Speaker: Children’s vision benefit guarantees OD role in health care reform

LAS VEGAS – “We have a valiant opportunity to be integrated into the overall health delivery system through the Affordable Care Act initiative on children’s vision,” Kathleen Elliott, OD, said at a continuing education session during Vision Expo West. “This parallels our inclusion for parity in the Medicare system of the previous generation.”

A comprehensive children’s eye exam is one of the 10 essential health benefits required by the Affordable Care Act (ACA), she said, and “we will be held to the standard of a comprehensive exam.”

Elliott said a general evaluation of the complete visual system should include: history, general medical observation, external and ophthalmoscopic exams, gross visual field and basic sensorimotor exam. It also often includes, as indicated, biomicroscopy exam with cycloplegia or mydriasis and tonometry. Always include initiation of diagnostic and treatment programs, she said.

“Some of these you can’t do on patients really young, but make a note on the chart indicating that,” Elliott said. “Have children’s eye charts and retinoscopy bars for young and uncooperative kids. Get good at retinoscopy again.”

She recommended practitioners visit http://www.infantsee.org/.

“We are low on the numbers, and it’s a great health initiative,” she said.

Three to 4 million infants are born per year, but only 10,000 InfantSee exams are performed, she added.

Elliott shared basic guidelines on children’s refractions.

“The average refraction will be between +2 D and +6 D,” she said. “And it can change rapidly over the course of a few months.”

She recommended always performing a cycloplegic refraction in infants younger than 1 year.

“If they’re 9 months old and +7 D or +8 D, they will get glasses (CR -1),” she said. “Use 1% cyclopentolate/2.5% phenylephrine. It’s important to get a full dilation.

“I had a 10-year-old who couldn’t see the board anymore,” she continued. “On the autorefractor he was –9 D. Once we cyclopleged him, he was +0.25 D. We prescribed cyclopentolate every day for a week to try to get the accommodation relaxed so he could make it through the school day. They can accommodate amazingly, and you can miss it unless you cycloplege.

“If you have an 8- or 9-month-old that’s already -4 D or -5 D, definitely prescribe for that,” she continued. “If you have a 2- or 4-month-old that’s -4 D, you don’t need to prescribe anything because their world is close up.”

Elliott recommended giving the dilating drops to the mother to instill in the child an hour prior to the appointment so they come in already dilated.

“We do early morning appointments,” she said. “Tell parents to put the drop in while the child’s still asleep.”