Home

Provincial Vision Screening Training Manual

Contents

1. Child Missed or Absent for Screening Parent Guardian waa Refusal Notification to parent guardian Record Absent on Child Record Health Record Exemption Child Presents for Screening Child does NOT Present for Screening 1 Pass Screening Fail Screening or Could Not be Tested Child must pass a r E i E Ref Parent Guardian Attempt contact to A Eo Refusal support follow up as Screening Record Screening Results or Record CNT on Child Health Record per Health Authority guidelines 2 Fail Screening Child does not pass Stereopsis and or does not pass HOTV or SureSight Screening Attempt up to three contacts to support Beate referral and follow up d Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 22 of 70 Guidelines for Referral Abbreviations O D Oculus Dexter Right Eye O S Oculus Sinister Left Eye O U Oculus Uterque Both Eyes SureSight Vision Screener Referral Criteria 36 months to Kindergarten age 1 SPHERE lt 1 0 Dor gt 3 0 D SPHERE readings display as a MINUS OR PLUS Record or symbol on results form 0 5 0 1 0 1 5 2 0 2 5 Within normal limits 2 CYLINDER gt 1 5D All CYLINDER readings will display as a MINUS symbol in current setting of SureSight Ignore the MINUS symbol when interpreting results 0 0 5 1 0 Within normal limits 3 DIFFEREN
2. GUIDELINES FOR MISSED OR ABSENT KINDERGARTEN CHILDREN 10 GUIDELINES FOR CHILDREN UNWILLING OR UNABLE TO BE TESTED AFTER SCREENING ATTEMPTED 5 0000 isa 10 VIII VISION SCREENING TOOLS AND PROCEDURES 0 00 00 ccceecee cece eeeeseeeeeeccceceeees 13 WELCH ALLYN SURESIGHT VISION SCREENERS cccccccccccessssscececececcacssesescecececcaceaeseseecececeaees 13 STEREOPSIS VISION SCREENING PROCEDURE USING THE RANDOT PRESCHOOL STEREOTEST 17 IX REFERRAL PROCESS vvssececsscccieccccteseccsesesecceccssescsccetescvecscuscsevesacceccstescicvviescuedevessiviosecducvsscecscveiecceccsseess 20 VISUAL ACUITY WELCH ALLYN SURESIGHT VISION SCREENER REFERRAL CRITERIA 20 STEREOPSIS RANDOT PRESCHOOL STEREOTEST REFERRAL CRITERIA ccccesseeeeecececeeees 20 X RECORDING THE VISION SCREENING RESULTS ccccscscscscscscscscscscscscscscscscscsesescsesescseseses 21 XI VISION SCREENING UNDER SPECIAL CIRCUMSTANCES cccccscscscscscscscscscscsevcsesesccseseses 24 XII VISION SCREENING CHECKLISTS ssssesssssssososososososssososososososososososososososososososososososososososososoeseo 27 VISION SCREENING STEREOPSIS CHECKLIST 3 ocococonononononononononononononononononononinininonoss 28 XIII CASE FINDING FOR VISION CONCERNS ccccsccsscscssssscscscscscscscscscscscscscscscsccccccscsescseseseseseses 29 OBSERVATION AND ASSESSMENT TO SUPPORT CASE FINDINGS 0 ccccccccc
3. coat of the eye SPHERE The power of the eye which determines hyperopia and myopia A display unit on autorefractor device gt Negative numbers indicate myopia near sightedness gt Positive numbers indicate hyperopia far sightedness STEREOPSIS Binocular visual perception of three dimensional space STEREOSCOPIC VISION Ability to perceive relative position of objects in space without such clues as shadow size and overlapping STRABISMUS Tropia or squint SUPPRESSING The act of accepting the image seen with one eye and ignoring that seen with the other eye SUSPENSORY LIGAMENTS OF LENS A complex structure of multiple bands of fibers which hold the crystalline lens in place TENSION INTRAOCULAR The pressure of the fluids inside the eye against the outer structure TROPIA A root word denoting a manifest or observable deviation from normal of the axis of the eyes strabismus used with a prefix to denote the type of strabismus as heterotropia esotropia exotropia UVEA Entire vascular coat of the eyeball It consists of the iris ciliary body and choroid Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 66 of 70 VISUAL ACUITY Sharpness of vision in respect to ability of the eye to distinguish detail as an object is placed further away or as 1t becomes smaller in size Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 67 of 70 Page__of__ HA LOGO SAMP
4. difference in visual acuity 2 A marked unilateral refractive error 3 Muscle imbalance or 4 A combination of the above This difference between the two eyes interferes with proper binocular vision often giving a blurred or double image The brain not capable of dealing with double vision diplopia will turn off suppress the offending image In the usual case the suppressed eye will lose or fail to develop proper visual discrimination If fine visual discrimination is not developed by the time the child is six or seven years old the central visual acuity may be permanently impaired and no longer subject to correction If the condition is detected and treated early significant improvement may occur Prognosis is most favorable when treatment is begun by the age of 18 months The type of treatment depends on the age of the patient the present acuity and the age of the patient at the onset of the disorder Patching corrective refraction eye exercises orthoptics or a combination of these procedures usually constitutes treatment Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 37 of 70 APPENDIX B Sample Template Letters Vv Template letter to Superintendent Template letter to Licensed Childcare Facility Template letter to Principal Template letter to Parent Template letter to Teacher Template letter Child Referral Template letter General Screening Template letter Passed Screening Templ
5. docm Page 19 of 70 IX REFERRAL PROCESS Guidelines for Referral Individual eyes are referred to as O D Oculus Dexter Right Eye OS Oculus Sinister Left Eye O U Oculus Uterque Both Eyes Welch Allyn SureSight Vision Screener Referral Criteria 36 months to Kindergarten age 1 SPHERE lt 1 0 D or gt 3 0D SPHERE readings display as a MINUS OR PLUS Record or symbol on results form 0 5 O 1 0 1 5 20 2 5 Within normal limits 2 CYLINDER gt 1 5D All CYLINDER readings will display as a MINUS symbol in current setting of SureSight Ignore the MINUS symbol when interpreting results 0 0 5 1 0 Within normal limits 3 DIFFERENCE gt 1 5D Difference readings do not display as a minus or plus symbol 0 0 5 1 0 Within normal limits NOTE ANY READINGS IN THE YELLOW HIGHLIGHTED AREAS REQUIRE A REFERRAL Stereopsis Randot Preschool Stereotest Referral Criteria Age of Child Randot Preschool Stereopsis Referral Criteria 20 months to Refer if unable to determine stereopsis at 100 seconds of arc Kindergarten age Older Student Refer to eye specialist if symptomatic Complete the Vision Screening Referral and Follow Up form for any child who fails screening or could not be tested Record the screening results as Pass or Refer or Could Not Test for each screening test administered See Appendix
6. does help the child to concentrate on the screening activities To assist families with access to screening and possible further testing childcare facilities are asked to provide an enrollment list which contains the children s names parent s names child s birth date telephone number and address Licensed childcare facilities are allowed to share this information under Section 9 of the Public Health Act which permits persons providing health services access to information in the child s enrollment record required to carry out that service Public health staff will send licensed child care providers a package that includes parent notices about the vision screening program Parents have the right to opt out of screening without consequences to future public health service delivery Please distribute the notices to families before the screening visit If the notices are not sent out in time please tell us so that the screening can be re scheduled After screening the parent will receive a notice to let them know their child was screened Parents of children requiring follow up will be contacted by public health staff If you have a concern about a child s eye sight please discuss this with public health staff We may share screening results with you however parents have the right to opt out of disclosure of screening results All information will be collected used and or disclosed in accordance with the Freedom of Information and Pro
7. done with the child wearing the lenses Position the child 10 FEET from the chart Give the child the lap card to hold on his her lap A helper may sit or stand next to the child and hold the lap card If you do not have a helper have the child hold the lap card flat on his her lap with the letters right side up as the child is looking down at them Test each eye separately always starting with the right eye Make sure the other eye is completely occluded but avoid pressure on the eye Use the occluder glasses or occluder paddle provided Do not have the child cover the eye with his her hand Point to one of the letters on the chart Ask the child to either point to or cover up a matching letter on the response panel to indicate his her choice If the child is correct point to a second letter and have the child match it Continue pointing to the letters until the child correctly matches at least 4 of the 5 letters on a line Do not isolate letters all letters on a row should be visible Make sure your pointer is directly under the letter To avoid ruining the chart use only the non marking end of a pen or pencil Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 57 of 70 9 Avoid going straight across a line changing sequence on that line and always moving down the vision chart 10 Due to the limited attention span of the young child and to avoid fatigue test only two or three of the larger letters on each line t
8. e g record screening results for children who pass and fail on their electronic child health record Vision screening results are recorded in two places gt As the screening is being done the results are recorded on the class list or on the appointment list form as o Pass or Refer for stereopsis and o Plus or Minus symbol and Number if using the SureSight Vision Screener e g 2 0 or 1 5 to indicate SPHERE S and CYLINDER C and Reliability R for each eye DIFFERENCE D between eyes OR o Fraction e g 10 10 for each eye for visual acuity if using the H O T V chart gt Screening results and follow up for children who are referred are to be recorded on the child s health record Results are recorded as Pass or Fail gt Referral outcome for children who are referred are to be recorded on the child s health record E g No apparent problem Under continuing care etc NOTE Paper lists indicating detailed vision screening results and completed Vision Screening Referral and Follow up Forms are to be maintained for program evaluation purposes For additional details on Documentation refer to the Orientation Program for Public Health Nurses Module 3 Documentation and Legal Issues Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 21 of 70 DECISION TREE VISION SCREENING AND REFERAL Vision Screening Provided To Child Vision Screening NOT Provided To
9. of the level of intervention they have received and how early their hearing loss was identified Be sure to discuss with the child s parents or support person what will work for their particular child and be prepared to engage them in support of a successful screening experience Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 25 of 70 VISION SCREENING UNDER SPECIAL CIRCUMSTANCES Cont d General Communication Tips Present information to the child at their eye level Make communication a positive experience for the child Be receptive to what the child is trying to communicate Focus your communication to one topic at a time Ensure the child has a clear view of your face and hands Be sensitive to the individual needs of the child VVVVVV Visual communication gt If you don t know any signs use visual aids or ask the child s support person to facilitate communication Gesturing or illustrating what you will be doing is also an effective communication approach gt Make sure there is no visual noise behind you when you are trying to communicate with the child Visual noise distracts the child s attention from your efforts to communicate gt Tf you are using a sign language interpreter make sure that they have completed communicating before changing topics gt Attention getting techniques such as light shoulder tapping or eye contact with a small wave can be used Auditory communicatio
10. one or both eyes Kindergarten age Refer if other symptoms are present Refer if unequal acuity where there is a 2 line difference between each eye i e OD 10 10 OS 10 15 Older Student Refer if 10 15 or worse in one or both eyes Grade 1 and older Refer if other symptoms are present Refer if unequal acuity where there is a 2 line difference between each eye i e OD 10 10 OS 10 15 gt Use of the H O T V in ages less than 36 months is at the discretion of the Health Authority and is based on professional judgement of the screening personnel For example some children younger than 36 months may be mature enough to understand screening instructions and complete vision screening procedures Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 59 of 70 VISION SCREENING H O T V VISUAL ACUITY CHECKLIST Purpose This check list should be used regularly until these points become habits when testing visual acuity Instructions To check the accuracy of your own testing ability read over the check list immediately after you have finished giving the test To check the accuracy of another person s test administration score your observations below Before Test Visual Acuity Checklist For Eye Charts Yes No 1 Screener prepared the child for the test familiarized the child with the vision chart S
