St Andrews experts call for ‘decolonisation’ of infant eye test

Researchers from the University of St Andrews School of Medicine are calling for the renaming of eye examination terminology to help promote racial equality in healthcare.

The ‘red’ reflex test is a crucial eye examination performed in newborns to detect sight-threatening conditions. It involves shining a light into the infant’s eyes to observe the reflection from the retina, which is commonly expected to be red in colour.

However, this expectation is problematic, as it is based on a Eurocentric perspective that assumes a ‘normal’ reflex should be red — a reflection more typical in lighter-skinned individuals.

The call for a name change is included in a pivotal report in Eye Nature.

The report highlights that in those with darker skin tones the reflex can present in different colours, such as yellow, orange, or less bright hues, leading to misinterpretation, unnecessary referrals, and perpetuating racial biases in healthcare.

To address these issues, researchers at the University propose renaming the test to the “Fundal Reflex Test,” a more neutral, anatomical term that better represents the diverse population it serves and aligns with the principles of decolonisation.

One of the authors of the report, Dr Andrew Blaikie, is a consultant ophthalmologist in the NHS Fife and senior lecturer at the University of St Andrews.

Dr Blaikie said: “Language shapes our perceptions and practices. Decolonising terminology has the potential to inspire similar initiatives across healthcare. It’s a step toward dismantling long-standing biases, promoting inclusive medical education, and ensuring all patients, regardless of background, receive respectful and equitable care.”

Dr Blaikie is also the lead on the Arclight Project run through the University of St Andrew’s School of Medicine, which enables those working in low and middle income countries to equip, train and empower health workers at all grades to confidently diagnose and manage eye and ear disease.