173 Neb. Admin. Code, ch. 7, Attachment 2B
VISION SCREENING COMPETENCIES: MYOPIA (DISTANT VISION)
Essential Steps for Accurate Measurement
COMPETENCY | KEY POINTS AND PRECAUTIONS |
1. Assemble required equipment and supplies. Prepare screening environment. Measure a distance of 20 ft. or 10 ft. from the chart to the location where students will stand for screening. (The correct distance is determined from information on the screening chart.) Mark the distance clearly. The screening area should be quiet and free from distraction. The chart should be fully illuminated, either with backlighting or in a fully lit room. No glare should fall on the chart. If the wall used the hang the chart is crowded with stimuli, create white space around the chart (flip chart paper) to reduce visual distraction. | Chart should be placed at height so passing line is at child's line of sight. For younger children, it may be helpful to have a second screener next to the child, in order to better observe and to hear the child's spoken identification of the symbol. For all children, screeners must be positioned in such a way as to view the child's face throughout the screening in order to detect unusual positioning or squinting, or attempts to use both eyes to see. If using Titmus, Optec, or Keystone telebinocular or other technologies: obtain equivalent screening results, expressed in acuity measure at 20 ft. for each eye separately. Note: Some types of screening equipment may not be recommended for all ages. Follow manufacturer directions closely for accurate measurements. |
2. Students place their heels on the mark. | Students who have been prescribed glasses or contacts should wear them during screening. A notation that corrective lenses were worn should be included in documentation of the screening result. Glasses should be inspected and cleaned if necessary prior to the screening. Notification of parent of need for further evaluation is indicated if the fit of the glasses is inadequate or they are in need of repair. |
3. Prescreen: before screening, confirm the child can reliably identify symbols presented. The primary screener stands at the chart and begins prescreening by pointing to the largest symbols at the top of the chart and asking the child to identify each.. | The older child very familiar with screening practices may need little preparation for screening. Prescreen with both eyes uncovered A student's confidence may be encouraged by interacting with and receiving praise from the screener. The student can use any name for a symbol as long as it's used consistently. Very young children: screen in a setting with minimum distractions. Use handheld response cards if available to allow the child to point to the matching symbol. |
4. For screening, have the student cover the left eye first. Repeat with the right eye covered. | |
Suggestion for occluders: child's hand, palm cupped over eye (avoid pressure on eye). Consistency in this technique helps assure accuracy in recording right eye results first, followed by left eye results. Varying the order of letter or symbol presentation may help identify the child who has memorized (but may not actually see) a line. | |
5. Start the screening. For the young child, start the screening at the 20/80 line or above, pointing directly under the symbol, using a vertical pointer, without obstructing the symbol. Proceed pointing to symbols randomly as you work down the chart until reaching the passing line (one symbol per line). (i.e. 20/30 for ages 6+). For the older student, who needs little preparation for screening, consider starting at three lines above passing for age (20/60). | For a young child, starting at the top of the chart and moving down may help the child accommodate and focus their vision for screening. Observe the eye is covered. Observe and note whether the child is squinting. To pass a line, the child must correctly identify at least one more than half the symbols on that line. If the child struggles or hesitates, go to a larger line. If the child passes the larger line, offer the next smaller line again. Move steadily at the child's pace. For some children, vision screening is a challenging exercise of manual dexterity and/or letter comprehension. Offer encouragement and praise as the screening progresses. Proceed with screening to the smallest line the child can pass (referred to as screening to threshold). |
6. Record results | Results are expressed as a fraction, with the numerator representing the distance of screening (20 ft., or 10 ft. expressed as 20 ft. equivalents using the measures found on the chart). The denominator is the smallest-sized line the student successfully passed by correctly reading one more than half of the symbols for that line. Notations should be made if the student is screened wearing glasses or contact lenses. Parents should be notified of need for further evaluation if screener observes behaviors or signs indicating vision concern, for example persistent squinting; head-tilt or other positioning trying to see the vision chart; unusual appearance of the eyes. |
7. Carry out rescreen and notification procedures per local school practice/policy. | Students who do not pass the initial screening should be rescreened within 2-4 weeks to verify results. Parents of students aged 3-5 years and in kindergarten are notified of need for further evaluation when screening result in either eye is 20/50 or worse. Parents of students in all other grades are notified of need for further evaluation when screening result in either eye is 20/40 or worse. Parents of students in all grades are notified of need for further evaluation when screening results show a two line difference between the passing acuity of each eye. |
Additional information and resources are available from the DHHS School Health Program, 402-471-1373.
173 Neb. Admin. Code, ch. 7, Attachment 2B