11. page of the booklet by either pointing to the shapes or naming each shape seen while pointing to the test target If the child responds correctly to at least two of the three test shapes at the 200 seconds of arc level top panel of test 1 testing proceeds to the 100 seconds of arc level bottom panel of Test 1 Omit test booklet 2 as the provincial cut off criteria for stereoacuity is 100 seconds of arc for children 36 months to kindergarten age This testing can be tiring for a young child Provide encouragement and praise frequently to maintain co operation and to acknowledge child s patience and effort TAKE TIME to make sure the child understands HINT To maintain a 3 year old child s attention the following process can be used 6 Match one shape at 800 seconds of arc Match one shape at 400 seconds of arc Match two shapes at 200 seconds of arc and Match two shapes at 100 seconds of arc Record the best smallest stereopsis result in seconds of arc Hints for Screeners VVVVVVV Some children need additional time to appreciate stereopsis Do not let the child see the booklets without wearing the stereoglasses Always ask questions the child can understand Play a matching game prior to testing if children are uncertain about matching items Use the Randot Preschool Stereotest Copy of Answer Key see appendices Provide encouragement and praise the child and Allow adequate time for testing Pro
12. service We are requesting aboriginal ancestry information in support of action item 10 in the Transformative Change Accord First Nations Health Plan Aboriginal children under age of six on and off reserve will receive hearing dental and vision screening All information will be collected used and or disclosed in accordance with the Freedom of Information and Protection of Privacy Act You will be contacted to schedule the dental survey and vision screening visit Public health staff will send a package for each teacher with parent notices about these services These notices need to be distributed prior to the visit If it should happen that this is not done please notify the public health staff immediately so that the visit can be re scheduled A pamphlet about Healthy Kids Program for children aged 0 18 living in low income families is included with this letter It will be helpful to parents if you could include this information in a school newsletter Following service provision each kindergarten child will receive a notice to inform the parent that their child was screened and to provide some helpful hints on keeping their child s teeth and eyes healthy Parents of children requiring follow up will be contacted by public health staff Public health nursing staff will continue to accept vision or dental referrals for any student experiencing vision difficulties or dental pain or infection from any grade Please contact the publi
13. that eye 11 If unable to successfully obtain an acceptible reliable reading result after TWO attempts refer the child If the child meets the referral criteria fails screening with acceptible reliability reading results refer the child do not rescreen Children can accommodate if an eye is re screened 12 To stop a test at any time hold down any button until you hear the 5 tones sound 13 Record the results for Sphere S Cylinder C and Reliability R for each eye 14 Record the Difference D between both eyes 15 Repeat the process for the next child Reliability Number Cylinder Child Adult Mode SO Difference Reliability Numbers and Results Reliability Number indicates the number of good readings obtained and their consistency based on a 1 to 9 scale The higher the reliability number the better the reading Reliability Reading Results gt 6 to 9 indicates an acceptable test result gt 5 or less indicates that the testing must be repeated gt 9 99 or 9 99 indicates a reading outside the unit s measurement range repeat testing required see item 11 above for information on rescreening and reliability readings If the patient did not appear to fixate on the unit during data acquisition repeat the test even if reliability numbers are gt 6 An asterisk on a reading in child mode indicates it is in American Academy of Ophthalmology AAO pre school ref
14. to the appointment Ask the eye doctor to fax the completed form to the health unit or you can return the completed form to the health unit or school If you have any questions about this program or about your child s vision please contact us at XXX XXX XXXX Sincerely Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 43 of 70 TEMPLATE LETTER GENERAL SCREENING Dear Parent or Guardian This year your child s class will take part in a vision screening program at your child s school child care facility This will be done by insert health authority public health staff as part of a province wide screening program Vision screening will be done on mm dd yyyy Healthy vision is important for your child s learning We want to find and help children who may have eye problems which can affect their learning This screening does not replace regular eye exams with your eye doctor optometrist ophthalmologist If we find any possible concerns with your child s vision we will let you know A letter will be sent home with information if there is a need to see an eye doctor for further follow up To support your child s learning we will also notify your child s school principal daycare of the screening results If you do not wish your child to be screened or if you do not want your child s principal daycare to be informed of the vision screening results please contact us at XXX XXX XXXX If yo
15. top of the vision chart Measure and mark the distance between the chart and the child to be screened with tape to ensure the distance is maintained throughout the screening session Place the chart at eye level with the child It is important for the child to be able to look straight ahead and not be looking off to the side or lower than the letters If the child stands during screening a chair could be placed with the back closest to the child This will prevent the child from creeping forward and will give the child something to hold onto Children waiting to be screened should not be facing the vision chart H O T V Eye Chart Indicates distance child should be N from the chart for vision testing YO A A a SS O O A HOTV Response Numerical value that indicates 8 em Card and Flash Cards the size of the symbol Preparing a child for screening using the H O T V 1 2A 3 Note Show the child the flash cards using care not to call the letters by name Ask the child to match each flash card symbol with one on the response panel lap card When the symbols can be matched without difficulty the screening may begin The child must learn to identify the shape of the symbols rather than the name of the letters Recognition can usually be taught in a few minutes or less depending on the maturity of the child Procedure for H O T V Screening 1 3 If the child wears corrective lenses screening must be
16. 0 2010 HC docm Page 26 of 70 XII VISION SCREENING SURESIGHT VISION SCREENER CHECKLIST Purpose This check list should be used regularly until these points become habits when using the SureSight Vision Screener Instructions To check the accuracy of your own testing ability read over the check list immediately after you have finished giving the test To check the accuracy of another person s test administration score your observations below Before Test SureSight Vision Screener Checklist Yes No 1 The screener checked that the battery was charged prior to use 2 Screening location was met guidelines gt Quiet area without distractions gt Appropriate lighting avoided bright light window glare 3 Child mode setting selected 4 The screener checked that the Cylinder displayed in a MINUS Convention During Test SureSight Vision Screener Checklist Yes No 1 Tester turned unit on Za Child positioned at eye level with screener and device 3 Child s right eye screened first then left eye screened 4 Tester adjusted screening distance until steady tone heard 5 Unit pointed at the child s pupil cross hairs aligned on the pupil 6 Screener instructed the child to look at red light Te R L button selected to retest right or left eye 8 Referred children who coul
17. 01 KELOWNA OKANAGAN SIMILKAMEEN TRAIN9 OKS s F P P F REF AWR Recording Vision Screening Diagnostic Referral Outcome Information Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 53 of 70 d Delete Delete gt a Delete po 1 Search For and Select Client 2 Navigate to PHS Module Client Summary Screen 3 Record new Service Information indicate appt type Update and Add 4 Provider refers to eye doctor in this step Client Summary Enter either Professional Status Source Name HA or City for filter Professional Status Source Name Provider Personnel Filters L OTHER HA City a v appt Date appt Type HA Branch Provider Recorded By B v OKANAGAN SIMILKAME KELOWNA w v OKSTRAIN1 Sel td Appt Date Appt Type HA Branch Provider NWBA ECHA IMMS PSTA EDCO HEAR DEN ISS Y 2008 04 07 UPDATE OKANAGAN SIMILKAMEEN KELOWNA OTHER PROVIDER 2008 03 03 PHONE VISIT OKANAGAN SIMILKAMEEN KELOWNA ADAMS COLEEN 2008 02 11 SCHOOL OKANAGAN SIMILKAMEEN KELOWNA ADAMS COLEEN 5 Navigate to VISION tab 6 Select Screening Type DIAGNOSTIC Add 7 Record appropriate eye doctor referral outcome information as per standards and Add Vision Services Exemptions Appt Date 2008 05 30 Type DIAGNOSTIC v Acuity Right v Acuity Left w visual Stereopsis v Delete Delete Delete Glasses lt vi
18. 10 2010 HC docm Page 52 of 70 Recording Follow up Contact 1 Search For and Select Client 2 Navigate to PHS Module Client Summary Screen 3 Record New Service Information indicate appropriate appt type and Add Client Summary Enter either Professional Status Source Name HA or City for filter Professional Status Source Name Provider Personnel Filters y TRAIN9 OKS ua Ha City v v appt Date appt Type HA Branch Provider Recorded By 8 v OKANAGAN SIMILKAME KELOWNA vw v OKSTRAINO Sel td Appt Date Appt Type HA Branch Provider Y 2008 05 01 SCHOOL 4 Navigate to VISION tab 5 Select Screening Type UPDATE 6 Record contact follow up information and Add Vision Services 2008 05 14 PHONE VISIT OKANAGAN SIMILKAMEEN KELOWNA TRAIN9 OKS OKANAGAN SIMILKAMEEN KELOWNA TRAIN9 OKS NWBA ECHA IMMS PSTA EDCO HEAR DEN YISS Select Y Select Exemptions Appt Date 2008 05 14 Type UPDATE v Acuity Right v Acuity Left v visual Stereopsis v Glasses v visual Colour v Action PHONE CONTACT v Outcome AWAITING RESOLUTION v Referral Source v 7 Follow up results will display in Vision Services History block Vision Services History Date Branch HA Provider Type A R A L vs Gis ve Action Outcome RefSre 2006 05 14 KELOWNA OKANAGAN SIMILKAMEEN TRAING OKS u PHC AWR 2008 05
19. B for form NOTE Children with observable eye conditions should be referred immediately to an eye doctor or family physician if e The eye turns in or out The child has crusty or red eyelids The child has drooping lids The child has different size pupils or eyes The eyelids are swollen The child has conjunctivitis pinkeye Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 20 of 70 IX REFERRAL PROCESS Cont d Guidelines for Contacting Parent Guardian Regarding Vision Referrals 1 Send letter and Vision Screening Referral and Follow Up form to the child s parent guardian as soon after the screening as possible Letter to advise the parent guardian gt That the screening indicated the child should receive further follow up by an eye doctor gt To take the Vision Screening Referral and Follow Up form and to their appointment with the eye doctor Suggested inclusion Healthy Kids Program pamphlet gt To have the eye doctor complete the form and fax return result to the Health Unit 2 Suggested Action gt Attempt up to three contacts to support child referral and follow up gt Client follow up should be completed within four months after referral X Recording the Vision Screening Results Record kindergarten screening results by variance e g record screening results for only those children referred on their electronic child health record Record all preschool age 3 year old results
20. CE gt 1 5D Difference readings do not display as a minus or plus symbol 0 0 5 1 0 Within normal limits NOTE ANY READINGS IN THE YELLOW HIGHLIGHTED AREAS REQUIRE A REFERRAL Randot Preschool Stereotest Age of Child Randot Preschool Stereopsis Referral Criteria 36 months to Kindergarten age Refer if unable to determine stereopsis at 100 seconds of arc Older Student Grade 1 and older Refer to eye doctor if symptomatic Use of the SureSight Vision Screener and Randot Preschool Stereotest in ages less than 36 months is at the discretion of the Health Authority and is based on professional judgement of the screening personnel For example some children younger than 36 months may be mature enough to understand screening instructions and complete vision screening procedures Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 23 of 70 XI VISION SCREENING UNDER SPECIAL CIRCUMSTANCES Occasionally the screener will encounter children with special challenges who may be unable or unwilling to perform the required task rapidly or in the usual manner These children may require more time to be screened and therefore one should be prepared to slow down the process to accommodate them The expectation for the screener is to be able to screen children according to outlined procedures While some adjustments may be made in how you interact with the child the screener should
