G is for Guidelines. Professional medical societies including the AAP, AAO and AAPOS issued published guidelines on instrument-based vision screening, including photoscreening, in 2012.

GUIDELINES

For Vision Screening

FAQs

Answers to Frequently Asked Questions

Have the key medical professional societies for pediatricians and ophthalmologists published guidelines or recommendations related to instrument-based vision screening?

Yes. The American Academy of Pediatrics (AAP), the American Academy of Ophthalmology (AAO), the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Association of Certified Orthoptists (AACO) issued a joint policy statement titled, “Instrument-Based Pediatric Vision Screening Policy Statement,” which was published in Pediatrics journal in November, 2012. (Pediatrics 2012; 130:983–986).

“Instrument-based screening is quick, requires minimal cooperation of the child, and is especially useful in the preverbal, preliterate, or developmentally delayed child,” the American Academy of Pediatrics and the other professional societies (AAO, AAPOS & AACO) said in the statement.

Did the policy statement or guidelines from AAP, AAO, AAPOS and AACO specifically mention photoscreening?

Yes. AAP, AAO, AAPOS and AACO had this to say, among other things, in the joint statement: “Photoscreening uses optical images of the eye’s red reflex to estimate refractive error, media opacity, ocular alignment, and other factors, such as ocular adnexal deformities (eg, ptosis), all of which put a child at risk for developing amblyopia. Photoscreening instruments, which assess both eyes simultaneously, have been found to be useful for screening children, and their output is interpreted by operators, by a central reading center, or by computer.” iScreen Vision uses a central reading center to interpret, or analyze, its photoscreening images. The statement also said, “Both photoscreening and autorefraction offer hope in improving vision-screening rates in preverbal children, preliterate children, and those with developmental delays, who are the most difficult to screen.”

Did the policy statement and guidelines issued by AAP, AAO, AAPOS & AACO discuss at what ages photoscreeningcan have the greatest benefits as part of a wellness visit or routine physical at a pediatrician or doctor’s office?

Yes. The policy statement said, “In children younger than 3 years, few professionals can reliably determine acuity in each eye by using a vision chart. Therefore, for younger children, the preferred methodology is instrument-based detection of risk factors for amblyopia—primarily photoscreening and autorefraction.” It also noted, “Photoscreening and handheld autorefraction are recommended as an alternative to visual acuity screening with vision charts from 3 through 5 years of age.”

Did the guidelines and recommendations from the AAP, AAO, AAPOS & AACO discuss payment or the CPT code that should be used for photoscreening?

Yes. The policy statement had this to say about Current Procedural Technology Code 99174 for instrument-based vision screening, also known as CPT 99174. “Additionally, visual screening is often inappropriately bundled into a global fee for the health maintenance visit, despite the fact that this is a separately identifiable service with real costs and established relative value units (RVUs). The adoption of any such technology will be highly dependent on the payment decisions of third party payers. Primary care physicians will likely be slow to adopt these new technologies, despite their merit, if they are expected to absorb the cost without adequate payment for their up-front costs and their time. A level-1

Current Procedural Terminology code, 99174 with RVU 0.69, has been assigned to photoscreening. The adequacy of such an RVU depends on the cost of the screening device.”

Where can I find the full-text of the policy statement and recommendations for instrument-based vision screening?

The full text of the policy statement is available on the website for Pediatrics journal at:

http://pediatrics.aappublications.org/content/130/5/983.full

Professional Society Guidelines FAQ
These FAQs discuss vision screening guideline from professional societies including: the American Academy of Pediatrics (known as the AAP Vision Screening Guidelines or American Academy of Pediatrics Vision Screening Guidelines); the American Association for Pediatric Ophthalmology and Strabismus (known as the AAPOS Vision Screening Guidelines or American Association for Pediatric Ophthalmology and Strabismus Vision Screening Guidelines); and the American Academy of Ophthalmology(known as the American Academy of Ophthalmology Vision Screening Guidelines or AAO Vision Screening Guidelines).