In January 2016, the American Academy of Pediatrics updated its vision screening policy for pediatricians. The biggest change was the incorporation of instrument-based screening to help identify children who may benefit from early intervention to improve vision or correct vision problems. Early detection and treatment of amblyopia is key to preventing unnecessary blindness. Primary care physicians play a key role in its detection through vision screening in preschool and school-age children. Instrument-based screening allows the screening of more children sooner in life.
The policy statement recommends that instrument-based screening in the office setting be first attempted between 12 months and 3 years of age and at annual well-child visits thereafter until acuity can be tested directly. The US Preventive Services Task Force recommends automated vision screening with level B evidence for all children at least once between the ages of 3 and 5 years. The Affordable Care Act requires that health plans must cover, without copayment, the preventive services with an A or B rating (CPT code 99177 can be used).
Before the new recommendation, I was not convinced we were consistently catching children with vision problems using a combination of Snellen charts and optotypes. It was also occasionally frustrating and certainly time consuming performing these vision tests in preschoolers. I welcomed exploring the addition of photoscreening to my practice.
A Plusoptix representative gave us a demonstration of the device in our office, after which the company provided us with a trial machine to use. After several weeks and experience on many types of children, we decided to purchase a machine. We had a few stumbling blocks with our first machine and some connectivity issues out of the gate, but our Plusoptix rep along with the company’s customer support team were very responsive and rectified the problem efficiently and successfully. Our customer support specialist was there every step of the way during our learning process.
We incorporated our first Plusoptix device about a year and a half ago, and liked it so much we added a second one. We use it to screen children ages 1 through 8; some of these kids may not be verbal or able to sit still for a traditional vision test. Not everyone we identify as needing a referral will have a vision problem. We make sure parents understand that this is a screening test, and the results may require further investigation. The pediatric ophthalmologists are comfortable with some amount of overreferrals, knowing they are catching kids with vision problems.
The nurse in charge of our vision screenings loves how much quicker the device is in preschoolers. Rather than having to read the letters or shapes, now it only takes a few seconds and a print out of the result goes right in the chart. If there is a referral, we coordinate that and give the patient’s parent or caregiver a copy.
No one test or device is perfect. Today, however, I am much more confident that between talking to parents, performing our examination, and implementing photoscreening with the Plusoptix, we are doing a much better job finding vision problems earlier. The device is also an alternative for screening developmentally delayed children of all ages.