21. F DEAR PARENT Your child s vision was checked today as part of the Public Health vision screening program Your child needs a full eye exam by an eye doctor 1 PLEASE MAKE AN APPOINTMENT WITH AN EYE DOCTOR OPTOMETRIST OR OPHTHALMOLOGIST 2 TAKE THIS FORM WITH YOU TO YOUR APPOINTMENT AND GIVE IT TO YOUR EYE DOCTOR SIGN BELOW TO RELEASE THE EYE DOCTOR S RESULTS RECOMMENDATIONS TO THE HEALTH AUTHORITY THE RELEASE OF THE FOLLOWING INFORMATION IS AUTHORIZED BY Parent Guardian Signature TO BE COMPLETED BY PUBLIC HEALTH SCREENER SCREENING LOCATION Vision Screening Result Outcome Record Result as Pass or Refer The personal information collected is to support client referral and follow up and to evaluate the vision screening program by insert Health Authority and at a provincial level The personal information will be kept confidential in compliance Welch Allyn SureSight H O T V eye chart Right Eye Pass L Refer Left Eye L Pass Refer Difference Pass L Refer Stereopsis Pass Refer with the Freedom of Information and Protection of Privacy Act If you have any Could Not Test Tested wearing glasses questions about the collection and use of this information contact your Public Child has glasses but glasses not worn during testing Health Nurse at Other observable concer
22. LE PRESCHOOL or SCHOOL VISION SCREENING RESULTS Date Screened L Daycare Preschool Site Name Referred Preschool Health Fair Absent C Head Start Strong Start Unable to Test Sure Sight Vison Screener Stereopsis Comments T lt O D 3 fo E Q e lt O Key R Reliability 6 9 Refer if Sphere S Sphere Less or equal to 1 0 or greater or equal to 3 0 C Cylinder Cylinder D Difference Greater than or equal to 1 5 CNT Could Not Test Difference For students with glasses Greater than or equal to 1 5 WG Wearing Glasses Stereopsis NW Not Wearing Glasses Other than 100 seconds of arc This information is subject to and protected by the Freedom of Information and Protection of Privacy Act Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 68 of 70 Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 69 of 70 APPENDIX C Instructions to set SureSight machine configuration to Minus Cylinder convention IMPORTANT NOTE All SureSight machines MUST be set to a Minus Cylinder convention BC referral criteria is based on the MINUS cylinder convention The following instructions are adapted from the WelchAllyn SureSight Vision Screening Manual To set the SureSight unit to the minus convention 1 Open the battery cover located on the underside of the unit by sliding it in the direction indicated by the arrow and lift up 2 Rotate the lever holdin
23. NFIGURATION TO MINUS CYLINDER CONVENTION 0 cccccscscsssssssscssscscscssscssccscscscscscscscssssscscscscccseccccccccscccscsesesesescseseses 70 Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 3 of 70 I PURPOSE OF THE VISION SCREENING TRAINING MANUAL The purpose of the Vision Screening Training Manual is to provide vision screeners with the information required to carry out the vision screening program in the preschool age and or kindergarten age population This manual can be used as a basis for teaching vision screeners staff or volunteers basic vision screening techniques to ensure consistent standardized practice and procedures by all vision screeners and associated staff II OBJECTIVES After reviewing this manual and having successfully completed a training session the vision screener will be able to 1 Understand the vision screening services offered to the preschool age and or kindergarten population by the Health Authorities 2 Understand the purpose of the screening procedures for stereopsis and refractive errors visual acuity 3 Accurately carry out the screening procedure for stereopsis and refractive errors visual acuity 4 Record and interpret the results of the screening procedure 5 Make appropriate referrals if indicated and liaise with other professionals involved in follow up e g eye doctors teachers etc 6 Record findings of the referrals and complete necessary f
24. Provincial Vision Screening Training Manual BC Ministry of Healthy Living and Sport August 10 2010 e a BRITISH Y a COLUMBIA NC Y2 4T The Best Place on Earth northern health Interior Health fraserhealth Vancouver pn health ISLAND i Ervine Hati CoastalHealth ealth Services Authority Promoting wellness Ensuring care a uth O rity Q oo Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 1 of 70 TABLE OF CONTENTS I PURPOSE OF THE VISION SCREENING TRAINING MANUAL occcccccccccccnononononononononononononononononononos 4 M OBJECTIVES aca ii 4 Ill OVERVIEW OF BC MINISTRY OF HEALTH VISION SCREENING PROGRAM occcccccccccccccnccos 5 IV VISION DISORDERS THAT MA Y BE DETECTED BY SCREENING o coccccccccccccnononononononononcnonononos 6 Vs VISION SCREENING visicsc esccciccosesecesscecesasoctccccsescccdasecesccessstevcusocebeccpescoscucesetbdupsscoscusosescscpescesdebosesbcesescesecs 7 VI VISION SCREENING TOOLS GENERAL GUIDELINES 0 cccccscscscscscscscscscscscscvcseseseseccseseses 7 WELCH ALLYN VISION SCREENER TO TEST FOR REFRACTIVE ERRORS 0ccsssececccececeeceeeees 8 STEREOPSIS VISION SCREENING FOR PRESCHOOL AGE AND KINDERGARTEN AGE CHILDREN 8 VISION CHARTS TO TEST A CUILY 2 i256 heels bois a A ee eee 9 VII VISION SCREENING GUIDELINES FOR PLANNING AND PREPARATION cccccscsoves 10 GUIDELINES FOR SMALL KINDERGARTEN COHORTS cccccncononononononononanananananananino 10
25. T PRESCHOOL STEREOTEST COPY OF ANSWER KEY RA Booklet 3 y Ther panel 800 Top panel 200 Y JM sec of arc sec of arc L Bottom 100 sec of arc Test start with Booklet 3 top panel and move down when child correctly identifies at least 2 out of 3 test objects in each panel Record record best smallest stereopsis result in sec of arc Refer if unable to pass stereopsis at 100 sec of arc Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 49 of 70 Suggested Guidelines Data Entry PHIS Public Health Module 1 Search For and Select Client 2 Navigate to PHS Module Client Summary Screen 3 Record Service Information and Add Client Summary Enter either Professional Status Source Name HA or City for filter Professional Status Source Name Provider Personnel Filters Ba ADAMS HA City a Y appt Date Appt Type HA Branch Provider Recorded By B v OKANAGAN SIMILKAME KELOWNA j v OKSTRAIN1 Add Sel td Appt Date Appt Type HA Branch Provider NWBA ECHA IMMS PSTA EDCO HEAR DEN YISS Y 2008 02 11 SCHOOL OKANAGAN SIMILKAMEEN KELOWNA ADAMS COLEEN 4 Navigate to VISION tab 5 Select Screening Type Screening 6 Record vision screening information as per options 1 4 and Add Option 1 Child did not pass at least one part of screening Enter Pass Fail details glasses info if relevant select Action ref
26. Tab o Record Type as Update o Record Outcome as Under Continuing Care e For families who decline screening or referral associated to screening because the child was previously seen by an eye doctor seen 6 months prior to screening and there were no problems with the child s vision o Create New Service PHS Summary Screen o Navigate to Vision Tab o Record Type as Update o Record Outcome as No Apparent Problem e For families who decline screening or referral associated to screening because the child was previously seen by an eye doctor seen 6 months prior to screening and received and completed treatment o Create New Service PHS Summary Screen o Navigate to Vision Tab o Record Type as Update o Record Outcome as Treatment Completed Recording Outcome for children prescribed glasses e Corrective lenses with no recall appointment or recall in a year document as treatment complete e Corrective lenses with a recall appointment in 6 months or less document as under continuing care APPENDICES Cont d HOTV VISION SCREENING TOOLS AND PROCEDURES Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 55 of 70 General Room Requirements when using H O T V charts Room Size The room should be at least 5 feet longer than the test distance e g 15 feet when using a 10 foot eye chart Lighting Room Well lighted without glare without dist
27. Use gestures or pantomime to demonstrate what will be done Continue to verbalize your instructions Allow the child to observe other children being screened Use a play technique if necessary Sometimes an older child sibling can be assigned to help the child complete the vision screening VVVVVV 4 The child with learning difficulties Some children are unable to grasp and follow instructions They may forget the response they were taught during the conditioning procedure Even when they can clearly see the symbol they may not respond appropriately due to confusion A lack of response may mean that they either did not understand the instructions or are unable to follow screening directions It is preferable to work with these children on an individual basis gt The child may require a quiet room with no distractions of other children gt Check the child s understanding of what was expected of them gt The child with learning difficulties responds very well to positive social reinforcement A simple Very good or Good job can do wonders for this child s motivation gt The screening procedure may need to be more rigorous and have a more individualized conditioning process 5 Children with hearing loss Children with hearing loss are as individual as any other child Understanding the importance of visual communication for the child is important The communication ability of these children will vary as a result
28. about vision and eye health to parents guardians and care providers E g at newborn visits Well Child Health Clinics or Parent Guardian Toddler programs preschools and childcare settings Child Development Centres or locations frequented by young children and their families 2 Use an appropriate screening tool to screen for visual acuity refractive errors and stereopsis and provide follow up to determine outcome 3 For any child who fails the vision screening or who exhibits signs of eye trouble refer for further examination using the Vision Screening Referral and Follow up form Facilitate follow up to outcome 4 Determine outcome of referrals and enter onto appropriate forms health records 5 Access and maintain records for vision services as per Health Authority guidelines and relevant legislation e g FOIPPA School Act etc Provide consultation to parents guardians or other care providers about vision screening 7 Collect and maintain program statistics and provide to the Ministry of Healthy Living and Sport as per evaluation guidelines D Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 5 of 70 IV VISION DISORDERS THAT MAY BE DETECTED BY SCREENING The purpose of vision screening is to detect vision disorders such as refractive errors amblyopia and strabismus at an early age less than 6 years AMBLYOPIA or Lazy eye is where the vision in one eye is weaker than the other The child s brai
29. al Acuity Checklist For Eye Charts Yes No ER The test results were recorded accurately and on the appropriate screening list A correct referral was made and a Vision Screening Referral and Follow up form was correctly completed Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 60 of 70 Preschool Vision Screening Protocol Self Test True or False Questions 1 Question Answer 2 Question Answer 3 Question Answer 4 Question Answer 5 Question Answer 6 Question Answer 7 Question Answer 8 Question Answer Provincial Vision Screening Training Manual_August 10 2010 HC docm If a child is having a difficult time on the visual acuity screening show the child only one letter at a time to reduce the confusion True or False False A child with amblyopia will record a better visual acuity when tested with one letter or symbol at a time This means that the child s vision problem may be missed It is important to always show a line of letters or symbols when assessing vision in a young child If a child does not know the alphabet a picture chart can be used as replacement True or false False Many picture charts will give an incorrect assessment of visual acuity Only HOTV letters or Lea symbols may be used for pre literate children Covering one eye with a hand cup or spoon is an effective technique for measuring visual ac
30. are due to the pigment of the iris Retina The inner layer the RETINA is a highly specialized multi layered extension of the optic nerve which receives light stimuli and converts them to electrical impulses for transmission to the brain The retina consists of cones and rods which are the nerve receptors of light stimuli Cones and Rods The CONES are responsible for acute or sharp vision and our ability to discern colors There are approximately 7 000 000 cones in the retina In order to activate the cones there must be a minimal amount of light present The amount of light required to activate the cones is about the same as the amount of light emitted from a full moonlit night In dim light the RODS take over the function of sight Hence night vision is attributed to the rods There are approximately 125 000 000 rods in the total retina The rods do not see color but allow you to pick up gross movements general shape and form lightness and darkness in varying shades of gray Rods have very poor visual acuity Therefore our visual acuity under dim lighting conditions is poor because the cones are not functioning The retina covers the posterior 2 3 of the eyeball extending from the optic nerve to the ora serrata At the optic nerve there are no light receptors rods or cones to send electrical stimuli to the brain Light falling on this area is not seen by the brain thus the term blind spot If you follow a horizontal line
31. arly but close objects appear blurry Hyperopia is corrected with positive lenses A condition whereby the eye while at rest over refracts the light from a distant object so that the image of the distant object is focused in FRONT of the retina The person perceives a blurred image that cannot be improved by accommodation The condition is usually a structural congenital and or developmental anomaly The person sees near objects clearly but distant objects appear blurry Myopia is corrected with negative lenses Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 6 of 70 ASTIGMATISM A vision condition that occurs when the front surface of the eye the cornea is slightly irregular in shape This irregular shape prevents light from focusing properly on the retina As a result vision may be blurred at all distances Astigmatism V VISION SCREENING Screening is a process by which a large number of persons are assessed by a fast efficient method in order to separate them into different groups The purpose of vision screening is to separate those children who probably do not have vision problems from those who should be examined by an eye doctor for further assessment and possible follow up The goal of the provincial vision screening program is universal vision screening of preschool age and or kindergarten children However a target of 100 percent may not be feasible as
