Digital infrared reflex testing and asynchronous teleconsultation for infant eye screening

Early detection and documentation of anterior segment opacities in infants (aged 1–6 months) is limited by resource constraints and specialist availability. This study aimed to evaluate the usefulness of digital infrared reflex testing (IRRT) and to estimate the feasibility of asynchronous teleconsultation between primary care paediatricians and ophthalmologists for infant eye screening. From April 2024 to March 2025, 189 infants aged 1–6 months underwent both digital IRRT and standard red reflex testing (RRT) in primary care settings. Digital images and clinical data were evaluated using teleconsultation between paediatricians and ophthalmologists. The feasibility endpoints included the proportion of successful teleconsultations, user acceptability, and technical barriers. IRRT versus RRT diagnostic agreement and the IRRT inconclusive examination rate were also assessed. Teleconsultation was feasible in 84% of the cases. The principal barriers were operational issues (time and setting) and staff training needs. Digital IRRT had an inconclusive result rate of 5.3% and high agreement with RRT (AC1 = 0.994, 95% CI: 0.983–1.000). Digital IRRT combined with teleconsultation is a feasible and accurate approach for infant eye screening in primary care settings, supporting image documentation, integration into telemedicine workflows, and potential future AI applications.