West Virginia
COUNCIL
o f Sc ho o l Nurse s
RECOMMENDATIONS
For
Vision Screening
Vision screening for school children is intended to help identify children who have a
vision problem that might affect physiological or perceptual processes of vision that
could interfere with academic performance. Vision screenings are not diagnostic, but
screening results may indicate a potential need for further assessment. The grade level in
which students receive vision screenings vary from state to state. W.Va. Code §18-5-17
requires a vision screening on all children prior to entering a West Virginia public
school for the first time.
The United States Preventive Services Task Force (USPSTF), a division of the Agency
for Health Care Research and Quality (AHCRQ), estimates the occurrence of visual
impairments in children five years of age and younger is between 5% to 10% (USPSTF,
2004). The National PTA has estimated that more than 10 million children from birth to
age 10 have vision problems that cause them to fail in school (Press 2000). The
incidence of visual problems increases among children with certain chronic, genetic, and
congenital conditions; socioeconomic backgrounds; or parents or siblings with an
identified vision problem (NASN, 2006). The highest incidence of newly acquired vision
anomalies is between the ages of 9 and 13 (Proctor 2005).
The West Virginia Council of School Nurses (WVCOSN) recommends the following
vision screening schedule:

Visual acuity for all first time enterers and visual acuity between the
ages of 11-13 years
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Devised: December 27, 2006
Revised: January 22, 2009
The following students should also be screened on a priority basis:



Students referred by teacher, parent, or student him/herself
Students at high risk: special education, repeating a grade or failed a
previous vision screen without professional evaluation
Additional screenings such as color vision or near vision may be
performed if concerns are present.
If time and resources permit, screening of additional grades is recommended.
Vision acuity testing should be selected according to the child’s developmental level.
Developmental Level
Recommended Tool
Visual Function

Pre-language
Students Ages 3-4
LEA Symbols Chart
Distance Vision

Kindergartners
LEA Symbols Chart
Distance Vision

School Aged and
Adolescents
Snellen E Chart
Other evidence-based
tools
Distance Vision
Other types of screening tools are available for use, however it is recommended that the
school nurse follow evidence-based practice and utilize screening methods that research
has shown to be effective. When performing vision screenings the school nurse should
follow the appropriate procedure for the selected testing tool. Accurate screening is
essential to identify vision problems and avoid false positives.
It is recommended that students who failed the initial vision screening should be
rescreened before referral to reduce the incidence of inaccurate results. In children ages
3,4 and 5, the recommended standard for referral of distance visual acuity is 20/40 or
worse in each eye or if there is a two line or more difference between eyes. In children
ages 6 and older, the recommended standard for referral of distance visual acuity is 20/30
or worse in each eye or if there is a two line or more difference between eyes. A referral
2
Devised: December 27, 2006
Revised: January 22, 2009
letter communicating the results of the screening and a request for a report from an eye
care professional with the results of examination or recommendations should be given to
the parent or guardian as soon as possible. A method should be developed for tracking
referrals and for encourage follow-ups as needed. The West Virginia Information System
(WVEIS) provides a method for recording and tracking vision screening results.
The responsibility of the school nurse is to help identify potential vision problems, and
work as a liaison between student, family and vision professional to promote adequate
follow-up treatment. The school nurse should work collaboratively with the medical
community to coordinate and prevent duplication of services. A total of 98% of West
Virginia children have or qualify for medical insurance and should be receiving a
comprehensive physical exam (i.e. Health Check) annually with a vision screening. The
health provider’s vision screening results shall be valid up to one year and meet the
requirements of vision screening, as indicate in W.Va. Code §18-5-17 and West Virginia
State Board of Education policy. The school nurse also needs to be aware of community
services available to assist students in obtaining follow-up treatment.
DISCLAIMER:
The “Recommendation” of the West Virginia Council of School Nurses (WVCOSN) is not representative of West
Virginia State Code or West Virginia State Board of Education recommendation or policy. This is a
recommendation based on consensus, evidence-based practice reviews and current research from the WVCOSN.
The WVCOSN is set forth by W.Va. Code §18-5-22.
The certified school nurse is responsible for utilizing nursing judgment and skill to determine the safest delivery of
health care on an individual case-by-case situation in the West Virginia public school setting while protecting the
welfare and health of the student. Every situation is unique and requires a collaborative team approach lead by the
certified school nurse, which includes, but not limited to, the student, parents/guardians, school administrator,
experts in the field and the student’s primary health care provider, at the local level.
3
Devised: December 27, 2006
Revised: January 22, 2009
References:
Hartmann, E., Bradford, G., Chaplin, P.K., Johnson, T., Kemper, A.,
Kim, S., Tootle., W. (2006). Project Universal Preschool Vision
Screening: A Demonstration Project. Pediatrics 117(2).
National Association of School Nurses (2006). Issue Brief: School Health
Nursing Services Role in Health Care: Screening for Vision
Impairment. Online at http://www.nasn.org/Default.aspx?tabid=284.
Pizzarello, L., Tilp, M., Tiezzi, L., Vaughan, R., & McCarthy, J. (1998). A school-based
program to provide eyeglasses: Childsight. Journal of the American Association for
Pediatric Ophthalmology and Strabismus, 2 (6), 372-374.
Press, L.J. (September 2000). Students With Persistent Problems – The
Visual Connection. School Nurse News.
Proctor, S.E., (2005). To See or Not To See: Screening the Vision of
Children in School. Castle Rock, CO: National Association of School
Nurses, Inc
U.S. Preventive Services Task Forces (2004). Screening for Visual
Impairment in Children Younger than Age 5 Years: A Systematic
Evidence Review for the U.S. Preventive Services Task Force.
Online at
http://www.ahrq.gov/downloads/pub/prevent/pdfser/visualser.pdf.
4
Devised: December 27, 2006
Revised: January 22, 2009