2.5.1. Visual Acuity and Refraction

External structures of the eye were examined with a pen flashlight and head loupe. Red reflex testing [30] was measured with a direct ophthalmoscope with the lens power set at 0. The red reflex brightness should be identical in both eyes. Any absence of the red reflex, difference between the eyes, or abnormal pupil color may indicate a serious eye condition. The quantification of visual acuity was measured using Cardiff cards [31] and broken wheel tests [32]. Refractive errors were assessed with the non-cycloplegic method and measured with Mohindra retinoscopy [33]. The retinoscope light was the only stimulus for the toddler and did not induce accommodation. The unexplored eye was occluded, and the optometrist was 50 cm from the child. Shadows observed were neutralized with positive or negative spherical or cylindrical lenses. The spherical equivalent (SE) was calculated to homogenize the refraction variables.
