Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 173 - CONTROL OF COMMUNICABLE DISEASE › Chapter 7 - SCHOOL HEALTH SCREENING, PHYSICAL EXAMINATION AND VISUAL EVALUATION › Attachment 173-7-2B - MYOPIA (DISTANT VISION) SCREENING COMPETENCIES

Current through June 17, 2024
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.