The eyes provide a window into the overall health of patients—conditions like diabetes, hypertension and even head injury can be diagnosed earlier and more easily with something as simple as a routine eye exam. This extends to children, who have much more to lose if eye-related conditions remain undiagnosed and untreated.
In fact, the National Eye Institute estimates that amblyopia—a condition often referred to as “lazy eye”—affects up to 3% of children in the United States.1 When left untreated, amblyopia can cause severe visual disability, including significant visual impairment, vision loss and even legal blindness. With early diagnosis, physicians can prevent these outcomes entirely, but only when eye exams are performed early and often.
This was the key message in a recent webinar hosted by Dr. Melissa Wong, a board-certified ophthalmologist and a fellowship-trained pediatric ophthalmologist and adult strabismologist. When she stresses the importance of early intervention for pediatric vision issues, it’s because it affects real lives.
Here’s what pediatric clinicians and physicians should know about eye exams for children, according to insights from Dr. Wong’s presentation.
“The repercussions of undertreated or untreated amblyopia are very far-reaching, and screening is vital because many of the causes of amblyopia are invisible even to the most vigilant primary care physicians [and] parents,” says Dr. Wong.
What should physicians look for in order to spot amblyopia? Symptoms to look for include:
These risk factors can be detected in a number of ways, including with a clinical exam at the well-child check, with a chart-based visual acuity test, and with photoscreeners or autorefractors.
Dr. Wong says the benefit of using autorefractors or photoscreeners in a child’s eye exam is that screening can take place much younger than with other tests. Specifically, the U.S. Preventative Services Task Force recommends vision screening for children aged three to five years.2 Dr. Wong also notes that instrument-based vision screening may be beneficial for children with developmental disabilities who are unable to read a visual acuity chart.
“Pediatric ophthalmology treatment ranges from eye glasses, patches, drops to even surgery,” Dr. Wong said. “These treatments can be very effective if we’ve not missed that critical period of vision development. Family medicine physicians and pediatricians are at the forefront of detection, and no child is too young or too difficult.”
As noted by Dr. Wong, vision screening through vision acuity testing and instrument-assisted testing are both covered by most insurance payers. In fact, the USPSTF recommends instrument-based vision screening with a “B” level evidence rating, meaning there is high certainty the net benefit is moderate and the practice should provide this particular service.
The Affordable Care Act also requires health plans to cover preventative services that have an “A” or “B” level evidence rating—which means the majority of payers reimburse. The mean reimbursement was $22 for commercial payers and $16 for Medicaid.
“Different insurance carriers will reimburse different amounts,” Dr. Wong highlights. “It’s best to call different offices to know what the reimbursement rate is and what codes are accepted.”
Plus, reimbursement for instrument-based vision screeners is available using the appropriate CPT codes. As a result, instrument-based vision screeners can pay for themselves with reimbursement. Reimbursement coding for vision screening is dependent upon the vision screening technique, for example:
Additionally, the Americans with Disability Act offers federal tax advantages for the purchase of an instrument-based vision screener.
“There is no price tag that anyone can put on [vision screenings] because untreated amblyopia leads to permanent vision damage as a child becomes an adult,” says Dr. Wong.
One of the major benefits of instrument-based vision screening is that it can be easily included in any clinician’s practice. The tools needed are minimal and the skillset to use a photoscreener or autorefractor is quick to acquire.
“Instrument-based vision screening can be very easily integrated into your clinic workflow. All you really need is the photoscreener or autorefractor and a dimly lit room,” says Dr. Wong. “It can take seconds to minutes—it takes away the need for you or your medical assistant [to check] to see if a child is peeking around the occluder, if they really understand what you’re asking them to do, or if they just simply memorized all the symbols on the chart.”
In addition, Dr. Wong says any layperson can be taught to use an instrument-based vision screener, making it ideal not just for pediatricians, but other qualified individuals.
Although photoscreeners and autorefractors are vital for early detection, Dr. Wong did warn that some patients may need to be referred to pediatric ophthalmologists. Young patients with a family history of vision problems, or children who cannot successfully complete an instrument-based vision screening should see a specialist for a full eye exam with dilation, according to Dr. Wong.
Instrument-based vision screening is simple, reimbursable and crucial for early detection of vision impairment—but it also can have real impact on patients, Dr. Wong stresses.
“The goal of having all these tools to screen is to increase access to screening so we can [diagnose] more children earlier and successfully manage their amblyopia,” Dr. Wong says.
Dr. Wong stressed that early detection leads to more effective treatment, which can save a child’s vision as they move into adulthood. She reiterated that even the most vigilant parent or doctor may not spot the signs of amblyopia without regular vision testing.
Instrument-based vision screening provides an opportunity for all children to be screened during regular check-ups with their pediatrician. As a result, more children will be referred to eye doctors during the early stages of amblyopia and other vision disorders, shifting the care delivery to a preventative stage and thus potentially eliminating vision loss in children.
1. Facts About Amblyopia. (2013, September). Retrieved June 1, 2019, from https://nei.nih.gov/health/amblyopia/amblyopia_guide.
2. U.S. Preventative Services Task Force. Final Recommendations Statement. Vision in Children Ages 6 Months to 5 Years: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/vision-in-children-ages-6-months-to-5-years-screening. Accessed July 18, 2019.