Going Green
This educational offering is
joining others in an effort to save
our environment by making the
handouts available on our
website
www.arkansascsh.org.
To show respect for our
speakers and participants,
PLEASE place your cell
phone on silent or vibrate.
Should you need to answer a
call, PLEASE go outside to
hold your phone conversation.
Respect the speakers and
other participants around you
by refraining from side bar
conversations during the
session.
If it is that important, please
step outside!!!!
The planning committee &
faculty attest that NO relevant
financial, professional or
personal conflict of interest
exists, nor was sponsorship of
commercial support obtained,
in the preparation or
presentation of this educational
activity.
VISION
SCREENING
CERTIFICATION
Importance of Vision Screening
• One in 20 preschoolers has a
vision problem.
• One in 5-10 school-aged children
has a vision problem.
• Impaired vision can seriously
impede learning.
• Early identification and treatment
can prevent or at least alleviate
many vision problems.
Purpose of Vision Screening
• To screen a large number of children in
a short amount of time.
• To separate those children likely to
have vision problems from those not
likely to.
• To refer those children who do not
pass the screening or who are suspect
for vision problems.
Landmarks of Visual Development
• 4-12 wks
– Binocular fixation
• 12-20 wks
– 20/200
• 44 wks-12 mo
• 18 mo-2 yrs
– Accommodation
developed
– 20/40
• 2-3 yrs
– 20/30
– 20/50 - 20/100
• 5 yrs
– Full binocular vision
– Min. potential for
– Amblyopia may develop
amblyopia
• 6 -18 mo
– Convergence developed
• 6 yrs
– Approaches 20/20
Parts of the Eye
Common Ocular Abnormalities
Black Eye
Conjunctivitis
Blepharitis
Chalazion
Stye
Entropion
Of upper eyelid due to
scarring
Of lower eyelid
Dacryocystitis
Ptosis
Coloboma
Coloboma
Cataract
Strabismus Types
• Tropia
– Eyes which are always improperly
aligned
• Phoria
– Eyes which have a tendency to misalign
when fusion is interrupted
Esotropia
Bilateral Esotropia
Exotropia
Hypertropia
Pseudostrabismus
(also Pseudotropia or pseudoesotropia)
Refractive Errors
• Myopia (Nearsightedness)
• Hyperopia (Farsightedness)
• Astigmatism
Astigmatism
Amblyopia: Definition
• Vision that cannot be corrected to
better than 20/40.
• Unilateral or bilateral
• Brain suppresses poor image
• Normal appearance
• Reversible if detected and treated
early
Amblyopia
Predisposing Factors
• Poor clarity
– Cataract
• Poor focus
– Nearsightedness
– Farsightedness
• Poor aim
– Strabismus
Treatment
– Clearing the media
– Cataract removal
• Focusing the image
– Corrective lenses
• Correcting aim
– Occlusion therapy
– Drops
Amblyopia Therapy
Usher’s Syndrome
• Hearing Loss and Retinitis Pigmentosa
• Screen children with hearing loss
Vision
Screening
Screening
Procedure
Observation
• Appearance
• Behavior
• Complaints
Appearance
•
•
•
•
•
•
Whites
Iris
Pupil
Lids
Lashes
Immediate referral if
abnormal
Behavior
•
•
•
•
•
•
•
Head tilt or turn
Blinking or rubbing
Avoiding close work
Squinting/frowning
Closing or covering eye
Reading problems
Frustration/poor attention
Complaints
•
•
•
•
•
Headaches
Nausea
Dizziness
Burning or itching
Blurring
Visual Acuity-Far
• Screen one eye at a time.
– If a child wears glasses, perform the screening
with the child wearing the glasses.
• Screen at 20 feet – Snellen Chart
– Literate children
• Screen at 10 feet – Age Appropriate Chart
– Allen Chart/Tumbling E’s
– Pre-literate children/non-English speaking
• Any eye with vision poorer than 20/40 is a
screen failure.
Plus 2 (+2.00) Visual Acuity
• Test for farsightedness.
• Perform exactly as the distance visual
acuity except;
• Hold a +2.00 lens in front of the
tested eye (fellow eye covered).
• Any eye that improves 2 lines
of vision with the +2.00 lens is
a screen failure.
Instrument Screenings
• Titmus
• Optec
• Keystone
Lateral & Vertical Muscle BalanceFar (Titmus & Optec)
• Right eye on; left eye off.
• Give instructions:
– “Here is a box. I will throw a red ball. Tell me
where the ball lands.”
• Turn left eye on.
• Need immediate answer.
– If not, repeat test.
– To pass the child should report the ball landing
‘in the box’ or ‘on the line’.
Lateral & Vertical Muscle Balance-Far
Titmus & Optec
Titmus 2
A
Right Eye
B
Left Eye
Titmus OV7 & Optec
Right Eye
Left Eye
Lateral Muscle Balance-Near
Titmus
• At completion of Muscle Balance Far
screening switch lever to ‘near’
setting.
• Procedure is the same now as the
Lateral Muscle Balance Far screening.