32. atching lenses or o the best visual correction for the individual child may have been achieved Note Children who have received a diagnostic eye exam 6 months prior to vision screening do not need to be screened and do not require a referral to an eye doctor if screened and did not pass screening 2 The shy frightened or crying child Some children are easily distressed by new or unfamiliar situations When the child understands that the screening is harmless and perhaps even an enjoyable experience the child usually begins to cooperate with the screener This child needs reassurance and complete acceptance Under no circumstances should the child be intimidated Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 24 of 70 XI VISION SCREENING UNDER SPECIAL CIRCUMSTANCES Cont d gt Show the child the equipment and allow them to ask questions about it gt Allow a child exhibiting these emotions to observe a number of other children during the screening activity gt Tf you are unable to gain this cooperation during the initial screening excuse the child along with the group and refer the child 3 The child whose first language is not English Children who have English as a second language may show an inability to follow verbal instructions that are presented in English Check to see if the conditioning procedure is understood by the child Show the child the equipment and how it will be used
33. ate letter Missed Screening Template letter Fax Screening Reminder to Teachers VV VV V VV VV WV Template Vision Screening Referral and Follow up form Other Resources Ministry of Education link to school lists and contact information http www bced gov bc ca apps imcl imclWeb Home do BC Health Files gt Young Children and Their Eyes BC HealthFile 53a gt School Age Children and Their Eyes BC Health File 53b The Provincial Vision Screening Training Manual can be accessed online at gt http www hls gov bc ca women and children children and youth early childhood html vision Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 38 of 70 gt Health Authority Letterhead TEMPLATE LETTER SUPERINTENDENT insert Date 2007 Insert Name Superintendent School district insert Dear This school year public health staff will be offering the following in school health services for children These include gt Vision screening for all children in kindergarten to identify those with possible vision concerns and to evaluate our efforts in the prevention of visual disorders that could affect learning gt Dental health survey dental visual check for all children in kindergarten to identify those with dental concerns and to evaluate our efforts in the prevention of early childhood tooth decay gt Immunization services for Grade 6 and Grade 9 students gt Other HA ser
34. c health staff directly with any concerns We value your continued support of our efforts to improve the health status of children If you should have any questions please do not hesitate to call your local public health office We may be reached at XXX XXX XXXX Sincerely Enclosures Healthy Kids Program Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 41 of 70 Health Authority Letterhead TEMPLATE LETTER TEACHER Teacher letter ES Dear RE Vision Screening Vision screening has been scheduled for the kindergarten children in your class on at am The screener will briefly review preventive vision health practices with the children and teacher and then will provide the vision screening in a private area of the classroom We have included notes to be sent home with each child prior to our visit It is important that these notes be distributed to let the parents know we will be coming and to allow them to contact us if they have any questions Schools are asked to assist public health staff by providing a copy of the class list with the children s names parent s names child s birth date telephone number and address and indicate whether a child is of aboriginal ancestry Section 79 of the School Act permits persons providing health services access to information in the student record required to carry out that service Parents will be notified by letter sent out by insert Health Authority if t
35. creening location met guidelines Ze gt Quiet area without distractions gt Room size appropriate 3 Room area lighting was appropriate for the test used i gt Bright well lit room and light box was used 4 Distance from the chart to child was correctly measured 5 Vision chart was placed at child s eye level 6 Equipment was checked prior to use to ensure it was operational During Test Visual Acuity Checklist For Eye Charts Yes No 1 The child was not facing a window or other light source while reading the chart 2 The occluder did not apply pressure to the eye area 3 Each eye was tested separately 4 The examiner move fairly quickly down the chart starting at the top row 5 The examiner refrained from jumping from line to line i e i gt 10 25 to 10 15 back to 10 25 6 The examiner alternated the letter sequence on a line rather than pointing to the letters straight across one line 7 The pointer was held directly under each letter to avoid shadows 8 The tester presented the entire row and did not isolate letters 9 The examiner reassured and encouraged the child 10 ae examiner checked that the child s head was in the straight ahead position to the chart 11 The examiner frequently checked the child for signs of peeking and for squinting 12 The examiner was sure that children waiting for their turn were not looking directly at the chart Post Test Visu
36. d not be tested after TWO attempts 9 Reliability reading was 6 or higher for each eye 10 Repeated reading once if less than 6 or 9 99 11 Go Button selected to turn unit on if unit enters sleep mode Post Test SureSight Vision Screener Checklist Yes No 1 The test results were recorded accurately and on the appropriate screening list Za A correct referral was made and a Vision Screening Referral and Follow up form was correctly completed 3 Places SureSight unit in charging stand when not in use for prolonged periods during screening sessions e g during breaks and following screening session Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 27 of 70 VISION SCREENING STEREOPSIS CHECKLIST Purpose This check list should be used regularly until these points become habits when using the stereopsis test Instructions To check the accuracy of your own testing ability read over the check list immediately after you have finished giving the test To check the accuracy of another person s test administration score your observations below Pre Test Stereopsis Checklist Yes No 1 The examiner prepared the child for test gt Child was seated comfortably gt Stereoglasses were worn over regular lenses for children with eyeglasses 2 The tester explained the test procedure 3 The tester assured cooperation of child by giving
37. determine 1f the adjustments will impact the results of the screening If the adjustments in your approach or the procedure impact the results you should record this and refer the child for follow up Many children see themselves in terms of their performance The screener should remember that the outcome of the vision screening has absolutely nothing to do with the goodness of a child neither does it reflect on the personal worth of the screener If these points are kept in mind the integrity of the child will not be compromised and the screener will find it much easier to work with and relate to the child The following are some general helpful hints to assist the screener in obtaining a successful screening experience General Tips Present information to the child at their eye level Make the screening a positive experience for the child Be prepared to request the assistance of a familiar person or a support person in interacting with the child Don t assume a lack of response as understanding by the child during the conditioning procedure See if you can elicit a response gt gt gt gt 1 The child with glasses Children who have been prescribed glasses should be screened wearing glasses Screening may detect children with outdated prescriptions or who are in need of follow up from their eye care professional Higher rates of stereopsis referral may occur within this group due to o process of ongoing correction p
38. e secondary suppression and or amblyopia dimness of vision can be complications of a tropia A prefix is used to denote the type of tropia Types of Tropia are EXOTROPIA One eye is deviated outward ESOTROPIA One eye is deviated inward toward the nose HYPERTROPIA One eye is deviated upward HYPOTROPIA One eye is deviated downward Treatment Variable may include eye glasses orthoptic treatments eye exercises medication and or surgery Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 36 of 70 Amblyopia AMBLYOPIA is a general term meaning dimness of vision which cannot immediately be brought to normal standards by optical means It can develop in infancy or at any period during life The types which develop during later years are usually from toxic sources alcohol tobacco drugs or disease The type usually affecting children results from disuse of the macular area Amblyopia affects approximately 2 4 of the population The following discussion will center on amblyopia in children and its causative factors Fine visual discrimination occurs in the fovea centralis It is a process which must be developed during the preschool years If there is any interference which impairs or deters the orderly progression from general vision present at birth to binocular vision amblyopia can develop Differences between the images the two eyes send to the brain can occur if there is 1 A large
39. e for Screening Using the SureSight 1 Ifthe child wears corrective lenses screening must be done with the child wearing the lenses 2 Push the GO button on the unit Position yourself at eye level and square with the face of the child 4 Hold the unit 14 inches from the child at eye level a If the unit is too far away you will hear slow low pitched beeps b Slowly move closer At the correct 14 distance you will hear a steady low tone c When the unit is too close you will hear quick high pitched beeps d The crosshair will flash in synch with the tones Tell the child to look at the red light 6 When you are at the correct distance look through the peephole and align the cross hairs on the pupil of the child s right eye While the unit is acquiring data you will hear a very high pitched chirping sound with a steady low tone 7 When the test of the right eye is complete you will hear the tah dah sound Testing resumes 1 second after the first eye is complete so you do not need to press any buttons Nn Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 13 of 70 Turn the unit to the left eye and align the cross hair over the left eye s pupil and repeat At the end of the test you will hear the tah dah sound again 10 If the unit has not gathered a good reading from either eye you will hear 5 tones to signify that the testing has stopped You must re test
40. ececesesecececececececesesece 29 POSSIBLE SIGNS OF VISION PROBLEMS IN CHILDREN cccccssceccccesceccccesceccccecececssceceasencecees 29 QUESTIONS TO SUPPORT CASE FINDING ACTIVITIES cccccccesssecesseecssececesececseeecseeeesseeeesaees 30 VISION AND DEVELOPMENTAL MILESTONES IN INFANCY AND EARLY CHILDHOOD 31 APPENDIX As E E E PA EE EREE AARE soedescusssiases Soudoscbeisutsud ssedesce asses cosvedesslvstudecasselesebceseascens 32 ANATOMY OF THE EYE AND THE VISION PROCESS o000occccccconononoccccnnnnnonononocicccnnnconononnns 32 HOW WESEES Load O aio dias 34 HOW SEEING DEVELOPS iia in rd ri 35 BINOCULAR VISION St ado dao edi 35 MUSCLE BALANCE PROBLEMS 0 ccccccsececcccececcccecececcescecccsseecenssecceccuseeccasusceceaseseeceaaeneecees 35 AVMBEYOPIA AREE ETEA oaats realice if ues A E 37 APRENDI i EEE E PAE AE RETE EE TE E EE AE ERTE estates seeedeoseetocese 38 SAMPLE TEMPLATE LETTERS a iia 38 Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 2 of 70 BEIHEALTE FIR orcas na e es e de do dao ec dd de ada a e e 38 H O T V TOOLS AND PROCEDURES ssssssssssosssssssssssososososososososososososososososososoeosososssososseososososososososoeo 55 GLOSSARY N 62 VISION CARE PERSONNEL AND PROFESSIONAL DEFINITIONS cccccceeeseeececececcacesssesceccceceeees 62 GENERAL GLOSSARY 23 62st lee A ANSE RAE a dl 63 APPENDIX C INSTRUCTIONS TO SET SURESIGHT MACHINE CO
41. en might include O O look into the camera while I take a picture of you look in the green circle at the red dot inside and you will hear a little birdie chirp Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 15 of 70 VV VV WV o look at the red dot inside the flashing green lights and tell me when it changes color Encourage and praise the child o One more to go you re doing great o Good job If you are at the correct distance and NOT acquiring data o Make sure the unit is straight and level with the child o Remind the child to look at the red light check that the child is fixating on the device and o Slowly move the cross hairs around the eye When testing the second eye simply rotate the unit over since it is already at the proper angle and distance Make sure the child s eyelids are not occluding the pupil If the unit is in the sleep mode any button wakes the unit and displays the previous results A charged unit can test children for about 3 hours of continuous use To recharge the unit place firmly into the stand See Welch Allyn SureSight User Manual for full product details and instructions Care and Cleaning Instructions for SureSight Vision Screener Cleaning Clean windows with soft cloth dampened with 70 isopropyl alcohol or standard window cleaner Housing straps etc can be wiped down with isopropyl alcohol 10 Clorox alcohol pads s
