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  1. Home
  2. Individual and Family Health
  3. Preventive Health Care for Children, Teens and Young Adults
  4. Child and Teen Checkups (CTC)
  5. Vision Screening
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Vision Screening

  • Vision Screening Home
  • Vision Screening Manual Introduction, Background and Overview
  • Pediatric Eye Screening or Evaluation
  • Screening Preparation (Includes Re-Screening, Referral, and Follow-Up)
  • Procedures (Includes pass/refer criteria)
  • Frequently Asked Questions
  • Instrument Based Vision Screening
  • Resources and Glossary
  • Forms, Tools and Materials

Related Topics

  • C&TC Training Information
  • Hearing Screening
  • Child and Teen Checkups (C&TC)
  • Maternal & Child Health Section (MCH)

Vision Screening

  • Vision Screening Home
  • Vision Screening Manual Introduction, Background and Overview
  • Pediatric Eye Screening or Evaluation
  • Screening Preparation (Includes Re-Screening, Referral, and Follow-Up)
  • Procedures (Includes pass/refer criteria)
  • Frequently Asked Questions
  • Instrument Based Vision Screening
  • Resources and Glossary
  • Forms, Tools and Materials

Related Topics

  • C&TC Training Information
  • Hearing Screening
  • Child and Teen Checkups (C&TC)
  • Maternal & Child Health Section (MCH)
Contact Info
Child and Teen Checkups
651-201-3650
health.childteencheckups@state.mn.us

Contact Info

Child and Teen Checkups
651-201-3650
health.childteencheckups@state.mn.us

Vision Screening Forms, Tools and Materials

Forms

The following forms are available as printable PDFs

  • Child and Family Vision History and Risk Assessment (PDF) Revised 01/2022
  • Diseases and Conditions Associated Vision and Eye Abnormalities (PDF) 01/2022
  • Teacher and Child Vision Pre-Screening Worksheet (PDF) Revised 01/2022
  • Vision Screening Worksheet (PDF) Revised 01/2022
  • Vision Referral Letter (PDF) Revised 01/2022
  • Color Vision Advisory Letter (PDF) Revised 01/2022

Assessment Tools

Clinic Settings

  • Child and Family Vision History and Risk Assessment (PDF)
  • Distance Visual Acuity HOTV/LEA Symbols Vision Charts (PDF)
  • Distance Visual Acuity Sloan Letters Vision Chart (PDF)
  • Plus Lens (PDF)
  • Visual External Inspection of Eye (PDF)

Community Settings

  • Child and Family Vision History and Risk Assessment (PDF)
  • Corneal Light Reflex (PDF)
  • Distance Visual Acuity HOTV/Lea Symbols Vision Charts (PDF)
  • Distance Visual Acuity Sloan Letters Vision Chart (PDF)
  • Plus Lens (PDF)
  • Unilateral Cover Test (PDF)
  • Visual External Inspection of Eye (PDF)

Training Manual for Printing

  • Vision Screening Training Manual (PDF) Revised 01/2022

Child and Teen Checkups

  • Child and Teen Checkups Schedule of Age-Related Screening Standards (PDF)
  • Hearing and Vision Screener Checklist (PDF) Revised 04/2022
  • Vision Screening Fact Sheet (PDF) Revised 04/2021
  • Hearing and Vision Screening Quick Reference Guide (PDF) Revised 04/2022

Materials

  • LEA Symbols Prescreening Practice Sheet (PDF) Reviewed 01/2022
  • HOTV Prescreening Practice Sheet (PDF) Reviewed 01/2022
  • Equipment for Visual Acuity Screening (PDF) Reviewed 04/2022
Tags
  • children youth
Last Updated: 10/05/2022

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