Vision Screening: Preparing for Screening

Vision Screening Preparation

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General considerations: C&TC setting

Frequency: refer to Child & Teen Checkups (C&TC) Periodicity Schedule

Facility

The room selected for vision screening should be at least 12 feet long, well-lit, and free from distractions and direct sunlight glare.

Provider roles in C&TC clinics

Primary care provider: Usually updates history and performs the ophthalmoscope evaluation and tests muscle balance (Binocular Fix and Follow), Unilateral Cover Test, and corneal light reflex) as part of the physical exam.

Medical assistant or nurse: Usually performs visual acuity screening.

Note: A child who wears glasses and is under the care of an eye care professional needs an age appropriate visual acuity screening performed with their glasses on. They do not need Plus Lens screening performed.

Preparing for mass vision screening

Head Start, Early Childhood and School Screenings

Planning meeting:

  • Arrange a planning meeting for those persons who will be involved in the technical and administrative aspects of the screening process; determine the number of students to be screened and the number of staff and volunteers needed.
  • Reserve appropriate space for the screening site. Size determination should be based on which visual acuity charts will be used and how many stations will be necessary for the screening.
  • Identify the organization or schools' policies & procedures to address data privacy in a mass screening in order to maintain compliance with FERPA/HIPAA regulations.
  • Set calendar for volunteer recruitment and training dates and screening and re-screening dates.

Notification letter to parents:

  • Prior to the screening date, send out an informational letter with the details of the screening event including date, time, location, and what to expect; include a copy of the parent version of the Child Vision History Questionnaire for parent/caregiver to fill out and return to school.
  • Advise them there will be a second screening for children who have difficulty with any part of the first screening.
  • If after the second screening a child continues to be unable to meet passing criteria, parent/caregiver will be notified with a referral and strongly encouraged to have their child seen by an eye professional for further evaluation.
  • Any parent/caregiver who does not want their child screened should be advised as to the importance of the screening but when desired, the procedure they should follow so that their child will be excluded from the screening.
  • ESC students may be given sample HOTV or LEA SYMBOLS ® for practice opportunities prior to screening, if desired. There is also a LEA SYMBOLS ® puzzle to assist the child in preparation for the LEA chart.

Designate a vision screening coordinator:

Responsibilities:
  • Attend the MDH Training on vision and hearing.
  • Serve as primary person responsible for the smooth operation of the screening.
  • Recruit, schedule, and orient volunteers.
  • Train volunteers using resources available from MDH.
  • Assign volunteer tasks. It is best to make a volunteer an expert at one area instead of rotating that volunteer to different screening stations.
  • Provide on-site supervision.
  • Arrange for and maintain needed equipment and supplies.
  • Carry out or designate a person(s) to work in collaboration with the referral professional and be responsible for sending out referral letters, follow-up, and record keeping.

Referral/follow-up professional

A currently licensed (in Minnesota) professional nurse with MDH training in vision screening.

Responsibilities:

  • Determine which children need further professional evaluation based on MDH criteria.
  • Contact parent/caregiver if follow-up information about the referral is not received and explain the screening results as needed.
  • Communicate with appropriate staff regarding referrals and follow-up information.
  • Monitor child's vision and treatment as appropriate.
  • Maintain screening and follow-up information on the child's health record.
  • Evaluate the screening program.

Prescreening activities: two weeks prior to the intended screening date

  • Determine the number of children to be screened and their ages or grade level.
  • Determine the number of staff needed to provide mass screening.
  • Recruit volunteers and schedule dates and times for volunteer training and orientation, and the screening and re-screening sessions.
  • Screening facilities should be examined and reserved for the screening dates.
  • Copies should be made of the Teacher and Child Vision Pre-Screening Worksheet and distributed to classroom teachers to be filled out with the child’s name/age/grade and comments, if any.
  • Copies should be made of the Vision Referral Letter.
  • Determine the type and quantity of equipment needed and ensure that it is in working order.

Screening day activities

  • The vision screening coordinator will set up the vision stations in the screening area.
  • The stations should be arranged so children cannot hear and repeat the answers of other children being screened.
  • Visual acuity stations should be at least eight to ten feet apart from one another.
  • Volunteer training is done immediately prior to the screening on the clinic day; a minimum of one hour should be scheduled for this training.
  • Each volunteer is assigned his/her specific task.
  • Each volunteer must have an opportunity to practice before screening begins.
  • Children should have their completed vision screening worksheets (Teacher and Child Vision Pre-Screening Worksheet and Child Vision History Questionnaire for Parent/Caregiver) with them.
  • Any child with a diagnosed eye condition should be screened in accordance with the doctor's recommendations. An age appropriate visual acuity screening may be performed with glasses on, if they wear them.

