Primary Care Toolkit

PVS Toolkit

We are so excited you have taken the step to review our toolkit that helps support Pediatric Primary Care Practices in improving vision screening for their preschool age (age 3-5) patients. 1 in 20 preschoolers have a vision problem and 1 in 4 school age children have a vision problem requiring treatment. Vision screening early in a child’s life is critical for early detection of eye diseases. Early detection and treatment prevent permanent vision loss, loss of motor skills, and the inability to learn. Pediatric primary care settings are poised to be a crucial setting for early detection of vision problems due to:
  • Regular and frequent contact with children and parents/caregivers
  • Respect and trust from parents/caregivers
  • Access to patient history and risk factors
  • Coordinating care at the patient’s Medical Home
We are always here to support your work so please do not hesitate to reach out to our Senior Quality Manager – Kristen Fluitt with questions, the need for additional information/resources or if you would like more support with vision screening in your practice.

Set up a workflow that works for your practice

Preschool vision screening can fit easily into the clinical workflow in your practice.  It’s important to educate all office staff on the importance of early vision screening and what their unique role is in supporting efforts to improve vision care in the practice. It’s important that the workflow ensures that ALL children age 3 through 5 years old receive a full and complete vision screening during their well visit which includes:
Observation Steps: Caregiver Report of Child’s Behaviors and Ocular History
    • Do your child’s eyes appear unusual?
    • Does your child seem to see well?
    • Does your child exhibit difficulty with near or distance vision?
    • Does one of your child’s eyes appear to look inward toward nose, outward toward ear, upward toward forehead, or downward toward cheek while the other eye looks straight ahead?
    • Do your child’s eyelids droop or does one eyelid tend to close?
    • Has your child ever had an eye injury?
Consider using these questions which are phrased in a way that is easier for the caregiver to assess their child's behavior more OBJECTIVELY:
Yes  No Does your child rub their eyes often?
    Yes  No Does your child close or cover one eye when reading or looking at a close object?
      Yes  No Does your child squint their eyes when trying to see things near or far away?
        Yes  No Does your child tilt their head or turn their face when playing with a toy, trying to read, or trying to see something near or far away?
          Yes  No Does your child bring toys or books close to his or her face?
            Yes  No Does your child blink their eyes more than usual or is cranky when doing close-up work
              Yes  No Does your child seem unusually clumsy, as in they often bump into things often or knocks things over?
              Child's medical chart review-review child's chart for the following:
                • Was this child born prematurely (less than 32 completed weeks of pregnancy)?
                • Has this child had an eye injury that required a visit to the doctor?
                • Has this child been diagnosed with a condition that affects his or her physical, mental, and/or social and emotional development (such as cerebral palsy, Down syndrome, ADHD, or an autism spectrum disorder)?
                • Does this child have any other serious chronic health conditions (such as asthma, arthritis, or diabetes)?
              Caregiver/Chart Review of Family Ocular History
              Ask the family member/parent/caregiver about the following:
                • Eye Disorders (Cataracts, Strabismus, Amblyopia, Refractive Error)
                • Previous Eye Surgery
                • Is there a family history (including parents, grandparents, and siblings) of eye problems (such as wearing glasses before first grade, lazy eye, eye turn or crossed eyes, childhood cataract, or eye tumors)?
              Ocular Examination of Patient
              Trained and qualified medical staff should conduct the following examination procedures:
                • External Examination
                • Pupil Examination
                • Red Reflex Testing
                • Examination of Ocular Fundus
                • Assessment of Visual Function
              Screening for Distance Visual Acuity (DVA) and Stereopsis
              Trained and certified medical staff should conduct the following vision screening procedures:
                • Ensure that vision screening equipment is up to date and age appropriate. Currently, The Ohio Department of Health (ODH) recommends using the 5 ft LEA VIP single crowded LEA symbols for both DVA screening.
                • The Ohio AAP and Prevent Blindness, Ohio Affiliate have piloted this equipment in primary care practices and the practices found it to screen for BOTH DVA and stereopsis quickly, efficiently, and effectively. The vision screening process and equipment are recommended by the Ohio Department of Health and the National Center for Children’s Vision and Eye Health based on scientific evidence.
                • Contact Prevent Blindness, Ohio Affiliate (PBO) for pediatric vision screening certification ad to receive a free set of vision screening equipment valued at $930. This training is required for all practice sites.
                • Watch a video of a vision screening using the 5 ft LEA VIP equipment
              *It is important to remember that documenting the results of the screening and communicating results, making an appropriate referral for eye care, and ensuring follow-up by an eye care provider are just as important as the screening itself. 

