2. VISION SCREENING TRAINING

3. Pre-Test Indicate whether the following statements are True or False: 1. Vision acuity refers to the clarity of vision. 2. Learning is 50% visual. 3. Children may have visual problems yet show no symptoms. 4. The development of the seeing process stops at 4 years of age. 5. A person is considered legally blind at 20/100 with best possible correction in the better eye.

5. Vision & Hearing Screening Program and Audiometric Laboratory Adopted Rules Current Rules www.dshs.state.tx.us/vhs

6. Objectives Upon completion of this training, the learner will be able to: 1.Define and discuss visual acuity and common vision deficits 2.Summarize vision screening requirements 3.Differentiate between common visual problems 4.Use Hirschberg Corneal light reflex & cover/ uncover tests 5.Compare signs and symptoms of vision problems 6.Discuss approved eye charts and distinguish between pass/ fail visual acuity and referral status in all age groups.

7. VISION SCREENING TRAINING 1). Distance Acuity 2). Strabismus (a). Hirschberg Corneal Light Reflex (b). Cover & Uncover

8. DEFINITION OF VISION SCREENING BRIEF TEST(S) TO DETERMINE WHETHER A PERSON’S VISION FALLS WITHIN NORMAL RANGE

9. EARLY DETECTION IDENTIFIES Why is vision screening important?

10. LEARNING 80%

11. FIVE STEPS OF A VISION SCREENING PROGRAM 1. IDENTIFICATION 2. REFERRAL 3. TREATMENT 4.EDUCATIONAL CONSIDERATION 5.TRACKING & FOLLOW-UP

12. VISION SCREENING REQUIREMENTS WHO 4-years old by Sept. 1 Kindergarteners Other 1st – time entrants (4yrs through 12 th grade) WHEN Within 120 days of admission or Before the end of 1st semester 1st, 3rd, 5th, & 7th graders Anytime within school year (preferably within 120 days of admission)

13. School Vision Screening Children with poor vision in both eyes are usually identified by the families. Need to identify children with poor vision in one eye with no symptoms.

14. What is ‘vision acuity’? 1)the sharpness of the retinal focus within the eye 2)the health and function of the retina 3)the sensitivity of the interpretive faculty of the brain Commonly refers to the clarity of vision

15. How the eye works

16. THE SEEING PROCESS 4 - 6 months old Use both eyes together7.5 - 8 years old Eyes stop growing; optimum size reach and brain has learned to see

17. THE SEEING PROCESS Binocular Vision

18. THE SEEING PROCESS The brain will not tolerate double vision (diplopia)

19. THE SEEING PROCESS Good prognosis if this condition is treated by age 3 or 4 - poor prognosis if treatment not begun by age 7

20. COMMON VISUAL PROBLEMS REFRACTIVE ERRORS FARSIGHTEDNEARSIGHTED ASTIGMATISM

21. COMMON VISUAL PROBLEMS FARSIGHTED

22. COMMON VISUAL PROBLEMS NEARSIGHTED

23. COMMON VISUAL PROBLEMS ASTIGMATISM

24. Strabismus “Muscle imbalance”

25. Amblyopia “lazy eye blindness” affects about 1-2% of children PROGNOSIS with TREATMENT Below 4 Years of Age = GOOD Between 4 - 6 Years of Age = FAIR Over 6 Years of Age= POOR

26. Esotropia- eye turns in Exotropia- eye turns out Hypertropia- eye turns up

28. 1. Align your face with the child’s face 2. Hold Penlight in front of your face, “ 12 to 13” from child’s face 3. Light directed at bridge of the nose of the child 4. Observe the reflection of the penlight in the pupils of both eyes HIRSCHBERG CORNEAL LIGHT REFLEX TEST

29. Hirschberg Corneal Light Reflex Test *********************

30.  FAIL

31. Positive Hirschberg test

32. COVER-UNCOVER child must hold fixation on an object located at: 12” to 13” inches (near) and 10’ to 20’ feet (far)

33. Cover- Uncover Test 1.Align your eyes with the child’s eyes. 2. Hold target 12 to 13 inches from child’s eyes. 3. Child must fixate on the target (2-3 seconds) Materials: Occluder

34. 4. Cover the right eye with occluder, watch left eye for movement. (Leave covered 2-3 seconds) 5. Remove cover, watch right eye for movement. (allow 2-3 seconds... for eyes… to fixate on target again) 6. Cover left eye and repeat steps. Continued…

