1. 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.orgwww.arkansascsh.org.

2. 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.

3. 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!!!!

4. 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.

5. VISION SCREENING CERTIFICATION

6. 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. Importance of Vision Screening

7. 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.

8. Landmarks of Visual Development 4-12 wks –Binocular fixation 12-20 wks –20/200 44 wks-12 mo –20/50 - 20/100 –Full binocular vision –Amblyopia may develop 6 -18 mo –Convergence developed 18 mo-2 yrs –Accommodation developed –20/40 2-3 yrs –20/30 5 yrs –Min. potential for amblyopia 6 yrs –Approaches 20/20

9. Parts of the Eye

10. Common Ocular Abnormalities

11. Black Eye

12. Conjunctivitis

13. Blepharitis

14. Chalazion

15. Stye

16. Entropion Of upper eyelid due to scarring Of lower eyelid

17. Dacryocystitis

18. Ptosis

19. Coloboma

21. Cataract

22. Strabismus Types Tropia –Eyes which are always improperly aligned Phoria –Eyes which have a tendency to misalign when fusion is interrupted

23. Esotropia

24. Bilateral Esotropia

25. Exotropia

26. Hypertropia

27. Pseudostrabismus (also Pseudotropia or pseudoesotropia)

28. Refractive Errors Myopia (Nearsightedness) Hyperopia (Farsightedness) Astigmatism

35. Astigmatism

36. 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

37. 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

38. Amblyopia Therapy

39. Usher’s Syndrome Hearing Loss and Retinitis Pigmentosa Screen children with hearing loss

40. Vision Screening

41. Screening Procedure

42. Observation Appearance Behavior Complaints

43. Appearance Whites Iris Pupil Lids Lashes Immediate referral if abnormal

44. Behavior Head tilt or turn Blinking or rubbing Avoiding close work Squinting/frowning Closing or covering eye Reading problems Frustration/poor attention

45. Complaints Headaches Nausea Dizziness Burning or itching Blurring

46. 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.

47. 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.

48. Instrument Screenings Titmus Optec Keystone

49. Lateral & Vertical Muscle Balance- Far (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’.

50. AB Titmus 2 Titmus OV7 & Optec Right Eye Left Eye Lateral & Vertical Muscle Balance-Far Titmus & Optec

51. 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.

52. Lateral Muscle Balance-near Titmus & Optec AB Titmus 2 Titmus OV7 and Stereo Optec Right Eye Left Eye

53. Lateral Muscle Balance –Near Optec

54. Lateral Muscle Balance-Far Titmus & Optec

55. Vertical muscle balance-far Titmus & Optec

56. 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.

57. Lateral Muscle Balance-Far Keystone –1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 - fail pass fail

58. 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.

59. Vertical Muscle Balance Keystone Pass

60. 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.

61. – 2 3 4 5 6 7 8 9 10 - fail pass fail Lateral Muscle Balance-Near Keystone

62. 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’.

63. Titmus OV7, Stereo Optec 2000 Binocular Vision-Far

64. Titmus 2 Binocular Vision

65. Titmus OV7, Stereo Optec 2000 EEE Both eyes open – screen pass Binocular Vision-Far

66. 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 Vision - Far

67. Binocular

68. Keystone 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). red white blue Right eyeLeft eye Binocular Vision - Far

69. Keystone 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). red white blue red blue red white pass Binocular Vision - Far

70. Keystone Four circles widely separated is a screen failure. fail Binocular Vision - Far

71. 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.

72. 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.

73. Color

74. Re-screening

75. Why Rescreen? Cuts down on over-referral. Adds validity and parent confidence Improves follow-up. Saves time by decreasing amount of follow-up needed.

76. 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.

77. 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.

78. Data Entry

79. 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.

80. Data Entry No forms needed except for screening form Parent Notification/Doctor Report Form will be generated through APSCN

81. Screening Form Grade 1, room A ObsVa+2LMBfLMBnVMBFfFnCP/F ? Stu.A ppPppppppP Stu.B ppFppppppRe scr ee n Stu.C PpPpppppfP Stu.D FpPppppppRe fer

82. Paula Smith, State School Nurse Consultant Arkansas Department of Education, Office of Coordinated School Health 2020 West 3 rd St., Suite 320 Little Rock, AR.72205

83. 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

84. Vision Machine Repair BSI--Jack Stone --in Little Rock (501) 416-1232 2M Eye Instruments-- Mike Shivley-- in West Memphis (870) 735-0604