Organize screening clinic into "stations"

An efficient ratio for the stations is:
3:1 (3)-visual acuity to (1)-muscle balance (i.e., corneal light, unilateral cover) station.

When the color vision procedures are included the ratio is:
3:2 (3)-visual acuity stations to (2)-muscle balance/color vision stations.

Number of staff per station is determined by the age of the children

Pre-school through first grade:

Visual acuity screening may require two persons per station.

Older Children:

  • Muscle balance/color vision screening requires one person per station.
  • Visual Acuity Station: Approximately 20 children per hour can be screened.
  • A few additional volunteers will be needed to help with traffic flow.
Example based on the above guide:

To screen 300 children in 1-1 1/2 days, including color vision:

  • 4 - (Two muscle balance/color vision stations using two volunteers each (2X2))
  • 6 - (Three acuity stations using two volunteers each (3X2))
  • 1 - (One volunteer to bring the children to the clinic from the classroom, direct traffic flow to and from the various stations and to sort worksheets and record the results)
  • 11 Volunteers Total

Post screening activities

  • Sort screening worksheets into pass/re-screen groups to determine the number of children to be re-screened.
  • Screening results should be reviewed and documented on the child's individual permanent health record by the Referral/Follow-up Professional.
  • The above guidelines for organizing the screening and determining numbers of volunteers, vision stations, etc., can also be used in planning and preparing for the re-screening to take place 10-14 days after the initial screening.

Re-Screening, Referral, Follow-Up, and Program Evaluation

Head Start, Early Childhood Screening, School Screening

Rescreening Untestable Children

Rescreening is indicated for the child who did not PASS any part of the initial screening and did not have a condition requiring referral. Rescreening should be performed if a child was unable to follow instructions, was overly distracted during the testing, or was unable to complete the initial screening.

Children with the following should be referred directly for evaluation by an eye care professional:

  • Family or personal history of associated conditions or syndromes or concerns about visual behaviors are reported.
  • Observed eye abnormalities noted on the visual inspection, Corneal Light Reflex, Pupillary Light Response, or Red Reflex procedures.
  • Abnormal eye movements noted on the Binocular Fix and Follow or the Unilateral Uncover tests.
  • Children who resist having their eyes covered should always be suspected of having a visual deficit in the eye not being covered.

The purpose of a rescreen is to eliminate from referral those children who did not PASS the initial screening because of such factors as illness, anxiety, misunderstanding, etc. For children who lack an understanding of visual acuity screening, spend a few moments conditioning them to match the letters or symbols used on the acuity chart.

Rescreen at the following intervals:

  • Rescreen children 3 through 6 years of age the same day if at all possible. If not, rescreen within 6 months.
  • Rescreen children 6 years and older within 30 days.

Rescreening procedures are the same as those followed for the initial screening.
If still untestable after rescreening, REFER as soon as possible to be examined by an optometrist or ophthalmologist.

Considerations for children with cognitive impairments:

If a child does not know the alphabet or is developmentally unable to perform the Sloan Letters test of visual acuity, then screen with the HOTV or LEA SYMBOLS ® chart.

Referral

  • A referral is indicated if the child does not pass any portion of the re-screening except the color vision test.
  • The referral should be made by mailing a Referral Letter to the parent/caregiver within one week after the re-screening.
  • The Referral Letter should not be hand carried by the child.
  • A phone call to the parent/caregiver soon after the referral is mailed improves follow-up results and is important with any family where English is a second language. In addition, an interpreter fluent in the family’s language should be utilized for all phone calls to the parent/caregiver.

Follow-up and tracking

  • A tracking system is essential to follow-up those who are referred to assure the child receives the appropriate evaluation, treatment, and other services.
  • If the information about the referral is not received in 3-4 weeks, a phone call should be made to the child’s home. In some cases a home visit might be appropriate.
  • All pertinent information regarding the screening results, referral, parent/caregiver comments, and results of the professional evaluation and recommendations must be documented in the child’s health record.
  • It may be determined by the professional examiner that a child does not presently need glasses or other specific treatment, but this would not invalidate the referral if a problem was not confirmed.
  • Following professional diagnosis and treatment, further planning may be needed for the child whose vision status cannot be brought to within normal limits. In this case, the special education director should be notified so special programming can be implemented as needed.

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