              Workflow Tips

              Sample Workflow

              Remember – below is just a sample workflow.  Make your workflow work for YOUR practice!
1. Check with The Ohio Department of Health to ensure that your vision screening equipment is up-to-date
As previously mentioned, many primary care providers are still using out-of-date vision screening charts and equipment.  Our partners at Prevent Blindness, Ohio Affiliate offer training and equipment free of charge to providers.
  • Contact Prevent Blindness, Ohio Affiliate (PBO) for training and updated equipment The updated equipment provided by PBO has been piloted with many pediatric primary care practices.  They have found the equipment to screen for BOTH DVA and stereopsis quickly, efficiently, and effectively in the medical setting. The vision screening process and equipment are recommended by the Ohio Department of Health and the National Center for Children’s Vision and Eye Health based on scientific evidence.
    2. Set up vision screening equipment in a well-illuminated, quiet area free from distraction. Many primary care practices find having the equipment on a mobile cart is helpful so it can be helpful within the patient examination room. 
3-YEAR-OLD
We know it can be tough to obtain the cooperation of 3-year-old patients, but it is important to start attempting vision screenings with patients when they are 3.
  • Have the parents introduce the symbols to the child in the waiting room
  • Make the screening fun and “game-like”
  • Remember that it is acceptable for the child to give new names to the symbols as long as they are consistent throughout the screening
4-YEAR-OLD
5-YEAR-OLD
CPT code 99173
  • Screening test of visual acuity quantitative, bilateral
CPT code 99174
  • Instrument-based ocular screening, bilateral with remote analysis and report
Both 99173 and 99174
    • May be used in addition to preventive medicine services
    • Not to be used for vision testing for diagnostic reasons, (e.g., eye injury)
CPT code 99177
    • Instrument-based ocular screening, bilateral with onsite analysis
ICD – 1 – CM Codes
    • 121 – Routine child health exam with abnormal findings
    • 129 – Routine child health exam without abnormal findings
For re-checks of screenings that were not passed
  • Visit will be coded as CPT 99212 – 99215 (most likely a 99212)
  • Then code a Z01.00 if passed screening or a Z01.01 if a non-passed screening
Note: If the screening is not passed add diagnosis code for reason the screening was not passed (e.g., H52.1 myopia, or R94.118 if a specific disorder is not identified) R94.118 = abnormal results of other function studies of the eye
Remember that there are many reasons caregivers may not follow-up with referral including:
The Primary Care Medical Home can overcome many of these with:

Prevent Blindness Children’s Vision and Eye Health Resources

National Center for Children's Vision & Eye Health at Prevent Blindness:  The mission of NCCVEH is to improve the systems that address children’s vision and eye health by developing a coordinated public health infrastructure to promote and ensure a comprehensive, multi-tiered continuum of vision care for young children. This coordinated approach to vision health for children leads to a uniform implementation of successful screening programs, increased follow-up to eye care, improved surveillance, and stakeholder engagement.
Ohio Department of Health Resources
American Academy of Pediatrics Clinical Guidelines & Resources
Ohio Amblyope Registry & Resources: Run by Nationwide Children’s Hospital and funded by the Save Our Sight Program. The Ohio Amblyope Registry provides the support and resources needed to help parents overcome barriers and help their child be successful with the patching process.
  • This program provides free eye patches for the treatment of amblyopia, free literature about amblyopia and causes, as well as other important services to help families of children with amblyopia. All services provided by the registry are free of charge and restricted to Ohio residents.
Realeyes & Resources: Run by the Ohio Optometric Association and funded by the Save Our Sight Program. Realeyes is a FREE classroom education program created by the Ohio Optometric Association.
  • Includes four standardized, interactive, age appropriate curricula that are presented by volunteer optometrists in the community and meet current ODE standards. Topics covered include eye anatomy, eye safety and eye disorders. Schools also receive free eye safety kits from this program.
Play Hard Don’t Blink-Superspecs Program: Run by the Ohio Ophthalmological Society and funded by the Save Our Sight Program. This sports eye safety program works with leagues and individuals in Ohio to promote the use of protective eyewear to reduce the number of sports eye injuries in Ohio's young players.
  • This program provides baseball and softball helmets with face masks and sports goggles (including prescription goggles). The program also provides vocational goggles for students.The equipment is provided at no cost to the teams or leagues.

Demonstration Videos

Demonstration of MA completing screening, set up, and tips to aid with cooperation of child.

Support staff resources

See what the world would look like if you had an eye disease that threatened your sight like glaucoma and four other eye diseases. Explore the human eye using augmented reality with AR Eye brought to you by Prevent Blindness®! The Eye and How We See – Prevent Blindness Ohio -Click here for a video demonstrating how the app works.

Prevent Blindness Resources for Providers and Patients For family Use

Downloadable education fact sheets on everything from eye problems in children, sports eye safety, financial assistance for eye care.