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Vision Screening Guidelines:Birth – Five Years

Tanni Anthony

Colorado Department of Education

Part B Teleconference Series

February 2007

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TRAINING GOALS

Provide vision screening that is developmentally appropriate.

Establish best practices across the state for system consistency.

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SCREENING SHOULD

Be economical

Be easy to complete by trained personnel

Answer the simple question of whether there is or not a vision concern.

Proceed any other developmental evaluation of the child.

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SCREENING SHOULD NOT

Be used as an opportunity to infer any type of medical diagnosis.

The role of the screener is to simply determine whether a next step evaluation is needed for more information.

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Vision Screening Manual 0-5

http://www.cde.state.co.us/early/downloads/early_vision_manual.pdf

The manual and the protocol forms can be downloaded (the latter in word format so they can be customized for district use).

The manual was finalized in January 2005.

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Vision Screening Kits

At least one kit per Child Find team were disseminated in 2002-03

Funded by Colorado Services to Children with Deafblindness (a one time gift!).

Items: penlight, 2 monster caps, small toys, slinky, black foam sheet, cake decorations, fixation occluder, tape measure, tin, and Lea symbol test.

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Follow Along in Your Manual

Turn to Page 5 and review the screening tips.

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Components of 0-5 Visual Screening

Reviewing Intake History For High Risk InfoVisual Inspection of the Eyelids/ EyesPupillary ConstrictionAlternate Cover and/or Corneal Light TestFixation / Tracking / ConvergenceVisual AcuityCompensatory Visual Behaviors

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REVIEWING HISTORY (p. 6)

Information about the child’s medical and developmental history should be available from the Child Find intake information.

If not, there is a form in Appendix A for gathering information specific to a family history/child history as they pertain to vision.

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Quick Review: Visible Parts of the Eye

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Appearance of Eyelids / Eyes (p. 9-10)

MANY VISUAL PROBLEMS ARE VISIBLE.

Look at the child’s face and eyes.

Is there any evidence of asymmetry, unusual irritation, tearing, eye crossing, etc.

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Misalignment of Eyes

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Example of an Eye Deviation

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Eye Deviation Continued

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Example of a Drooping Eyelid

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Example of Cloudiness of Eye

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Cloudiness of Eye

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Usual shape/size of Pupil

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Unusual Pupil/ Iris Shape

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Pupillary Constriction (P. 8-9)

Practice with your penlight.

Do not direct the beam into the child’s eyes. Center the beam at forehead level.

Look for brisk and bilateral constriction with light. Dilation with light removal.

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Alternate Cover (p. 10-11)

Turn to page 10 in manual and follow instructions to practice with your partner.

Equipment: a fixation toy and the occluder.

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This is an important test to practice

Check out the video tape for the 1991 School Nurse Vision Screening Guidelines – look for the tape section on redress movement. This is a classic example of what to look for.

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Corneal Light Reflex Test (P. 11)

Look at where the light is reflected in each eye.

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Practice with Penlight

Have child (your colleague!) look straight ahead at the fixation paddle.

Shine a light at forehead level and look at reflection in both eyes.

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Corneal Light Test

The reflection should be central and symmetrical.

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Eye Teaming Tasks (P. 11-13)

Near fixation with cake decoration pellet and black foam sheet.

Horizontal and vertical tracking with penlight/monster caps or frog finger puppet.

Convergence with fixation stick, frog finger puppet, and/or penlight with monster caps.

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Lea Symbol Cards (P. 13-14)

For 2.5 years and older (if able)

Practice with set of cards

Remember to double the denominator if you screen from 10 feet.

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Compensatory Behaviors (p. 14)

Complete after screening.

Notice any unusual body posturing and/or eye behaviors (squinting, blinking, eye rubbing, etc.)

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Scoring the Screening Tool (P. 16)

Find and discuss the three outcomes.

Pass = no problems observed / reported

Re-screen = screener would like another chance to screen the child on another day.

Fail = refer to the next step medical specialist (based on family’s insurance etc.)

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Review Appendices

Forms in Appendix A

Handouts and Resources in Appendix B

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?s and Future Comments

Let us know how this is working for you!

Tanni Anthony

303 866-6681

Anthony_t@cde.state.co.us