WEST VIRGINIA COUNCIL OF SCHOOL NURSES
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
problems during childhood range from 5% to 10% (USPSTF, 2001). 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 as children move through their school years (NASN, 2001). The
highest incidence of newly acquired visual anomalies is between the ages of 9 and 13
(Proctor, 2005). Vision functions that may be examined in the school setting include:
near vision, including accommodation and convergence, distance vision, color vision and
binocular vision including stereopsis and ocular alignment (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
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
If time and resources permit, screening of additional grades is recommended.
Devised: December 27, 2006
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Visual acuity test, distance and/or near point, 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
Random Dot E/
Stereopsis test
Near Vision
Distance Vision
Binocular Vision

Kindergartners
LEA Symbols Chart
Random Dot E/
Stereopsis test
Near Vision
Distance Vision
Binocular Vision

School Aged and
Adolescents
Snellen E Chart
Other evidence-based
Tools
Near Vision
Distance Vision
Color 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 visual problems and avoid false positives.
It is recommended that students who failed the initial visual 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/near point 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/near point
visual acuity is 20/30 or worse in each eye or if there is a two line or more difference
between eyes. A referral 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 encouraging follow-ups as
needed. The West Virginia Education Information System (WVEIS) provides a method
for recording and tracking vision screening results.
The responsibility of the school nurse is to help identify potential visual 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 medical insurance and should be receiving a comprehensive
physical exam (i.e. HealthCheck) annually with a vision screening. The health provider’s
Devised: December 27, 2006
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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.
Devised: December 27, 2006
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References:
Hartmann, E., Bradford, G., Chaplin, P.K., Johnson, T., Kemper, A., Kim, S., Tootle W.
(2006). Universal Preschool Vision Screening: A Demonstration Project.
Pediatrics, 117(2).
National Association of School Nurses. (2004). Issue Brief on School Health Nursing
Services Role in Health Care: Screening for Vision Impairment. Retrieved on
March 2006 from http://cpmcnet.columbia.edu/texts/gcps/gcps0043.html
Pizzarello, L., Tilp, M., Tiezzi, L., et al. (1998). A New School-Based Program to
Provide Eyeglasses: ChildSight. Journal of AAPOS (American Association for
Pediatric Ophthalmology and Strabismus).
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. (2001). Screening for Visual Impairment. Guide
to Clinical Preventive Services 2nd Edition. Retrieved on March 2006 from
http://cpmcnet.columbia.edu/texts/gcps/gcps0043.html
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.
Devised: December 27, 2006
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