42. eness about eye health and eye development in early childhood Case finding may also occur during routine interaction with children and their families Some eye conditions may be apparent on observation or identified during routine health assessments Case finding uses public health practitioners physicians and other early childhood practitioners in established programs and services with referral to vision specialists for diagnostic testing and follow up A goal of the provincial vision screening program is to support case finding through provision of information about vision and eye health to parents guardians and care providers e g at newborn visits Well Child Health Clinics or Parent Toddler programs preschools and childcare settings Child Development Centres or locations frequented by young children and their families A Observation and Assessment to Support Case Finding Children with observable eye conditions should be referred immediately to an eye doctor or family physician gt Do the eyes look normal o eye turns in or out crusty or red eyelids drooping lids different size pupils or eyes swelling of eyelids conjunctivitis pinkeye 0 010 0 0 B Possible signs of vision problems in children Complaining of blurred vision Headaches Squinting rubbing the eyes or excessive blinking Covering or closing one eye Holding objects too close or avoiding activities requiring distance vision Preferri
43. er passing through a refractive substance FOVEA Small depression in the retina at the back of the eye the part of the macular area adapted for most acute vision Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 64 of 70 FUNDUS The inner surface of the posterior part of the eye FUSION Coordination of the images seen by each eye individually into one picture GLARE A quality of light which causes discomfort it may result from a direct light source within the field of vision or from a reflection of a light source not in the field of vision HYPEROPIA A refractive error in which the eyeball is too short from front to back or the refractive power of the eye is too weak so that parallel rays of light are brought to a focus behind the retina Far sightedness is a condition requiring a convex plus lens to correct HYPERPHORIA A tendency of one eye to deviate upward HYPERTROPIA A manifest or observable deviation upward of one of the eyes IRIS Coloured circular membrane which regulates the amount of light entering the eye by changing the size of the pupil LACRIMAL GLAND A gland which secretes tears It lies just above the outer corner of the eye LENS A refractive medium of colourless transparent substance so shaped as to converge or scatter rays of light LIMBUS CORNEA Edge of cornea where it joins the sclera MACULA LUTEA The small area of the retina that surrounds the fovea and wit
44. erral and Outcome Awaiting resolution client AExemption 4 EXE Y Y MEA ES YA Ges EY NWBA Y MAS ECHA BES AO NY AAA Vision D fi NOB A Lab A Other A Notes service Vision Services Exemptions Appt Date 2008 02 11 Type Y SCREENING Acuity Right FAIL v Acuity Left PASS v visual Stereopsis PASS Glasses FAILED TEST WITH GLASSES v visual Colour v Action REFERRAL w Outcome AWAITING RESOLUTION v Referral Source v C Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 50 of 70 Option 2 Child did not pass screening due to Difference reading on SureSight Record Stereopsis result leaving acuity fields blank if passed Record Action as Referral and Outcome Awaiting Resolution Exemptions Type Acuity Right Acuity Left Visual Stereopsis Glasses Visual Colour Action Outcome Referral Source Add Appt Date 2008 02 05 SCREENING Y Y J REFERRAL v AWAITING RESOLUTION v v Then create a note on child s record indicating reason for referral Record Difference result E g Vision screening Child s name referred to eye doctor due to Difference 2 0D Note Note Date and Time Note Client Comments Created By Created Date 2008 02 07 a 13 49 Vision screening Velma ref
45. erral range The AAO criteria is different from the BC approved referral criteria Use the BC approved referral criteria Sphere Readings Plus symbol indicates hyperopia Minus symbol indicates myopia Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 14 of 70 Cylinder Readings symbol indicates the machine is set to plus convention symbol indicates the machine is set to a minus convention NOTE All SureSight machines MUST be set to a Minus Cylinder convention BC referra criteria is based on the MINUS cylinder convention Welch Allyn SureSight Vision Screener l Right eye field Sphere see glossary Cylinder see glossary Difference between the eyes Child adult calibration Peephole with crosshair target for aiming Reliability measure Left eye field Self adjusting hand strap A and left right toggle Start button c Hints for screeners Child Adult Calibration o Clears readings o Changes calibration mode by holding button down Left Right Toggle amp Print o Selects single eye to re test or switches back to regular test o Prints results hold button down while aiming SureSight at printer Go button o Unit on Starts test o Unit Off recalls old reading if less than 5 minutes have passed gt Helpful phrases when working with childr
46. erred to eye doctor due to Difference 2 0D OKSTRAINS 05 a nso Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 51 of 70 Option 3 Child was absent from school and was not tested Enter Absent in Acuity fields Action Letter Sent and Outcome Awaiting Resolution Vision Services Exemptions Appt Date 2008 01 30 Type SCREENING v Acuity Right ABSENT v Acuity Left ABSENT v Visual Stereopsis Glasses v visual Colour v Action LETTER SENT v Outcome AWAITING RESOLUTION v Referral Source vi Add Option 4 Child was unable to be tested for some reason Enter Not screened unable to test in Acuity fields Action Referral and Outcome Awaiting Resolution Vision Services Exemptions Appt Date 2008 01 30 Type SCREENING v Acuity Right NOT SCREENED UNABLE TO TEST v Acuity Left NOT SCREENED UNABLE TO TEST v Visual Stereopsis mMm Glasses v visual Colour v Action REFERRAL v Outcome AWAITING RESOLUTION v Referral Source v Add 7 Saved information displays in Vision Services History block Vision Services History Date Branch HA Provider Type A R A L S Gls YC Action Dutcome RefSrc 2008 02 11 KELOWNA OKANAGAN SIMILKAMEEN ADAMS COLEEN S E P 2 E REF AWR Provincial Vision Screening Training Manual_August
47. for Refractive Errors An autorefractor is a lightweight portable handheld screening device that is easy to administer and objective eliminates the need for the child to respond The autorefractor operates by pressing a button on the unit and lining up the hand held device 14 away from the child s eye This instrument displays a measurement of refraction for each eye It automatically screens for common vision problems including near and farsightedness myopia hyperopia astigmatism asymmetrical focus and anisometropia unequal power between eyes It can be used to screen preschool age and kindergarten children Stereopsis Vision Screening for Preschool Age and Kindergarten Age Children Fusion is the mental ability to blend two similar images and see them as one Fusion should not be confused with depth perception Depth perception is a layman s term used to describe our ability to perceive that one object is in front of another This is a learned response using such clues as size shadows overlay of contours and perspective e g railway tracks Stereopsis is binocular visual perception of depth in three dimensional space Some people have finer fusion and stereopsis than others A stereopsis test is used to determine one s degree or grade of fusion in relation to 3 dimensional vision The purpose of a stereopsis test is to measure how minutely the two eyes can discern differences in the distances of objects from the obser
48. from the optic nerve toward the side of the head you will find an irregular area that has a yellow pigment called the Macula Lutea yellow spot This yellow spot covers a part responsible for central vision In the center of the area of central vision is a circular depression called the FOVEA fovea centralis The fovea meaning depression has a rod free territory Not only are there no rods but the cones become more compact which provides us with our most acute vision The OPTIC NERVE conducts the visual impulses from the retinal nerve fibers to the brain Crystalline Lens The CRYSTALLINE LENS is a semi transparent biconvex structure suspended in the eyeball between the anterior chamber and the vitreous whose main function is to focus the light rays on the retina When opacity occurs in the lens it is known as a cataract The ANTERIOR CHAMBER is the space that contains the aqueous humor which is a clear liquid that nourishes the front portion of the eye The VITREOUS is the posterior two thirds of the eyeball The vitreous contains the vitreous humor which is a clear gelatinous mass that maintains the shape of the eye The CILIARY MUSCLES of the eye by an automatic reflex action change the curvature of the lens in accordance with the distance of objects being viewed The lens becomes flatter or thinner to focus on distant objects and rounder or thicker to focus on nearby objects Provincial Vision Screening Training Manual_A
49. g the battery in and lift the battery from its compartment 3 View the DIP switches inside the battery compartment located on the button side of the unit 4 Using tweezers or another appropriate tool push the first switch away located on the side of the unit with the hand strap If correctly set to the Minus convention the switch will now be out of line with the other switches see image below ON DIP 123 4 5 6 7 8 Image 2009 TAP Graphics Ltd www tapgraphics com Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 70 of 70
50. h the fovea comprises the area of distinct vision Syn yellow spot MONOCULAR Pertaining to or having one eye MYOPIC A refractive error in which the eyeball is too long or the refractive power is too strong so that parallel rays of light are focused in front of the retina Near sightedness is a condition requiring a concave minus lens to correct NEAR VISION The ability to perceive distinctly objects at normal reading distances or about fourteen inches from the eyes NIGHT BLINDNESS A condition in which the sight is good by day but deficient at night and in any faint light OCCLUDE To cover OCCLUSION The method of obscuring the vision of one eye so as to force the use of the other eye OCULUS DEXTER O D Right eye OCULUS SINISTER O S Left eye OCULUS UTERQUE 0O U Both eyes OPHTHALMOSCOPE An instrument used in examining the interior of the eye OPTIC DISC The point of entry into the retina of the optic nerve It is more commonly known as the blind spot since it contains no light receptors and therefore has no vision OPTIC NERVE Second cranial nerve the special nerve of the sense of sight which carries messages from the retina to the brain Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 65 of 70 PERIPHERAL VISION Ability to perceive presence motion or colour of objects outside of the direct line of vision PHORIA A root word denoting a latent deviation in wh
51. heir child requires further follow up by an eye doctor optometrist ophthalmologist All information will be collected used and or disclosed in accordance with the Freedom of Information and Protection of Privacy Act We look forward to seeing you Enclosures Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 42 of 70 Health Authority Letterhead TEMPLATE LETTER CHILD REFERRAL Date Dear Parent Guardian of Y our child s vision was screened at school today as part of the Health Authority Name School Health Program A more detailed eye examination is needed and we have sent home a Vision Screening Referral and Follow up form with your child This does not mean that your child needs glasses but we recommend that your child be seen by an eye doctor optometrist or ophthalmologist for a more thorough examination If your child has been seen by an eye doctor in the last 6 months please contact the health unit in your area BC Medical Services Plan does provide some coverage for eye exams by optometrists however some optometrists do not accept that coverage as full payment for their services Some eye doctors may charge an additional fee for their services You may wish to confirm if there are costs that you need to pay at your optometrists office when you make the eye appointment for your child Please make an appointment with an eye doctor Take the Vision Screening Referral and Follow up form with you
52. heir eye care professional Higher rates of stereopsis referral may occur within this group due to o process of ongoing correction patching lenses or o the best visual correction for the individual child may have been achieved Note Children who have received a diagnostic eye exam 6 months prior to vision screening do not need to be screened and do not require a referral to an eye doctor if screened and did not pass screening Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 11 of 70 FACILITIES OR SCREENING SITE SELECTION Prior arrangements should be made regarding the date place and time that the screening will be carried out Check the screening location for suitability in advance Select a quiet room where you will not be interrupted If at all possible avoid carrying out screening in the classroom or busy locations Room lighting is important for successful screening General Room Requirements when using an SureSight Vision Screener Lighting Room Ambient lighting avoid brightly lit spaces Conditions Do not perform screening by uncovered bright windows a If the room is too bright the pupils cannot dilate properly if the room is too dark it is difficult to see b Check and adjust room lighting if devise indicates repeated low reliability results Battery The night prior to screening check that the battery is fully charged General Room Requirements when usi
