Article Text

Download PDFPDF
Original research
Comparative evaluation of a low cost direct ophthalmoscope (Arclight) for red reflex assessment among healthcare workers in Malawi
  1. Eleanor Dooley1,
  2. Obaid Kousha2,
  3. Joseph Msosa3,
  4. Eric Ndaule3,
  5. Carl Abraham4,
  6. Jennifer Parr1,
  7. Bernadette O'Hare5,6,
  8. Andrew Blaikie5
  1. 1 School of Medicine, University of Leeds, Leeds, UK
  2. 2 Department of Ophthalmology, NHS Tayside, Dundee, UK
  3. 3 Eye Department, Kamuzu Central Hospital, Lilongwe, Malawi
  4. 4 Optometry Department, College of Health Sciences, Lilongwe, Malawi
  5. 5 School of Medicine, University of St Andrews, St Andrews, UK
  6. 6 College of Medicine, University of Malawi, Malawi
  1. Correspondence to Dr Obaid Kousha, NHS Tayside, Dundee DD2 1UB, UK; okousha{at}


We compared the diagnostic performance and ease of use of a new solar powered low-cost Arclight direct ophthalmoscope (AO) to a more expensive traditional direct ophthalmoscope (TDO) (Keeler Professional V.2.8) in detecting abnormal red reflexes in simulated eyes. Both devices were used by 19 optometry students and 17 paediatric doctors based in the Kamuzu Central Hospital Campus in Lilongwe, Malawi. Participants examined four normal and four abnormal red reflexes using the two devices in random order. We scored the participants on their ability to identify clinical signs and make a diagnosis. Participants scored each device for ‘ease of use’. There was no statistically significant difference in diagnostic performance or ‘ease of use’ between the AO and the TDO when attempting to detect abnormal red reflexes in simulated eyes. We conclude that AO is an inexpensive yet equally effective alternative to the TDO in detecting red reflexes and due to its low cost, portability and consumable independence is well suited for use in low-income and middle-income countries.

  • affordable
  • diagnostics
  • diabetes
  • ophthalmology
  • neurology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @bernieaohare

  • Contributors ED contributed in planning the study, collected the data and involved in drafting the manuscript. OK analysed the data and wrote the manuscript. JM, EN, CA, JP and BO facilitated data collection and critically appraised the manuscript. AB designed the study, facilitated data collection and critically appraised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AB is seconded to the University of St Andrews from NHS Fife. The University owns a social enterprise subsidiary company, for which AB acts as an unpaid adviser. The social enterprise business sells the AO to users in high resource countries with all profits being used to fund distribution and education exercises of the device in low-income countries via the Global Health Implementation team at the University of St Andrews.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Anonymised data are available on reasonable request.