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What is a Functional Vision Evaluation?

When is it needed?

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Alan P Pearson OD PhD FCOVD

August 15, 2021

A Functional Vision Evaluation is different than an ordinary eye exam. A child that is struggling developmentally or academically, or a child that is receiving physical, occupational, or speech therapy should have a Functional Vision Evaluation to assess vision issues that could be present.  An adult who has had a concussion or an acquired brain injury and is experiencing vision, disorientation, or mobility challenges should have a Functional Vision Evaluation to assess if vision issues are present.  A functional vision evaluation looks at issues such as:

  • Two eye coordination / Binocular Skills / Lazy Eye
  • Focusing Skills Near and Far
  • Eye Tracking / Eye Hand / Vision & Vestibular / Visual Motor Skills
  • Integration of vision with other sensory and motor skills
  • Visual Perception / Visual Information Processing / Cognitive & Thinking Skills
  • Visual Attention / Vigilance / Comfort & Efficiency with near activities
  • Visual Emotional / Awareness of Social Cues / Perceptual Anxieties / Behavioral Issues

A Functional Vision Evaluation is an essential part of a comprehensive multidisciplinary approach in child development or adult rehabilitation.   A Functional Vision Evaluation is a much more involved than a routine or comprehensive eye exam.  A Functional Vision Evaluation always starts with an explicit problem situation shared by the patient or parent, or referred by another eye doctor or professional.  If there is no explicit problem situation, no referral, and the reason for the visit is only for a routine eye check to rule out the presence of a problem or need for eyeglasses, then the patient needs a routine or comprehensive eye exam, not a Functional Vision Evaluation.

Functional Vision Evaluations are billed to the medical portion of your insurance policy.  Since it is not routine or preventative eye care, it is not billable to your vision coverage plan. The service begins with the appropriate level of evaluation and management (CPT code 99203 to 99205) and may be subject to your insurance copays, deductibles, or coinsurance just like any other specialized medical office visit.  Most Functional Vision Evaluation services will also include extended service codes (for more than 75 minutes of doctor time: 99354 and 99355) and a special code for binocular vision evaluation (92060). If any additional services with other codes are needed, we will be sure to discuss these with you before providing the extra service.   The most typical combination at this clinic for a new Functional Vision Evaluation is 99203, 99354, 92060.

Upon the completion of a Functional Vision Evaluation Dr. Pearson can collaborates with other professionals in providing important vision information. After an evaluation, therapeutic activities can be prescribed. Some of these activities can be integrated within existing therapies or school programs, with progress monitored via Internet systems and occasional office visits.

Interdisciplinary Collaboration

COMMON QUESTIONS ABOUT FUNCTIONAL-VISION-EVALUATIONS:

Q: What is the difference between a Functional Vision Evaluation and the eye exam at my regular eye doctor?

A: Regular eye exams usually look at eye optics (need for eyeglasses) and eye health (disease) and usually only screen for the presence of functional issues. Time with the eye doctor averages about 15 to 30 minutes. The exam is usually billed to vision insurance. If the doctor finds functional issues they often refer the patient to a Functional/Developmental Optometrist such as Dr. Pearson who specializes in the area vision therapy and neuro-optometric rehabilitation. A Functional Vision Evaluations may include checks of eye optics and eye health, but more importantly includes extensive tests of binocular two eye coordination, eye tracking, and eye focusing as related to activities of daily living.  The evaluation may take 2 or more hours of the doctor's time involved in testing, consultation with parents, writing reports, creating a treatment plan, and communicating with other professionals. Functional Vision Evaluations are usually billed to major medical insurance. Patients seeing Dr. Pearson for functional vision issues can continue to see their regular eye doctor for regular eye health checkups.

Q:Who should have a Functional Vision Evaluation rather than a regular eye exam?

A:Regular eye exams are important to make sure no eye disease or eye optics issues are present, however, a child may "pass" their regular eye exam, with healthy eyes, 20/20 vision, and no need for eyeglasses, but still have serious functional vision issues impacting development, life functions and learning.  Also, and adult who has had a concussion or an acquired brain injury might have a healthy eye checkup after their accident but still have significant difficulties such as headaches, eye strain, dizziness, light sensitivity, etc. that can be signs of a functional vision issue.   Therefore, if your child is doing well developmentally and academically and you only want to know if they need eyeglasses and have healthy eyes then schedule a regular eye exam with your family eye doctor. On the other hand, if your child is struggling developmentally and/or academically, or if your child is involved with other therapies or tutoring, or has an IEP at school, then a Functional Vision Evaluation is recommended.  And, if you are an adult with vision symptoms and disabilities that do not resolve with eyeglasses alone then consider a Functional Vision Evaluation. 

Q: My child just had a regular eye exam, can he/she still receive a Functional Vision Evaluation?

A: In most cases, yes. The Functional Vision Evaluation is billed to major medical insurance, not vision insurance. But you may need a referral from your Primary Care Physician depending upon your insurance plan. Contact your insurance plan to be sure.

Q: Will the Functional Vision Evaluation determine if my child needs eyeglasses?

A: YES. Eyeglass prescriptions are common for functional vision issues. Eyeglasses are not always prescribed just for sharp vision, but may also be prescribed to help with eye coordination, focusing, or other visual skills. Eyeglasses may also be used therapeutically with periodic lens changes over the course of therapy. Dr. Pearson will write the appropriate eyeglass prescription but our clinics do not have an optical lab and frame shop. You can return to your regular eye doctor to purchase your eyeglasses.

Q: Does a Functional Vision Evaluation include eye drops?

A: NOT USUALLY.  Eye drops that dilate the pupil and are used in many routine or comprehensive eye exams will interfere with the measurement of visual function due to their temporary muscle paralysis effect. Therefore, we do not typically use dilating drops in our initial visit.   If the patient has not had any prior eye exam with dilating drops, or his/her most recent eye exam with dilating drops is more than one year from the date of this Functional Vision Evaluation, then we will be recommending a separate visit to complete an eye health evaluation with dilating drops before we initiate any recommended functional treatment programs.

KEY POINTS:

Vision is much more than 20/20. A 20/20 "vision report card" does not mean you or your child has no functional vision issues, in fact, most children and adults with functional vision issues have 20/20 visual acuity.

Visual skills are essential for child development and learning. 80% of what we learn comes through vision.

The majority of children in therapy programs such as physical, occupational, or speech therapy have at least mild, if not more serious functional vision issues.

Vision Screenings at school do not screen for or identify any functional vision concerns. Eye exams by an eye doctor are recommended by the American Optometric Association at 6 months, 2-3 years, and yearly starting at Kindergarten. A Functional Vision Evaluation should be considered if there are any developmental or academic concerns affecting your child.

Functional Vision Evaluations are usually billable to medical Insurance, not vision care insurance.

You can still go to your regular eye doctor for basic eyeglasses exams and eye health checks. Even if your child just had a regular eye exam, a Functional Vision Evaluation can still be completed and will look at different issues and answer different questions.

When visual issues are found, treatment is usually possible through vision therapy or some issues can be addressed in collaboration with physical, occupational, or speech therapy. At-A-Distance home based programs are also available for some situations.

To make an appointment, please call (425) 213-1016.


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