DESCRIPTION
Ocular photoscreening has been designed as an alternative screening method, not to detect amblyopia itself, but instead to detect risk factors for amblyopia, which include strabismus, high refractive errors and media opacities.
It is based on the principle of photorefraction in which the refractive state of the eye is assessed via the pattern of light reflected through the pupil. The images can then be analyzed based on the position of the corneal light reflex as well as the overall reflection of light from the fundus, which provides information on the child's fixation pattern and the presence or absence of strabismus. Individuals are photographed in a darkened room while looking at the camera. The photographs can be sent to a central laboratory for analysis, either by ophthalmologists or specifically trained personnel. Results are typically graded as pass, fail, or repeat photoscreening.
Amblyopia (i.e., lazy eye) is a disorder of visual development, manifested as decreased visual acuity in one eye. It affects more than 2% of the population, and is the leading cause of monocular vision loss in children and adults.
Note: Ocular photoscreening can be performed in several settings. For example, photoscreening can be performed in a public health setting or as part of school screening programs. In addition, photoscreening may be performed by ophthalmologists as an adjunct to an ophthalmologic exam. This policy only addresses the use of photoscreening in the setting of the primary care physician’s office, where it is performed as an adjunct or alternative to the standard visual exam. It is anticipated that the results of photoscreening would be used by the primary care physician to determine whether the patient required referral to a pediatric ophthalmologist for further evaluation.
POLICY
Ocular photoscreening in the primary care physician's office as a screening tool to detect amblyogenic factors in children is considered investigational.
See also:
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Assessment of photoscreening in the setting of the primary care provider will require population based studies to determine if photoscreening results in a higher referral rate to ophthalmology specialists compared to standard visual assessment. Studies are also limited to determine if there is an associated improvement in sensitivity and specificity for amblyogenic factors that lead to earlier diagnosis and treatment with a decrease in vision impairing amblyopia.
SOURCES
Agency for Healthcare Research & Quality. (2010, March). Guide to clinical preventive services, 2010 -2011. Recommendations for children and adolescents. Retrieved August 25, 2011 from http://www.ahrq.gov/clinic/pocketgd1011/gcp10s3.htm
American Academy of Ophthalmology. (2007). Preferred practice pattern. Pediatric eye evaluations. Retrieved November 16, 2009 from http://one.aao.org/asset.axd?id=7c006b69-9850-4c48-8413-9b9b65bf77d4.
American Academy of Ophthalmology. (2007, February). Policy statement. Vision screening for infants and children. Retrieved March 7, 2008 from http://one.aao.org/asset.axd?id=2efe6879-b631-4878-b878-18bc1679114c.
American Academy of Pediatrics. (2002, March). Committee on Practice and Ambulatory Medicine and Section on Ophthalmology. Use of photoscreening for children's vision screening. Retrieved August 25, 2011 from http://pediatrics.aappublications.org/content/109/3/524.full.
BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2010). Ocular photoscreening in the primary care physician's office as a screening tool to detect amblyogenic factors Archived (9.03.12). Retrieved August 17, 2011 from BlueWeb. (18 articles and/or guidelines reviewed)
Canadian Agency for Drugs and Technologies in Health (CADTH). (2007, February). Technology report: preschool vision screening. Retrieved November 18, 2009 from http://www.cadth.ca/media/pdf/I3001_preschool_vision_screening_tr_e.pdf.
Robbins, S. L., Christian, W. K., Hertle, R. W., & Granet, D. B. (2003). Vision testing in the pediatric population. Ophthalmology Clinics of North America, 16 (2), 253-267.
The Vision In Preschoolers Study Group. (2005). Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study. Investigative Ophthalmology & Visual Science, 46 (8), 2639-2648. (level 3 Evidence - Industry sponsored)
U. S. Food and Drug Administration. (2011, January). Center for Devices and Radiological Health. 510K Premarket Notification Database. K05266. Retrieved August 25, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf10/K102651.pdf.
ORIGINAL EFFECTIVE DATE: 10/14/2006
MOST RECENT REVIEW DATE: 10/13/2011
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.