The American Academy of Ophthalmology supports the measure: Vision Screening and Referral in Children. This measure would encourage early vision screening for visual impairments in children so that they can be appropriately referred to eye care specialists. The American Academy of Ophthalmology (AAO), the American Academy of Pediatrics (AAP), and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) recommend timely screening for the early detection and treatment of eye and vision problems in America's children, including during preschool years. Effective vision screening maximizes the rate of problem detection while minimizing unnecessary referrals and cost. Common eye conditions that can be detected include reduced vision in one or both eyes from amblyopia, uncorrected refractive errors, misalignment of the eyes (strabismus), or other eye defects. Early detection of treatable eye disease in childhood can have far-reaching implications for vision and, in some cases, for general health.

According to the American Academy of Ophthalmology Preferred Practice Pattern for Pediatric Eye Evaluations, vision screening should be performed periodically throughout childhood. The combined sensitivity of a series of screening encounters is much higher than that of a single screening test, particularly if different methods are used. In addition, eye problems can present at different stages throughout childhood. Several governmental and service organizations have developed policies on vision screening and most clinical authorities, including the American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Pediatrics (AAP), and United States Preventive Services Task Force (USPSTF), recommend some form of periodic vision screening for asymptomatic children.

However, the Academy notes that there is nothing in the background to suggest that failed screens are not referred consistently by clinicians within the rationale. Therefore, we support the removal of the referral requirement of the measure. The measure should only be whether or not a vision screening was performed.

While the Academy supports the measure, we encourage the measure developer to include CPT codes to this measure to ensure vision screening is captured in situations in which LOINC codes are not used or when EHR systems are not able to handle the new LOINC codes. The CPT codes that should be added to this measure include: 99173, 99174, 99177, and 0033T. While a LOINC code could be beneficial in that they are agnostic to the screening method, there is uncertainty regarding the degree to which EHR systems would incorporate these new codes, and including the four CPT codes, in addition to the LOINC codes, would ensure screenings are captured.

For more information or questions, please contact Rebecca Hancock, the Academy’s Director of the IRIS® Registry (Intelligent Research in Sight) at rhancock@aao.org.