53. ich the eyes have a tendency to turn from the normal position used with a prefix to indicate the direction of such deviation hyperphoria up esophoria in exophoria out POSTERIOR CHAMBER Space between the posterior surface of the iris and the anterior surface of the lens filled with aqueous PUPIL The opening at the center of the iris of the eye for the transmission of light REFRACTION a Deviation of the course of rays of light in passing from one transparent medium into another of different density b Determination of refractive errors of the eye and correction by glasses REFRACTIVE ERROR A defect in the eye that prevents light rays from being brought to a single focus exactly on the retina REFRACTIVE MEDIA OF THE EYE The transparent parts of the eye having refractive power cornea aqueous lens and vitreous RELIABILITY NUMBER indicates the number of good readings obtained and their consistency based on a 1 to 9 scale The higher the number the better the reliability RETINA The innermost coat of the eye which receives the image and changes it into nerve impulses which are transmitted to the brain RODS One of the two types of light sensitive nerve endings that are scattered over the surface of the retina making it possible to transmit visual impulses to the brain Rods perceive light and motion SCLERA The white part of the eye a tough covering which with the cornea forms the external protective
54. ild is five to six months of age Evidence of this is observed when we see the child pick up very small items Muscle Balance Problems The young child must also learn control of the six extraocular muscles which position each individual eye Movements of the eye up and down are controlled primarily by muscles which insert at the top and the bottom of the eye Side to side movements are controlled primarily by muscles that insert on either side of the eye Rotation inward or outward is controlled by various combinations of these muscles A child learns to control the muscles as a pair as the child turns the eyes to look at something the child wants to observe and then to work the muscles against each other in order to let both focus on an object which is less than twenty feet away A child must learn to relate all of these actions precisely and synchronize them exactly to the action of the muscle which controls the size of the lens There is much question as to just when this complexity of action is mastered probably not completely until after a child is well into his school years As part of the complete progression a coordinated balance must be developed so that as an object is moved away from or toward the nose the extraocular muscles can converge or diverge the eyeballs while the ciliary body changes the size of the lens in order to keep the object in focus Before the child can read comfortably the child must also learn to move the eyeballs ho
55. ingers Eye hand coordination grasps at and reaches Does your infant reach for or for objects bat at objects 6 months 8 Accurate eye control Does your baby see objects of Give your baby the freedom to months Move towards objects interest and move towards crawl and explore them Play patty cake and peek a boo with your baby 8 months 12 Grasp and throw Does your baby use his her Give your baby stacking and months objects eyes to coordinate movement take apart toys Feed self with finger around objects Provide objects your baby can foods touch hold and manipulate Judge distances Toddlers and Preschoolers Continued development of eye hand body coordination depth perception Does your toddler show interest in books stacking toys Does your toddler move and climb and throw in a coordinated manner Play ball play at the park playground Look at picture books Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 31 of 70 APPENDIX A ANATOMY OF THE EYE AND THE VISION PROCESS HORIZONTAL SECTION OF AN EYE Muscle gt SIR Dy P SS G Ss Sclera ae A Choriod Cornea XG Wer ie q lm 4 Fovea Anterior tT I 1 Chamber Lens Vitreous Pupil AN alo Angle of anterior f Optic Nerve chamber NOW BE Sub Arachnoid Ciliary Body SSS ee Space Muscle The eyeball consists of three concentric layers or coats the Sclera a
56. klets and suggest they assist the screener Have the child observe another child before attempting the screening one more time Refer if child unwilling or unable to be tested after screening attempted Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 10 of 70 GUIDELINES FOR CHILDREN LESS THAN 36 MONTHS OF AGE Use of the SureSight Vision Screener and Randot Preschool Stereotest or H O T V in ages less than 36 months is at the discretion of the Health Authority and is based on professional judgement of the screening personnel For example some children younger than 36 months may be mature enough to understand screening instructions and complete vision screening procedures Provincial SureSight referral criteria has not been established for children less than 36 months of age GUIDELINES FOR COMPLETION OF FOLLOW UP It is suggested that client follow up should be completed within four months after referral GUIDELINES FOR CHILDREN WITH HISTORY OF DIAGNOSTIC EYE EXAM 6 MONTHS PRIOR TO SCREENING Children who have received a diagnostic eye exam 6 months prior to vision screening do not need to be screened and do not require a referral to an eye doctor if screened and did not pass screening GUIDELINES FOR CHILDREN WEARING GLASSES Children who have been prescribed glasses should be screened wearing glasses Screening may detect children with outdated prescriptions or who are in need of follow up from t
57. n Signature of Health Unit Personnel yyyy mm dd EYE DOCTOR Public health staff will find your assessment of this child s vision helpful It will assist with client follow up and vision screening program planning and program evaluation Please FAX this completed form to the number below EYE EXAMINATION DATE MANAGEMENT LENSES NEEDED please indicate Cycloplegic exam Non Cycloplegic exam No treatment at this time Constantly Refraction Present lenses adequate For Distance Vision Right Eye Spheres Cylinder _ Corrective lenses For reading or close work Left Eye Sphere ___ Cylinder EA a aivilics Unaided Corrected Eye Patching Visat aouty Right eye a Right eye Low vision aids Child s first eye exam Left eye Left eye Vision Impairment Program Yes o No Stereopsis Present Not Present Seconds of Arc Strabismus Yes No Amblyopia Yes No Eye Doctor Signature Colour Vision Normal Abnormal Other observable concern Eye Doctor Name Please Print or use Office Stamp EYE DOCTOR PLEASE FAX THIS FORM TO INSERT HU CONTACT INFORMATION AND FAX NUMBER Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 48 of 70 RANDO
58. n for children who are hard of hearing or have Cochlear Implants gt Use a room that has minimal background noise as it can be difficult to hear gt Do not exaggerate facial expression or mouth movement when talking as this is distracting gt Make sure the child is looking at you when you are talking as they may be utilizing lip reading to support their hearing gt Use visual aids or gesturing as means of supporting your communication 5 The restless child Children at this young age certainly will have a short attention span However you will encounter children who are fidgety or unable to sit still for a short time gt Be sure that the child understands what is expected of them during the conditioning procedure Have them tell you what you explained to them gt Minimize any environmental distractions gt Check to make sure that they don t have to go to the washroom Sometimes fidgety behaviours are signs that they have to go to the washroom and need to be directed to do so 6 The child with a physical disability or having significant medical conditions Children with physical disabilities and significant medical conditions can still be screened with small adaptations Be very sure that these adaptations will not impact the results of the screening gt Be prepared to request the assistance of a familiar person or a support person in interacting with the child Provincial Vision Screening Training Manual_August 1
59. n his or her distance glasses even 1f the child seldom uses them True or false True The glasses should be used for both parts of the screening visual acuity testing and stereo testing If the child is unable to do the pretest proceed with the test procedure and complete the testing and assign a status of pass or refer True or false False If a child is unable to successfully do the pretest stop Do not proceed to the test procedure You may have the child observe another child before attempting the pretest one more time If the child is still unable to do it the child should be referred for a comprehensive eye examination by an ophthalmologist or optometrist Page 61 of 70 GLOSSARY A Vision Care Personnel and Professional Definitions FAMILY PHYSICIAN A family physician or general practitioner is a medical doctor who assesses diseases and problems of the eye in relation to other health problems Treatment includes eye drops and ointments Family physicians refer patients to ophthalmologists or optometrists when appropriate OPHTHALMOLOGIST An ophthalmologist or eye physician or surgeon is a medical doctor specializing in defects and diseases of the visual system who diagnoses and treats by medical optical and surgical techniques OPTOMETRIST An optometrist or doctor of optometry is a health care professional who examines the visual system Patient management includes prescribing glasses contact len
60. n ignores the weak eye and uses the stronger eye in an attempt to see If left untreated the child s brain develops a clear picture in the good eye and a blurry picture in the weak eye Lazy eye is often associated with crossed eyes or a large difference in the degree of nearsightedness or farsightedness between the two eyes It usually develops before the age of 6 STRABISMUS or Crossed eyes occurs when one or both eyes turns in out up or down and is usually caused by poor eye muscle control This misalignment often first appears before age 21 months but may develop as late as age 6 A child will not outgrow strabismus In fact the condition may get worse without treatment REFRACTIVE ERRORS Hyperopia Myopia and Astigmatism The normal eye has various transparent parts through which the light must travel to reach the retina Light is refracted by the transparent media so that the eye while at rest can form a clear image on the retina When light rays cannot be brought to a single focus on the retina of a resting eye a refractive error is present HYPEROPIA Farsightedness A condition whereby the eye while at rest insufficiently refracts light from a distant object so that the image theoretically is focused BEHIND the retina This may be due to a short eye or too flat a curvature of the cornea Sight may be normal or very poor depending upon the state of accommodation and the amount of hyperopia The person sees distant objects cle
61. nd Cornea the Uvea or Vascular coat and the Retina Sclera and Cornea The outer protective layer of the eyeball consists of the sclera and cornea The SCLERA is an opaque tough fibrous white tissue which protects the eyeball and gives it form The CORNEA is a transparent non vascular tissue located at the front of the eye It is a refracting and protective membrane through which light rays pass enroute to the retina The cornea contains many nerve endings which causes it to be extremely sensitive when injured Uvea or Vascular The middle layer is the uvea which consists of the choroid ciliary body and the iris The highly vascular CHOROID lies between the sclera and retina extending from the optic nerve forward to the ciliary body Its chief function is to provide nourishment to the adjacent retinal tissue the vitreous and lens The CILIARY BODY secrets aqueous humor It also provides attachment for the suspensory ligaments The ciliary muscles which control the shape of the lens are a part of the ciliary body Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 32 of 70 The IRIS is the pigmented diaphragm like structure which controls the amount of light entering the eye The PUPIL is the small dark hole in the center of the iris through which varying degrees of light are admitted The size of the pupil is determined by the reflex action of the muscles which control the iris The color of an individual s eyes
62. ndividual above would appear as VA 10 number of feet from symbol de 10 size of symbol Consider a person with a visual acuity screening result of 10 15 They were tested 10 feet from the symbols But they could not correctly identify any symbols until they were shown a 15 size symbol Thus the notation 10 15 denotes their visual acuity When screening is performed using a 10 foot chart the results would be 10 10 10 15 10 20 10 25 10 40 10 45 10 50 10 100 When screening is performed using a 20 foot chart the results would be 20 20 20 30 20 40 20 50 20 80 20 90 20 100 20 200 Please note HOTV screening procedure tools general information and checklists are located in Appendix A Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 9 of 70 VII VISION SCREENING GUIDELINES FOR PLANNING AND PREPARATION 1 Coordinate screening dates and locations with Health Authority staff and other agencies schools 2 Distribute vision screening information letters as appropriate e g parent guardian template letter teacher principal superintendent 3 Obtain lists of children to be screened e g class lists booking sheets etc 4 Ifneeded arrange for helpers to assist with screening activities e g older students may be of help bringing children to and from classrooms etc 5 Prepare children for vision screening Show children the vision screening equipment and tell the child h
