Ensure Good Vision Through Life

August is Children’s Eye Health and Safety Month.

With the upcoming school year just around the corner, August is dedicated to fostering proper vision care and preventing eye injuries in children. Good vision throughout infancy and childhood is paramount to proper physical development, performance in school, and overall good behavior and well-being. Regular vision checks are essential, and once a child’s best eyesight is established, it’s crucial to protect their sight from injury. The following information will help children on the road to a lifetime of healthy vision.

Healthy Vision Starts at Birth

One in four children has a vision problem ranging from mild to severe. Visual information accounts for 80 percent of a child’s learning processes; therefore, a child’s visual acuity can set them up for success or failure when it comes to developing gross motor skills and classroom learning. Unsurprisingly, 60 percent of children with learning disabilities have an undetected vision problem.

Vision changes can occur without a parent or child noticing — many times there are no obvious symptoms — so it is imperative that children receive regular screenings starting at birth. Since children may not be able to communicate a problem, or realize they have a problem, regular screenings are essential. Some early eye problems can affect vision for life if not found before it is too difficult or even impossible to treat. In rare cases, some vision problems can even lead to permanent vision loss or blindness.

Exams should follow this general schedule:

  • Check for signs of congenital eye problems at birth; premature babies have a greater chance of permanent vision loss;
  • Comprehensive eye exam between 6 and 12 months;
  • Exam at 3 years old;
  • Exam before starting primary school; and
  • Yearly exam after (or more often when problems are present).

Children should receive an eye exam every year after starting school — more frequently if a child has had a previous eye injury or risk factors exist such as a history of vision disorders in the family. Never rely solely on basic school screenings as an indicator of eye health. They usually only assess one or two areas of vision and are not a comprehensive exam. Children can pass a school screening and still have a vision problem.

According to the American Optometric Association, “It is important to know that a vision screening by a child’s pediatrician or at his or her preschool is not the same as a comprehensive eye and vision examination by a doctor of optometry. Vision screenings are a limited process and can’t be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems. Even if a vision screening does not identify a possible vision problem, a child may still have one.”

Common Vision Problems in Children

Coding for many of the common vision problems in children falls within the ICD-10-CM H53-H54 code range for visual disturbances and blindness.

The most common vision problem in school-age children is blurry vision or refractive error caused by:

H52.1    Myopia

H52.0    Hypermetropia

H52.2    Astigmatism

Strabismus (crossed or turned eyes), amblyopia (lazy eye; when vision in one or both eyes does not develop properly during childhood), and nystagmus (where the eyes make repetitive, uncontrolled movements, often resulting in reduced vision) are also common.

H50.9    Unspecified strabismus

H53.00 Unspecified amblyopia

H55.0    Nystagmus

Signs that a child may be experiencing vision problems:

  • Tilting the head or squinting when playing with toys, looking at the board, or watching TV
  • Frequent eye rubbing
  • Closes/covers one eye to play, read, or watch TV
  • Excessive tearing or blinking with no cause
  • Complaints of eye discomfort/fatigue
  • Sensitivity to light
  • Frequently bumps into objects or seems clumsy
  • Wandering eyes; eyes don’t line up or move together
  • Eyes seem to bounce or shake
  • Frequent headaches
  • Seeing double
  • Holding reading materials/toys close to the face
  • Distractibility during activities which require good vision

If a child has any of the signs or symptoms above, they should see their healthcare provider for a referral to a pediatric ophthalmologist or pediatric optometrist immediately.

Too Much Screen Time

Excessive use of electronic devices with screens is common in teenagers and increasingly more common in younger children. Multiple studies show that excessive close-up work with screens induces nearsightedness (myopia). Instances of nearsightedness have increased by 25 percent in the last 40 years. As children spend more time using computers and cell phones, they are experiencing more and more eyestrain and are at increased risk of developing vision loss.

Here are 10 tips from the American Academy of Ophthalmology (AAO) that children can follow to reduce eyestrain:

1. Set a timer to limit screen use.

2. Alternate reading an eBook with a real book and look up and out the window every two chapters.

3. After completing a level in a video game, look out the window for 20 seconds.

4. Pre-mark books with a paperclip every few chapters as a reminder to look up (use the “bookmark” function for an eBook).

5. Avoid using a computer outside or in brightly lit areas to avoid glare.

6. Adjust the brightness and contrast to your comfort level.

7. Use good posture when using a computer and when reading.

8. Hold digital media 18-24 inches away from the eyes.

9. Look up every now and then.

10. Blink when watching TV.

Courtesy of the American Optometric Association

Protecting Eyes Against Injuries

Protecting the health of the eye is only part of the equation. Protecting the eye against injury is just as important for ensuring a lifetime of good vision.

Sports-Related Injuries

Good vision is necessary for proper hand-eye coordination, depth perception, and eye tracking — all of which are important when playing sports. Most children take part in some kind of sports activity, whether it’s an organized school sport or a casual game in the backyard — resulting in tens of thousands of eye injuries each year. About 100,000 sports-related eye injuries happen every day, one-third of which occur in children under age 16. But a full 90 percent of these injuries could be prevented simply by wearing protective eyewear.

Eye injuries are the most common cause of blindness in children, so wearing adequate eye protection is important both in practices and in games. Regular eyeglasses and sunglasses do not offer sufficient protection from sports-related eye injuries. In fact, they can shatter on impact, causing even more damage to the eyes. Each sport has a specific type of recommended protective eyewear, but all sports goggles and face masks should be made with polycarbonate lenses.

Baseball accounts for the highest number of eye injuries for children ages 14 and under (W21.03 Struck by baseball; W21.11 Struck by baseball bat), but basketball, hockey, and racquet sports are also high in eye-related injuries.

Other Eye Injuries

Not all eye injuries occur during sporting events. Toddlers and young children, especially, suffer eye injuries every year from playing with toys (S05 Injury of eye and orbit), finding unsecured chemicals (T65.91 Toxic effect of unspecified substance, accidental (unintentional)), and more.

Common types of eye injuries include:

  • Corneal abrasion: scratched eye
  • Foreign body in the eye: penetrating or foreign object
  • Chemical burn: caustic foreign substance
  • Eye swelling: from being accidentally struck, bumped, or poked
  • Subconjunctival hemorrhage: broken blood vessels
  • Traumatic iritis: inflammation of the colored part of the eye that surrounds the pupil (iris)
  • Hyphema: bleeding in the anterior chamber of the eye, the space between the cornea and the iris
  • Orbital blowout fracture: crack or break in the facial bones surrounding the eye

Regardless of the circumstance, children should see an eye specialist after injury if there is redness, swelling, eye pain, problems with focusing, excess tearing, headaches, or changes in vision.

Check out ICD-10-CM Coding for Spring Fever Mishaps in the April 2020 issue of Healthcare Business Monthly for more about ICD-10-CM coding related to spring sports accidents.


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