Dr. Vicky Fischer O.D. - Pediatric Optometrist Vision Screening Training Dr. Vicky Fischer O.D. - Pediatric Optometrist

Presented by Dr. Vicky Fischer Pediatric Optometrist at Laria Eye Care and Heiken Children’s Vision Program

Goals of Vision Screening Training Standardize the Vision Screening Methods Discuss pros and cons of different eye charts available and test distances Review and correct common mistakes Cover the words and phrases we should use with students to achieve best results

What is a vision screening? Measures your distance visual acuity in your right and left eyes Vision Screenings are done in school, pediatrician’s offices or the DMV Can miss MANY vision problems

Use only the term “Vision Screening” Do NOT refer to a vision screening as A vision exam A vision test An eye exam An eye check, etc Using other terms creates confusion

Old Form New Form since 2011

Bad Eye Charts For k & 1st GRADE *The 20/40 Is missing! *What are these shapes?!

Prevents memorization: Good Eye Charts For K & 1st grade Prevents memorization: left eye right eye 5 symbols per line

Better Bad

Vision Screening in 3 easy steps Set-up the chart and tape Stand on the tape & cover the Eye Record the last line the child could read the majority of the letters (ie: 3 of the 5)

1. Set-up the chart Place chart at student’s eye level Mark a line on the floor at the distance the chart is calibrated for

What distance is my chart calibrated for? (This is written on the chart. Newer charts are for 10 ft) at a 10ft distance the 20/200 letter is 1.75 inches tall at a 20ft distance the 20/200 letter is 3.5 inches tall E 3.5”↕ E 1.75”↕ 20ft↔ 10ft↔ My eye chart says to screen at 10 feet, but why does it have 20/XX numbers on the side? We are accustomed to describing visual acuity in 20 ft notations: 20/20, 20/32, 20/40 etc. Thus: 10/10 on a 10 ft chart is described as 20/20 10/16 on a 10 ft chart is described as 20/32 10/20 on a 10 ft chart is described as 20/40

2. Stand on the line & Cover the left eye Tell the student to: “Stand on the middle of the line” “Cover your left eye with the center (palm) of your hand”

What the student does: What the screener says: Cover your eye with the palm of your hand

What the student does: What the screener says: Open your eyes really wide. Can you see them with your eyes open? Stand up straight like a statue

What phrases to use - you’re a cheerleader What the student says: I can’t see anything It’s blurry It’s too small uuuhhh (Kindergarteners won’t say anything) What the screener says: Just try your best. Tell me what you think it is – Wonderful! Give me your best guess You are doing great! Can you point to the one that’s the same? Good job! High Five!

How do I get pre-K & K to respond? Give them the practice card and say: “Let’s practice! This is a circle, moon, star, heart, triangle” “Can you touch the circle, moon, star, heart, triangle” (Pointing to top line of eye chart) “What is this one?” or “Touch the same one” Once they understand THEN cover their eye

How to cover a pre-k eye They can cover their eye with their palm & you put your hand on top You can use a clean tissue that YOU over their eye with your palm You can use an eye patch with a tissue underneath or occluding glasses that you alcohol before use (warning lice risk)

Ask the student to read the top line Then proceed down the right side of the chart reading each line Stop when the student misses the majority of the symbols on the line Record the last line that the student can read the majority of the symbols on the line 1 2 3

Point with your finger, a pointer, pen cap or pick-up stick Do NOT use a Pen tip, pencil or anything that may mark the chart

2. Record the last line majority of letters were read correctly Cover Left Eye Cover Right Eye Record right eye acuity Pass= 20/30 Record left eye acuity Refer=20/40

Do NOT do “Critical Line” Testing! Critical Line testing is when you ask the student to start reading at the 20/30 line to speed things up Critical Line testing causes students to fail UN-necessarily because they get nervous or need time to warm up

1 2 3 Threshold Screening (the fast version) Example: student 1 right eye The screener begins at the top of the chart, 1)asks the student to identify the first letter on each line until the student misses the letter 2)Then moves up one line and asks child/student to identify the full line of letter beginning with the 2nd letter on that line 3)Continue moving up one line until child correctly identifies the majority of letters on that line Cover Left Eye 1 2 3 Refer=20/40

1 2 3 Threshold Screening (the fast version) Example: student 1 left eye The screener begins at the top of the chart, 1)asks the student to identify the first letter on each line until the student misses the letter Continue moving up one line until child correctly identifies the majority of letters on that line Cover Right Eye 1 2 3 Pass=20/30

1 2 3 Threshold Screening (the fast version) Example: student 2 right eye The screener begins at the top of the chart, 1)asks the student to identify the first letter on each line until the student misses the letter 2)Then moves up one line and asks child/student to identify the full line of letter beginning with the 2nd letter on that line 3)Continue moving up one line until child correctly identifies the majority of letters on that line Cover Left Eye 1 2 3 Pass=20/25

1 2 3 Threshold Screening (the fast version) Example: student 1 right eye The screener begins at the top of the chart, 1)asks the student to identify the first letter on each line until the student misses the letter Continue moving up one line until child correctly identifies the majority of letters on that line Cover Right Eye 1 2 3 Refer=20/40

New Form since 2011 Can you save time by printing the school, date, your name and photocopying?