63. ng Randot Preschool Stereotest Lighting Room Well lighted room Conditions Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 12 of 70 VIII VISION SCREENING TOOLS AND PROCEDURES Welch Allyn SureSight Vision Screener The SureSight Vision Screener is an objective screening device that eliminates the need for a child to respond The device can be used for screening gt Preschool age and kindergarten age children gt Children with special needs Equipment Required for vision screening using the Welch Allyn SureSight gt Welch Allyn SureSight Vision Screener gt Charger Stand gt Chair s one for screener and one for the child a Preparing a Child for Screening Using the SureSight 1 Position the child so that the test can be conducted level with and square to the child s eyes 2 Push any button on the SureSight device to turn the device on 3 Show the child the SureSight unit Tell the child the vision screener has a red light and makes sounds Allow the child to see the red light and hear the sounds 4 Explain the test procedure to the child Screeners may want to demonstrate screening procedure on a teddy bear 5 Choose the child setting on the child adult calibration button The child setting is used for children 6 years and under Hold the button until you hear a double beep and see the desired icon on the LCD b Procedur
64. ng to be very close to work or television Poor performance in school Clumsiness or lack of coordination in physical activities Family history of vision problems Red itchy or watery eyes 0 00 00 0 0 00 0 00 Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 29 of 70 C Questions to Support Case Finding Activities Does your child have a family history of vision eye problems e g amblyopia lazy eye strabismus e If family history is present Optometrist s recommend that the infant be assessed by an eye doctor by 6 months of age Newborn to 8 weeks o Does your infant focus on your face o Does your infant follow an object with his or her eyes by 5 weeks 8 weeks to 12 weeks o Does your infant track objects toys with his her eyes o Does your infant bring his or her hands together by 8 weeks o Does your infant hold and sustain direct eye contact with you by 3 months 4 5 months o Does your infant move eyes together smoothly to look at objects o Does your infant reach for or bat at objects 6 8 months o Does your baby see objects of interest and move towards them o Does your infant s eye appear straight and work together 8 12 months o Does your baby use his her eyes to coordinate movement around objects Toddlers and Preschoolers o Does your toddler show interest in books stacking toys o Does your toddler move and climb and throw in a coordinated manner Sugges
65. o gain the child s confidence before moving quickly down to the smaller letters 11 The last line where 4 out of 5 test symbols are correctly identified represents the child s visual acuity 12 Do not screen below the 10 10 row on the HOTV chart 13 Record the result for each eye H O T V Hints for Screeners Maintain the distance during the test Do not allow the child to move up closer to the chart Always watch to make sure that the child s head is kept straight and there are no signs of peeking or squinting A child who peeks is likely a child not seeing well Make a game of the screening procedure Reassure the child that there is no right or wrong answers but encourage the child to do the best he can Tf the child seems to understand the procedure but is hesitant try testing the other eye Encourage and praise the child o One more test to go you re doing great o Good job VV V VW Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 58 of 70 Guidelines for HOTV Referral Abbreviations O D Oculus Dexter Right Eye Conversion of 20 foot distance to 10 foot distance charts O S Oculus Sinister Left Eye 20 20 10 10 20 30 10 15 20 40 10 20 O U Oculus Uterque Both Eyes 20 50 10 25 20 70 10 35 HOTV Vision Chart Age of Child Referral Criteria for H O T V Visual Acuity Chart 36 months to Refer if 10 20 or worse in
66. ollow up Preschool age child refers to children who are 3 years of age Kindergarten refers to children enrolled in a kindergarten program Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 4 of 70 HI OVERVIEW OF BC MINISTRY OF HEALTHY LIVING AND SPORT VISION SCREENING PROGRAM OBJECTIVES 1 To identify possible visual defects amblyopia strabismus refractive errors in preschool age children and or kindergarten age children 2 To facilitate treatment and care for preschool age children and or kindergarten age children with identified visual defects RESPONSIBILITIES 1 Ministry of Healthy Living and Sport is responsible for stewardship of the vision screening program 2 Health Authorities are responsible for ensuring screening personnel are trained and follow vision screening practices as outlined by the Ministry of Healthy Living and Sport Vision Screening Training Manual 3 The Vision Screening Steering Committee is a committee of health professionals whose purpose is to advise the Ministry of Healthy Living and Sport and Health Authorities on matters related to the Vision Screening Program delivered by Health Authority personnel Their responsibility is to provide advice and recommendations in the development implementation and evaluation of the Provincial Early Childhood Vision Screening Program HEALTH AUTHORITY ACTIVITIES 1 Support case finding through provision of information
67. onverging magnifying hyperopic or plus lens denoted by the sign CORNEA The anterior transparent portion of the outer coat of the eye through which light enters CRYSTALLINE LENS A transparent colourless body suspended in the anterior portion of the eyeball between the aqueous and vitreous chambers the function of which is to help bring the rays of light to a focus CYLINDER A measure of the power of astigmatism or irregular focus of the eye A display unit on autorefractor device DEPTH PERCEPTION The ability to perceive the solidity of objects and their relative position in space Syn stereoscopic vision DIFFERENCE The difference in mean spherical power between the two eyes DIOPTER A unit of measurement denoting the amount a lens can bend a light ray DIPLOPIA Double vision DIVERGENCE The ability to relax convergence or the ability to turn the eyes out ESOPHORIA A tendency of the eye to turn inward ESOTROPIA A manifest or observable turning inward of the eye convergent strabismus or crossed eye EXOPHORIA A tendency of the eye to turn outward EXOTROPIA A manifest or observable turning outward of the eye divergent strabismus or wall eye EYE DOMINANCE Tendency of one eye to assume the major function of seeing being assisted by the less dominant eye FIELD OF VISION The entire area which can be seen at one time without shifting the head or eyes FOCUS Point at which rays are converged aft
68. ort of action item 10 in the Transformative Change Accord First Nations Health Plan Aboriginal children under age of six on and off reserve will receive hearing dental and vision screening All information will be collected used and or disclosed in accordance with the Freedom of Information and Protection of Privacy Act We value your continued support of our efforts to improve the health status of children If you should have any questions please do not hesitate to call your local public health office We may be reached at XXX XXX XXXX Sincerely Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 39 of 70 Health Authority Letterhead TEMPLATE LETTER LICENSED CHILDCARE FACILITY Insert Date 2010 Insert Name Facility Operator Insert Name Licensed Childcare Facility Dear This year public health staff will be offering vision screening in licensed childcare facilities for children born in year XXXX Vision screening is a simple check to see if a child may have a vision problem Screening does not tell us if a child has a problem but tells us which children need further testing by an eye doctor Vision is very important to a child s learning Some vision problems like lazy eye amblyopia or crossed eyes strabismus can be treated more effectively when children are young Vision screening is quick and can be done even before a child learns to read No special space is needed but a quiet area
69. ow the screening device will be used gt The preschool age child should be instructed individually gt Kindergarten age children can be instructed in small groups of 3 to 5 children GUIDELINES FOR SMALL KINDERGARTEN COHORTS Health Authorities may elect to offer kindergarten vision screening at the health unit or other locations if the Health Authority deems that the number of kindergarten children enrolled does not warrant an onsite screening Suggested Action 1 A letter will be sent to parents guardians offering kindergarten screening at the health unit or an alternate site where screening will be performed by public health or designated personnel 2 Parents guardians will be contacted phone or mail if children do not present at the offered screening Advise that screening is recommended if parents guardians decline service Record refusal as an exemption due to parent guardian refusal GUIDELINES FOR MISSED OR ABSENT KINDERGARTEN CHILDREN Health Authorities will offer screening to children who missed or were absent on day of vision screening Suggested Action 1 Notification to parents guardians offering kindergarten screening at the health unit or an alternate site OR 2 The Health Authority may return to site to offer screening GUIDELINES FOR CHILDREN UNWILLING OR UNABLE TO BE TESTED AFTER SCREENING ATTEMPTED Let the child observe multiple screenings let them handle some of the tools occluder or stereopsis boo
70. preschool and kindergarten are not a mandatory programs families may decline service or may not complete follow up recommendations The kindergarten screening program is a temporary program until preschool age vision screening 1s realized Screening is NOT a diagnostic procedure and does not determine that correction of a possible defect or need for glasses is indicated The diagnostic aspects and recommendations are made only by an eye doctor Parents guardians should be instructed to seek professional evaluation whenever they have any doubt about their child s vision regardless of how recently the child may have been screened for vision with normal results VI VISION SCREENING TOOLS GENERAL GUIDELINES The following screening tools have been selected for vision screening of preschool age and kindergarten age children gt The Welch Allyn SureSight Vision Screener in combination with the Randot Preschool Stereotest or gt The H O T V vision chart in combination with the Randot Preschool Stereotest Visual Acuity Screening for Preschool Age and Kindergarten Age Children Visual acuity refers to the sharpness of one s eyesight It is the ability of the eye to distinguish the detail of an object Visual acuity can be tested using Vision Charts or other screening devices Screening of children 3 years of age Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 7 of 70 Welch Allyn Vision Screener to Test
71. r out of one of both eyes at 12 months of age should have a complete examination by an eye doctor During the toddler years vision skills continue to increase as the child develops eye hand body coordination fine motor skills and the visual motor skills necessary to learn to read A child s vision continues to develop until they are about 8 years old After that eyesight development is complete and can t be easily changed Binocular Vision In BINOCULAR VISION both eyes automatically adjust so that the image being viewed falls on corresponding parts of each retina The two images are fused and perceived as a single image by the brain fusion When the two images do not fall on corresponding parts of the retina 1 e one eye deviates double images result The brain will not tolerate double vision and usually will turn the unwanted image off suppression Before a child has adequate binocular vision the child learns to use several fine muscle processes which must be correlated with each other The child learns to adjust the size of the lens in the eye so that light can be focused on the macular area in the retina accommodation While the child is looking at pictures books and other small objects the very young child is practicing the focusing of light rays Stimulation of the macular area is of utmost importance since all acute or detailed vision originates in this area This learned process may be adequately mastered by the time a ch
72. racting windows or patterns on Conditions the wall Light Boxes Use a LIGHT BOX with the vision chart Light boxes should be placed so that a The child is not facing a window or other light source while reading the chart b The greatest amount of light comes from the light box and c The light box is at eye level with the child Extension cord 1f the electrical outlet restricts optimal placement of the light box H O T V Visual Acuity Screening The H O T V is a screening procedure particularly suited for determining visual acuity for gt Children 3 to 5 years of age gt Children not able to read the English alphabet gt Older children with special needs The child is not asked what the letters are but is taught to match the shape of the object nets eenn Gis HOTV Response SE AA Card and Flash Cards Equipment Required for H O T V Visual Acuity Screening Chair Extension cord Light box VVVVVVVVV WV 9 by 14 H O T V card for 10 FEET 4 object response H O T V lap card Four separate training H O T V flash cards Occluder glasses or eye cover paddle Pointer e g pencil or pen 10 foot measuring tape Masking tape or string to measure 10 feet Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 56 of 70 General Preparation for Visual Acuity Screening Using a Vision Chart 1 Check the chart s screening distance indicated at the