35. Whew! Time for a BREAK! Be back in 10 minutes, please!

36. CHECKLIST FOR SIGNS AND SYMPTOMS OF VISION PROBLEMS CHECKLIST FOR SIGNS AND SYMPTOMS OF VISION PROBLEMS

37. Signs and Symptoms EYE APPEARANCE COMPLAINTS

38. VISUAL ACUITY 20 / 20

39. DISTANCE FROM THE EYE CHART LINE ON THE EYE CHART WHICH A PERSON CAN READ FROM 20 ‘

40. LEGALLY BLIND 20/200 in the better eye with the best possible correction

42. The Snellen letter chart is available in both the 10’ & 20’ model.

43. The Snellen tumbling “E” chart is available in both the 10’ & 20’ model.

44. The H:O:T:V matching symbol chart set: ONLY the 10’ model is to be used.

45. UNACCEPTABLE EYE CHARTS PICTURE CHARTS

46. NUMBER CHARTS UNACCEPTABLE EYE CHARTS

47. ALPHABET CHARTS WITH EXTENSIONS OR SERIFS

48. UNACCEPTABLE EYE CHARTS MULTI-COLORED CHARTS

49. Eye chart(s) Cover card(s) Pointer Eye occluder 2 Ft 1 Ft Metal tape measure Masking tape RECORD Screening record

50. COVER CARDS If the child can not see read this line...

51. COVER CARDS Raise the paper to expose the next larger set of letters

52. LETTER CHART FOR 10 FEET SNELLEN SCALE B F U W T R L LETTER CHART FOR 10 FEET SNELLEN SCALE / V LINEARISOLATED

53. 1/2 + 1

55. Preschool Age 20/40 PASSING LINE This line is passing for children 4 years and younger School Age 20/30 PASSING LINE This line is passing for children 5 years and older

56. Preschool Age 20/40 PASSING LINE Have less than a TWO LINE DIFFERENCE between passing acuities of each eye AND

57. School Age 20/40 Begin LINE For children 5 years and older Preschool Age 20/50 Begin LINE For children 4 years and younger

58. IS ALWAYS THE LAST LINE THAT IS READ CORRECTLY (PASSED) Example: failed line 20/30 Visual acuity: 20/40

59.  Quiet Room  Uncluttered, unpatterned wall  Normal light, without shadows or glare  Place the eye chart with the passing line (20 / 40 or 20 / 30) at child’s eye level  Measure 20’ distance from 20’ chart (10’ from 10’ chart)  Mark 20’ or 10’ distance where child should stand

60. Position the eye chart on a light colored wall so that the 20/30 or 20/40 line is at the eye level of the average size child. Approximately 36” to 42” from the floor for children age 4-6 standing Passing Line

61. PLACE CHILD’S HEELS ON THE LINE IF YOUNG CHILD, TEACH GAME ON CHART IF YOUNG CHILD, HAVE “ READ “OVER CHART WITH BOTH EYES IF CHILD WEARS GLASSES, SCREEN WITH GLASSES ON COVER CHILD’S LEFT EYE, TELL TO KEEP BOTH EYES OPEN

62. SCREENING TEAM MEMBERS Ideally, the vision screening team will consist of three certified vision screeners to fill the following positions: SCREENER RECORDER/OBSERVER CHART ATTENDANT

63. 10 or 20 feet Screener Recorder/Observer Chart Attendant VISION SCREENING TEAM

64. TEST RIGHT EYE FIRST Use linear method Point to letters in SNAKE-LIKE Pattern Begin 1 line above passing line Test to 20/20 line or to 1st line missed Record right eye acuity, repeat procedures for left eye

65. Decide child’s ability to be Screened with: Letter, Tumbling “E”, or H:O:T:V: Place Eye Chart on clear wall At child’s Eye Level to the Passing Line: 20/30 –20/40 Condition Child with Eye Chart Heels at the distance 10’ or 20’

66. Distance Acuity Screening Tip of the pointer directly below each symbol. Always react to the child in a positive manner.  Screen with glasses or contact lenses on. Screen Right Eye First If paper occluder is use, cup it to avoid touching the eye, throw away after each use.

67. Child reads “PRACTICE” Line With both Eyes open Cover Left Eye, telling the child to keep both eyes open. - start screening on practice line To pass a Line Child must identify One more than half the symbols on the line Screened to 20/20 or 1 st line missed Visual Acuity Is Always Last Line read correctly !

69. Rescreen Criteria Distance Acuity If child fails either or both eyes, rescreen in about 2-3 weeks

70. 1. Fails the 2 nd distance acuity screen (rescreen within approximately 2-3 weeks) 2. Fails any muscle balance test 3. Shows signs or symptoms of a visual problem 4. Fails any other professional test REFER WHEN CHILD

71.  Re-screen using an approved eye chart  Be skillful on the proper use of the instrument  Be attentive to the child being screened Titmus, Keystone, Etc.

72. FOLLOW - UP ( TRACKING ) LEARNING WHAT HAPPENS TO A CHILD AFTER REFERRAL

73. PRACTICUM

74. Passing Line Define the word “Acuity” 2 Line Difference/Large Visual Acuity Practice Line 2 Types Window Cards To Pass a line H:O:T:V: At what distance? 20/200 Acuity Begin Screening on 20/?? line The Eye Chart should always be placed so that…..

75. Post Test Turn in evaluation form with test