring. (Paediatrician)

... don't clog up the sick kids, you have a review appt coming. Sick kids won't see you for this reason so you'll waste yours and their time. Wait for the review to come through, try to keep calm and enjoy your baby.

@Rodders92 @nocoolnamesleft thank. You — this is reassuring. I’m white European but our daughter seems to have mostly inherited my husband’s genes including dark hair and eyes. Her skin isn’t particularly dark but she’s more tan than me. We do live in a very white area!

Really hoping for good news as my husband also presented a more “white reflex” today and her eyes are symmetrical. She holds our eyes too.

Are cataracts in babies quite rare? What usually happens in such a scenario and what is the long and short term outcome for their sight? Should we be worrying about this at this stage?

@esgill hi OP sorry you’re going through this. We had the same when DS was a baby and remember it well.

In our case he was born with a congenital cataract in his left eye. He had lens replacement surgery at 4 weeks old and 6 year of patching. He wears a bifocal lens in that eye now - the vision is his right eye is perfect. You would never know really, he just looks like any other kid wearing glasses and it hasn’t stopped him doing anything so far.

Hoping for a good outcome for you re perhaps paler retina, but if it is congenital cataracts it’s not the end of the world. The science is so good now and they can really do a lot for them. Happy to answer any questions on our experience if this is the answer you get. Best of luck to you and DD.

@Tisfortired thanks so much for the reply. It must have been scary to have your 4-week old baby operated on. What’s the vision like in your DS’s left eye? Both our baby’s eyes have been noted as missing the red reflex. Could you see the clouded lens in your baby’s eye and did it appear to impact his vision before surgery?

Thanks everyone for the reassurance. Very relieved to say the consultant saw our daughter today and she’s totally fine — he said every week he gets referrals like this from non-Caucasian babies. He said the colour in her eyes isn’t white like in cataract patients — it’s more the colour of East Asian parents and he said there should be more information about the red reflex for GPs and patients. I hope this helps someone else in future as I didn’t find much about this via Google except the scary stuff…