Lateral Muscle Balance-near
Titmus & Optec
Titmus 2
A
Right Eye
B
Left Eye
Titmus OV7 and Stereo Optec
Right Eye
Left Eye
Lateral Muscle Balance –Near
Optec
Lateral Muscle Balance-Far
Titmus & Optec
Vertical muscle balance-far
Titmus & Optec
Lateral Muscle Balance-Far
Keystone
• Right eye on; left eye on.
• Place slide ‘Lateral Phoria – use at far point’.
• Give instructions
– “Here is a row of numbers, 1 to 15, and an
arrow/pointer. What numbers) does the arrow point
most closely to?”
• Need immediate answer
– If not, repeat test.
– To pass the child should report the arrow pointing to a
number(s) between 8 and 11. Any other answer is a
screen failure.
Lateral Muscle Balance-Far
Keystone
– 1 2 3 4 5 6 7 8 9 10 11 12 13 14
15 fail
fail
pass
Vertical Muscle Balance-Far
• Performed at ‘far’.
• Keystone
– Right eye sees a column of figures with a
central circle and 2 figures above and
below.
– Left eye sees a horizontal line.
– To pass the child should see the line
passing through the circle or just above
or below the circle.
Vertical Muscle Balance
Keystone
Pass
Lateral Muscle Balance-Near
Keystone
• Use slide labeled ‘Lateral phoria – use
at near point’ (place at the near
point).
• Again a row of numbers (2 -10) and
an arrow are present.
• A response of the arrow pointing
between 4.5 and 6.5 is a screen pass –
outside this is a screen failure.
Lateral Muscle Balance-Near
Keystone
–
2 3 4 5 6 7 8 9 10
-
fail
fail
pass
Binocularity
(fusion) at far
Optec/Titmus
• Can use whichever of three slides you
have—only need to use one.
• Pass criteria depends on the slide.
• Test in far position.
• Test with both eyes ‘on’.
Binocular Vision-Far
Titmus OV7, Stereo Optec 2000
Binocular Vision-Far
Titmus OV7, Stereo Optec 2000
Both eyes open – screen pass
E
E
E
Binocular Vision - Far
Titmus 2 (Optional)
A correct response with this screen is for the child to see all
4 boxes/objects when both eyes are ‘on’.
Binocular
Binocular Vision - Far
Right eye
Keystone
Left eye
red
white
white
blue
A correct response with this screen is for the child to see 3 circles
with both eyes. The circles should be in a vertical line or only
minimally separated (if minimally separated it is acceptable to see 4
circles).
Binocular Vision - Far
Keystone
red
red
red
white
white
white
blue
blue
blue
pass
pass
pass
A correct response with this screen is for the child to see 3 circles
with both eyes. The circles should be in a vertical line or only
minimally separated (if minimally separated it is acceptable to see 4
circles).
Binocular Vision - Far
Keystone
fail
Four circles widely separated is a screen failure.
Binocularity
(fusion) at Near
• This screen is performed as was
fusion at far except the instrument is
switched to the ‘near’ setting. Or the
‘near’ slide is place in the instrument.
Color
• Performed with both eyes open.
• Use a standard instrument slide or a
standard hand held red/green color
testing card.
• To pass the student should be able to
read/recognize the numbers
presented.
Color
Re-screening
Why Rescreen?
•
•
•
•
Cuts down on over-referral.
Adds validity and parent confidence
Improves follow-up.
Saves time by decreasing amount of
follow-up needed.
Referral
• Immediate referral if do not pass:
– Observation (Appearance)
• Re-screen in four to six weeks if do not
pass:
– Visual Acuity
– +2.00 test
– Instrument screenings
• Refer if do not pass any part of re-screen
• Color vision deficit does not require a
referral.
Tips
• Observation with glasses on and off.
• Glasses on for machine screening.
• Keep child’s head in place on
machine—no peeking with “good”
eye!
• Adjust machine to child’s height.
Data Entry
Data Entry
• Vision screening data is entered into
APSCN
• Data queries will be pulled on Nov.
15 and April 15.
• Training for APSCN will be provided
at your Ed. Cooperative.
Data Entry
• No forms needed except for
screening form
• Parent Notification/Doctor Report
Form will be generated through
APSCN
Screening Form
Grade 1, room A
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Stu.B
Stu.C
Stu.D
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Paula Smith, State School Nurse Consultant
Arkansas Department of Education, Office of Coordinated School Health
2020 West 3rd St., Suite 320
Little Rock, AR.72205
School District
Mailing Address
City, State, Zip
Phone
Fax
Administrator
School Nurse
Student’s
Name
Screening
Date
Referral
Date(s)
Parent/Guardian
Name
Mailing Address
RESOURCES
• www.brandonburlsworthfoundation.org
Examinations and Eye glasses
• vicki@arkansasoptometric.org
501-661-7675
411 S. Victory, Suite 206, Little Rock,
AR 72201
To borrow Titmus vision screeners
Vision Machine Repair
• BSI--Jack Stone --in Little Rock
(501) 416-1232
• 2M Eye Instruments-- Mike Shivley-in West Memphis (870) 735-0604