Download Guidelines for Vision Screening

CCSS Guidelines for Individual Student Vision Screening
Purpose: To test acuity of vision at a distance; to detect possible myopia, hyperopia,
amblyopia, astigmatism, or other anomalies
Equipment needed:
Snellen Chart, or Tumbling “E” chart, or Primary Lea chart, (charts may either
be 10ft. or 20ft.)
Paper cup or large spoon
Masking tape
Pen
SST vision screening form, if applicable, with Dept. of Ed. Parental permission to
test signed form (SST manual, page 31)
Hyperopia glasses: grades pre-K through 3 use +2.25 lens
Grades 4 and above use +1.75 lens
Procedures and Passing Criteria and Failure Procedures:
1. Explain the procedure to the child according to the functional level of
understanding. With that level in mind, decide which test should be used for that
child. Allow the student to practice the procedure at a distance close enough to see
the test chart without difficulty. Be sure the room has adequate lighting; the
student and the chart should be away from the sunlight glare. Instruct the student
who wears glasses to keep glasses on, unless the student states sight is better
without the glasses or if the glasses are for reading purposes only.
2. Measure from the chart 10ft. or 20ft. accordingly; place a piece of tape on the floor
to mark the spot where the child should place their heels. Place the chart on the
wall at the average eye level of the students.
3. Ask the student to stand at the tape and cover his/her left eye with the spoon or
cup. Assistance may be necessary to accomplish proper vision occlusion. Reverse
the procedure when testing the left eye.
4. Instruct the student to keep both eyes open during the procedure and begin to read
where you are pointing (pointing should be done below the letter or symbol).
5. Start at the top of the chart and progress downward. Allow the child a maximum of
5 seconds per letter or symbol.
6. Note the last line that is read correctly (correctly means that the majority of the
letters on the line were read correctly). The last line read correctly is the outcome
for that eye.
7. Repeat the procedure for the left eye. Allow a brief period of pupil adjustment
(about 10 seconds should be adequate.)
8. Repeat the procedure for both eyes, again allowing for pupil adjustment.
9. 20/20 or 20/30 is passing; anything less than that is considered failing. If the
student has a passing result in one eye, but fails the other eye, or with both
eyes, the student is still considered failing. To be considered passing, the
student must have 20/20 or 20/30 in both eyes together and individually. (The
exception to this rule is for pre-K and Kindergarten; 20/40 is acceptable as long
as there is not more than one line of difference between the two eyes.)
10. Do not allow the student to squint or to uncover the covered eye. If the student is
obviously struggling to see the chart, progress upward again until the student is
comfortable.
11. If the student passes in both eyes and individually (without corrective glasses
on), test for hyperopia using the appropriate lens.
a. Use the same procedure as above except have the student put on the
hyperopia lens prior to covering the left eye. Repeat the procedure for the
left eye and both eyes.
b. If the student can read the 20/30 or the 20/20 line with either eye or both
eyes WITH the hyperopia lens on, there may be hyperopia; the student
would then be considered failing. (the hyperopia lens should make the
chart unreadable)
12. If the student fails the test, tell the student that his/her eyes did not do as well as
expected. You will have the school nurse recheck them at a later date
using a different type of vision test. (Younger children may be told that they are
playing a vision game rather than a test).
13. Document results on the appropriate form. If the student failed the test, give the
school nurse the SST vision screening form and a copy of the parent signed
permission form. Be sure the student’s name, date of initial screening, and grade
is on the referral.
14. The school nurse will recheck the student within two weeks using a Titmus
vision screener. The nurse will test for: visual acuity, amblyopia, muscle balance,
accommodation, and an assessment for strabismus and pterygium, etc.
15. If the student fails the SECOND vision test, a physician’s referral form will be
completed and a letter to the parents will be sent with the physician’s referral.
Referral Criteria:
-
each eye must see at least the 20/30 line (20/40 for pre-K and K)
more than one line of difference between the two eyes must be
referred
if student is unable to comprehend instructions
when using the hyperopia lens, the student is able to read the
20/30 or the 20/20 line with either eye.
Abbreviations:
O.D. = Ocular Dexter = Right Eye
O.S. = Ocular Sinister = Left Eye
O.U. = Ocular Unitas = Both Eyes
References:
Vision Screening Guidelines for School Nurses, NASN, Inc., 1995, pg. 6-9
To See or Not To See, NASN, 2005, pg 97, pg 116
Clinical Guidelines for School Nurses, School Health Alert, 5th edition, 2002, pg. 215-219
School Health Resource Manual, Children’s Healthcare of Atlanta, 2002, pg.9.1-9.6
SST Manual, Georgia Department of Education, 2001.
Updated 1/20/2015