1. VISION SCREENER TRAINING
DCPS Vision Services

2. Program Overview: 45 year collaboration between DCPS and DCCPTA
64,546 students screened in school year
6,208 students referred and parents notified
1,508 trained volunteers participated with screening
6,097 hours were spent conducting screenings in…
154 schools

3. SCREENING OUTCOMES: Our screenings discovered: cataracts
ocular allergies
glaucoma
legally blind – 20/200 or worse in the best eye. Correctable to 20/25 or better
amblyopia – if not detected and treated at early age, blindness could result
finger count – could only count fingers at near point. Correctible to 20/25

4. Prior to Screening
Contact Vision Screening coordinator to schedule screening
Sign up volunteers to assist with screening
Print two forms from DCPS Wellness website: Referral letter (approximately 10% of your total enrollment) and Grade Level Referral List (one per grade level). Directions for printing documents is located inside the “Essentials Folder” (Green Folder)
Locate Red Folder in Vision Materials and have all volunteers sign in

6. Equipment and Materials
DCPS Vision Services Provides:
Supplies including “Magic Shoes”; Red and Black Pens; 20’ Ribbon
Eye Occluders
Registration Forms
“To The Parent Of” Envelopes
Snellen Charts with LEA cards or SLOAN letter cards
Schools Provide (Printed from DCPS Wellness Website):
Student Referral Form
Grade Level Referral List

7. Setting Up for Vision Screening
Space used for screening must be at least 25 feet
Tables or desks will be necessary for setting up machines
Chairs should be provided for screeners
Machines should be taped down front and back – approximately ½ inch off edge of table to allow mask to move up and down
“Magic Shoes” should be taped down at 10 feet to heel. These will be used for PK – 2nd grade. For 3rd – 5th, place a piece of tape at 20 feet.
Red and black pens and occluders should be placed at each screening station

9. Registration Form
Student registration forms must be completed prior to the screening
The top section must be completed including: student name, student number, grade level, teacher name, and date of screening. Instructions for printing labels will be included in the Green Folder
Second section (contact information) is completed only if student does not pass second screening.
If a student is absent or has been opted out by parent, check the appropriate line at bottom of the form.
Students who do not pass but have new glasses or a permanent difficulty (confirmed by teacher or another adult) check Failed – Not Referred.

11. Grading Criteria Passing for PK is 20/40
Passing for K – 3rd grade is 20/30
Passing for 4th – 5th grade is 20/25
Start screening on the passing line for each grade level
A student must get one more than half to pass a line
If a student does not get one more than half correct, raise the mask and screen on the next line up. Continue raising the mask until the student passes a line. The student’s acuity will be the lowest line the student can read.

12. Special Education Students
Students with the following exceptionalities screen at line higher:
InD – Intellectual Disabilities (Formerly TMH, EMH, PMH)
EBD – Emotional/Behavioral Disabilities
AD – Autistic Disorder
DD – Developmentally Delayed
The passing criteria for PK-3rd grade is 20/40. 4th and 5th grade students should pass at 20/30.
Any student with cross or wall eye, droopy lid, etc., unless already under a doctor’s care, should be referred.
All other students falling under ESE – Hearing Impaired, Physically Impaired, Specific Learning Disabilities, Speech and Language Impaired, Gifted – will screen using the General Education criteria.

13. Screening
Screening with LEA symbols or Apple-House-Umbrella requires two people – screener and pointer
Review symbols with PK and K prior to screening. A copy of the symbols being used should be placed at each screening station
Verify the student’s name on registration form
Using one occluder per student, hold occluder over left eye. 2nd grade and above may hold their own occluder
Screen right eye first – reading from left to right. Screen left eye reading from right to left
Occluders should be discarded after screening.

15. Recording Results
Once acuity has been determined, write the score next to the respective eye.
Passing scores must be written in BLACK. Failing scores must be written in RED.
If a student cannot see the top line on the chart, write the line # next to the respective line with a “+” indicating the child’s score is off the chart.
Check the appropriate line for: Absent, Unable to screen, Parent opt-out

16. Re-Screening
If a student does not pass the initial screening, then they must immediately be placed in another line and be screened a second time.
Criteria is identical for re-screening.
If student passes re-screening, check the line “Passed” at the bottom of the registration form.
If student doesn’t pass re-screening, check the line “Referred” at the bottom of the registration form.
Students marked as absent must have two additional opportunities to screen.

17. Screening for Symptoms
Students with observed symptoms such as eyes turn in or turn out, should be referred. Note under Referred – Other Symptoms.
Students with eyelid drooping over half the eye, should be referred.
Any unusual appearance, please note observation under “Other”
A second volunteer should corroborate observation

18. The Paperwork
3 manila envelopes per grade level – marked Passing Male, Passing Female and Referrals – including School # and Grade Level. All envelopes provided by Screening Services
4 additional envelopes (these are not by grade level): Absent, Unable to screen, Parent opt-out and Withdrawn.
Upon completion of screening, registration forms are to be separated by grade level.
Passing Male forms are placed in Passing Male envelope and Passing Female forms are placed in Passing Female envelope

19. The Paperwork (Cont’d)
Contact information including telephone numbers must be provided for all referred students for follow-up should students not return medicals.
After all Referred students have been written on Referral List and letters have been written, have school office make a copy of Registration forms and provide to School Counselor.
Registration forms for referred students should be placed in Referral envelope
Registration forms for Absent, Unable to Screen, Parent opt- out and Withdrawn are placed in the respective envelopes.

20. Referral Letter
Prepare a Referral Letter for each student who does not pass the vision screening
Be sure to complete the top section of the letter using the re-screening results for acuity
Write the student’s name on the “To The Parent Of” envelope. Include the teacher’s name in the bottom right corner of the envelope
Seal letter in envelope and give envelopes to teachers to go home with student

22. Referral List
Each Referral list should include date, school name, school # and grade level.
Each referred student’s name will be entered on the list along with teacher’s name (elementary only).
Be sure to include whether a student was screened with glasses and the students’ acuity.
A photocopy must be made of Referral list and provided to School Counselor
Referral List should be placed in Referral Envelope

24. Wrapping It Up
After all paperwork has been completed, place manila envelopes and all unused materials along with Essentials Folder (green folder), in box to be returned to Vision Services
Place Snellen Charts in box. Please indicate any problems with charts so that they may be repaired before sending them out to another school
Be sure to include Volunteer Sheet in Red Folder
Seal box and tape Return Label (found in the Green folder)
Place box in school mail

26. Final Checklist Did all referred students receive re-screening?
Were there three attempts to screen absent students?
Was contact information provided for all referred students on Registration form?
Was a Referral Letter written for all referred students?
Was a copy made of Referred students’ Registration form to be placed in students’ cumulative folder?
Was a photocopy of Referral List provided to Guidance Counselor?

27. Contact: Any additional questions, please contact
Tracy Scott – or (904)
Edie Brooks – or (904)