1 Vision Screening Guidelines: Birth – Five Years Tanni Anthony Colorado Department of Education Part B Teleconference Series February 2007

2 TRAINING GOALS Provide vision screening that is developmentally appropriate. Establish best practices across the state for system consistency.

3 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.

4 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.

5 Vision Screening Manual ds/early_vision_manual.pdf ds/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.

6 Vision Screening Kits At least one kit per Child Find team were disseminated in 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.

7 Follow Along in Your Manual Turn to Page 5 and review the screening tips.

8 Components of 0-5 Visual Screening Reviewing Intake History For High Risk Info Visual Inspection of the Eyelids/ Eyes Pupillary Constriction Alternate Cover and/or Corneal Light Test Fixation / Tracking / Convergence Visual Acuity Compensatory Visual Behaviors

9 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.

10 Quick Review: Visible Parts of the Eye

11 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.

12 Misalignment of Eyes

13 Example of an Eye Deviation

14 Eye Deviation Continued

15 Example of a Drooping Eyelid

16 Example of Cloudiness of Eye

17 Cloudiness of Eye

18 Usual shape/size of Pupil

19 Unusual Pupil/ Iris Shape

20 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.

21 Alternate Cover (p ) Turn to page 10 in manual and follow instructions to practice with your partner. Equipment: a fixation toy and the occluder.

22 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.

23 Corneal Light Reflex Test (P. 11) Look at where the light is reflected in each eye.

24 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.

25 Corneal Light Test The reflection should be central and symmetrical.

26 Eye Teaming Tasks (P ) 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.

27 Lea Symbol Cards (P ) For 2.5 years and older (if able) Practice with set of cards Remember to double the denominator if you screen from 10 feet.

28 Compensatory Behaviors (p. 14) Complete after screening. Notice any unusual body posturing and/or eye behaviors (squinting, blinking, eye rubbing, etc.)

29 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.)

30 Review Appendices Forms in Appendix A Handouts and Resources in Appendix B

31 ?s and Future Comments Let us know how this is working for you! Tanni Anthony