Vision Screening Online Training Program - Visual Acuity Screening

Vision Screening Online Training Program

Module 6 (continued): Distance Visual Acuity Screening
(C&TC: Usually performed by a nurse or medical assistant)

Children ages 3 through 5 years

Preparing the child for the procedure

Have the child stand, or sit at a table or desk, with the response card in front of them, eyes at a 10 foot distance from the chart.

Example of HOTV and Lea Symbols vision charts.

Matching method

Condition (practice with) the child to match optotypes by pointing to the same optotype on the response card as is being pointed to on the wall chart.

Child positioned 10 feet away from a visual acuity cart while someone is pointing at it and Child Pointing at a an apple icon on a Lea Placcard

Verbal method

Child Pointing to a placcard on their lapThe screener should explain the procedure to the child and how the child is to respond.

Ask the child to name the symbol as the screener points to it; for example, HOTV or apple (can also call it a heart), house, circle or square.

A child can be prepared in advance of the screening by using the pre-screening practice sheets for LEA SYMBOLS® or the HOTV.

Vision screening occlusion equipment

Occlusion equipment temporarily blocks vision in the eye not being screened during vision screening. It is never recommended at any age to use a hand to cover the eye. Kids peek. Peeking can be a factor for children who PASS when they can't see, known as a false negative. The ability of a child to peek is impressive, even with constant vigilance.

Butterfly shaped occluder glasses (left and right eye), wraparound sun glasses, plastic occluders, and occlusion screening patches

Occluder glasses

One pair of glasses for the right eye and one for the left eye is recommended for visual acuity screening for children younger than 10 years of age.

  • Occluder glasses can be purchased online.

  • An alternate cost-effective way is to make your own specially constructed occluder glasses.
    • Use inexpensive child-sized wraparound sunglasses.
    • Pop the right lens out and occlude the left lens with duct tape or a large sticker making sure there are no gaps left open.
    • Do the same with the other pair, but pop the left lens out and occlude the right lens.
    • Because children come in all shapes and sizes, it is recommended that various sizes of children's sunglasses are purchased to ensure a proper fit.

The above instruction are also available on the Pediatric Eye Screening or Evaluation webpage under the equipment drop down link.

  • Plastic occluders with lips or spectacle occluders such as the ones below can be purchased online.
    Plastic Occluders with lips Spectacle occluders
    • They are to be used during the unilateral cover test.
    • They can be used for visual acuity screening for children 10 years of age and older.
    • Plastic occluders can also be used to cover an eye for other tests where a child is unable to wear occluder glasses (e.g., already wearing glasses, refuses to wear them, etc.). Be sure the child is not peeking around the occluder and that it is held in the proper position. The small raised area should be positioned to the inside of the child's eye and aligned with the bridge of the nose and under prescription glasses. It may be helpful in these situations to have one person holding the occluder over the eye and monitoring the child for peeking and ability to tolerate the occluder while another person administers the test. Kids peek.Girl wearing an adhesive occlusion patch on her left eye and a roll of micropore paper made by 3M
      Micropore paper tape used with permission from 3M Company
  • Adhesive temporary occlusion eye patches or 2 inch micro-pore paper tape can be helpful for children who will not wear occluder glasses. They can be used in cases where other forms of occlusion are not effective. These patches and tape may be purchased online or at medical supply stores.


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