73. reschool Stereotest 1 Prepare the child by saying this is a game and you would like the child to look through a pair of magic glasses and match the pictures 2 Have the child put on a pair of stereoglasses Children wearing glasses should wear their eyeglasses during testing with the stereoglasses worn over their own glasses 3 Hold the book directly in front of you about 13 inches from the child s eyes under good lighting b Procedure for Randot Preschool Stereotesting 1 Hold Stereotest Booklet 3 in front of the child Confirm that the child can identify each of the test shapes on the left page of the booklet by either pointing to the shapes or naming each shape seen while pointing to the test target If the child responds correctly to at least two of the three test shapes at the 800 seconds of arc level top panel of test 3 testing proceeds to the 400 seconds of arc level bottom panel of Test 3 Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 17 of 70 If the child has difficulty the book may be moved around to catch the light better Turning the book upside down makes the pictures sink into the page and is also sometimes helpful a If the child has correctly identified at least 2 of the 3 test objects in each panel on Stereotest Booklet 3 move on to Stereotest Booklet 1 Hold Stereotest Booklet 1 in front of the child Confirm that the child can identify each of the test shapes on the left
74. rizontally across the page while maintaining the other muscle controls Any abnormality in the associated movement of the two eyes so that they cannot complete their action simultaneously indicates some type of underlying difficulty Common causes of muscle balance problems include congenital muscle abnormalities muscles too long or too short nerve paralysis and refractive errors Other common causes include problems with accommodation This is when the eyes Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 35 of 70 have a tendency to converge or diverge too much or not enough relative to the object they are looking at This can cause significant eyestrain headaches and can also at times cause intermittent constant double vision Types of Muscle Balance Problems Phoria The tendency of an eye to turn from the normal position Types of Phoria are EXOPHORIA Tendency for one or both eyes to deviate outward ESOPHORIA Tendency for one or both eyes to deviate inward toward the nose HYPERPHORIA Tendency for one eye to deviate upward HYPOPHORIA Tendency for one eye to deviate downward Treatment Variable may include eye glasses orthoptic treatments eye exercises medication and or surgery Tropia strabismus squint The turning away of an eye from the normal alignment while looking at a specific object Fusion is either abnormal or lacking Because the brain cannot tolerate a double imag
75. se at Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 45 of 70 TEMPLATE LETTER MISSED SCREENING Health Authority Letterhead Date Dear Parent Guardian of The insert health authority provides routine vision screening as part of the school health program in the kindergarten year Your child was away from school today when vision screening was done We want to find and help children who have possible vision problems which can affect their learning We believe this is important and ask that you call the health unit to make an appointment to have your child s vision screened Insert HA contact information here Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 46 of 70 TEMPLATE LETTER FAX SCREENING REMINDER TO TEACHERS Date Dear Kindergarten Teacher and Principal This fax is a reminder that on the students in your Kindergarten class es are scheduled for their vision screening A private area in the classroom is required for this screening If you have any questions regarding these screenings please call Vision Screener at phone number We thank you in advance for your support in these Public Health Programs Sincerely Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 47 of 70 Health Authority Logo VISION SCREENING REFERRAL AND FOLLOW UP Child s Last Name First Name Birth Date y m d Client ID PHN Gender M
76. ses vision therapy orthoptics low vision aids and referral for consultation to the appropriate medical practitioner for treatment of ocular or systemic disease or eye surgery OPTICIAN An optician is a technician who grinds fits and dispenses corrective lenses on the written prescription of an ophthalmologist or optometrist ORTHOPTIST An orthoptist is a medically supervised practitioner who evaluates binocular vision problems and treats such problems with occlusion exercises or prisms Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 62 of 70 GLOSSARY Cont d B General Glossary ACCOMMODATION The adjustment of the eye for seeing at different distances accomplished by changing the shape of the crystalline lens through action of the ciliary muscle thus focusing a clear image on the retina AMBLYOPIA Reduced visual acuity not correctable by refractive means and not attributable to obvious structural or pathological ocular anomalies AMETROPIA Imperfection in the refractive powers of the eye so that images are not brought to a proper focus on the retina includes hyperopia myopia and astigmatism ANISOMETROPIA A condition in which there is a different type of refractive error between the two eyes 1 e one eye is hyperopic while the other eye is myopic ANTERIOR CHAMBER Space in the anterior portion of the eye bounded in front by the cornea and behind by the iris filled with aqueous h
77. sual Colour v Action v Outcome UNDER CONTINUING CARE v Referral Source v ED 8 Follow up results will display in Vision Services History block Vision Services History Date Branch7 HA Provider Type A R A L YS Gls YC Action Dutcome 2008 05 30 KELOWNA OKANAGAN SIMILKAMEEN OTHER PROVIDER D ucc 2008 05 14 KELOWNA OKANAGAN SIMILKAMEEN TRAINS OKS u PHC AWR 2008 05 01 KELOWNA OKANAGAN SIMILKAMEEN TRAIN9 OKS s E P P F REF AWR Recording Exemptions to Vision Screening Vision Screening Services declined 1 Search For and Select Client Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 54 of 70 RefSrc Navigate to PHS Module Client Summary Screen Navigate to Exemption tab and click on New Exemption Select Service type Vision Effective From is date services declined Enter comment Screening declined by relationship Full Name and SAVE NMP un Exemptions Client VISION VELMA Service VISION y Effective Frorn 2008 02 11 B Effective To 8 Screening declined by mother Verna Vision Comments Unique Situations The following recording processes are to be used for charting outcome information e For families who decline screening or referral associated to screening because the child is under current treatment or ongoing follow up with an eye doctor o Create New Service PHS Summary Screen o Navigate to Vision
78. tandard window cleaner or soapy water Handling Store in warm dry place Keep in carry case when not in use Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 16 of 70 VIII VISION SCREENING TOOLS AND PROCEDURES Cont d Stereopsis Vision Screening Procedure using the Randot Preschool Stereotest The Randot Preschool Stereotest is a screening procedure particularly suited for determining stereopsis for gt Children as young as 2 years of age gt Children who are non verbal Randot Preschool Stereotest with 3 test panels and stereoglasses In each test booklet the left hand page shows two dimensional black and white silhouettes of two sets panels of four test shapes The right hand page contains two sets of four random dot patterns in different sequences that are on the left hand page In each set of random dot patterns one contains no test shape while the remaining contains test shapes While wearing Stereoglasses the child must correctly identify at least two of the three test shapes at each disparity level Equipment Required for Randot Preschool Stereotesting gt Randot Preschool Stereotest 3 booklets gt Stereoglasses NOTE an extra set of glasses may be needed for unusual circumstances gt Matching game Optional Health Authority to determine if required gt Randot Preschool Stereotest Copy of Answer Key see appendices a Preparation for screening using the Randot P
79. tection of Privacy Act We value your continued support of our efforts to improve the health status of children If you should have any questions please do not hesitate to call your local public health office We may be reached at Sincerely Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 40 of 70 Health Authority Letterhead TEMPLATE LETTER PRINCIPAL insert date 2010 insert Name Principal Insert Name School Dear This school year public health staff will be offering the following in school health services for children in support of learning These include gt Vision screening for all children in kindergarten to identify those with possible vision concerns and to evaluate our efforts in the prevention of visual disorders that could affect learning gt Dental health survey dental visual check for all children in kindergarten to identify those with dental concerns and to evaluate our efforts in the prevention of early childhood tooth decay gt Other HA services e g Kindergarten Hearing screening Immunizations etc Schools are asked to assist public health staff by providing a copy of the class list with the children s names parent s names child s birth date telephone number and address and indicate whether a child is of aboriginal ancestry Section 79 of the School Act permits persons providing health services access to information in the student record required to carry out that
80. ted resources for distribution gt BC Health file 53A Young Children and Their Eyes BC Health file 53B Elementary School Age Children and Their Eyes BC Health file 26 Sun Smart Your Kids Healthy Kids Program pamphlet Babies Best Chance VV VV Y Toddlers First Steps Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 30 of 70 Vision and Developmental Milestones in Infancy and Early Childhood Age Developmental Questions for Case Finding Suggested Activities for Milestone Parents Guardians Care Providers Newborn Focus on objects 8 12 When you hold your baby Move baby s arms or legs inches does your infant focus on simultaneously to fostering your face appropriate bilateral and Regards faces or binocular development objects of interest for a Does your infant follow an Keep reach and touch toys few seconds object with his or her eyes by within your baby s focus about 5 weeks eight to twelve inches 8 12 weeks Follows moving objects Does your infant Talk to your baby as you walk with eyes tracking Track objects toys with around the room his her eyes Hang a mobile above and Bring his or her hands uence together by 12 weeks Hold and sustain direct eye contact with you by 3 months 4 5 months Coordinated eye Does your infant move eyes Let your baby explore different movements together smoothly to look at shapes and textures with his or a objects her f
81. the child a chance to get used to examiner During Test Stereopsis Checklist Yes No 1 The tester put the stereoglasses on the child before showing the child the stereo booklets 2 The book was held gt Ateye level or slightly below eye level gt 13 in front of child and gt There was adequate light on book 3 The child was given enough time to respond to questions 4 The screener showed the stereopsis booklets in the correct order dependent on the child s response E g The screener began with test booklet 3 and proceeded to booklet 1 if the child successfully responded to both test panels 5 The screener began with the first test panel on the booklet prior to showing the second test panel 6 The child responded correctly to at least 2 of the 3 test shapes on each panel before the screener proceeding with the next test panel Or the screener followed the modified process for 3 year olds page 21 Post Test Stereopsis Checklist Yes No 1 The test performance was interpreted correctly 2 The stereopsis result was recorded correctly 3 A referral was made and a Vision Screening Referral and Follow up card was correctly completed Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 28 of 70 XIII CASE FINDING FOR VISION CONCERNS Case finding is a process where information is provided to parents guardians or childcare practitioners to raise awar
82. u do not contact us we will screen your child s vision and share the screening results If you choose not to participate this will not affect your child s eligibility for other services or quality of care provided If your child has been seen by an eye doctor in the last 6 months please let public health staff know as we may not need to screen your child Information about your child s vision screening will be recorded in your child s health record at the Health Unit The information collected is to support your child s referral and follow up and to monitor the vision screening program by insert health authority and at a provincial level We make sure that this information stays private We collect use and share this information only as allowed by law the British Columbia Freedom of Information and Protection of Privacy Act If you have any questions please contact us Sincerely Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 44 of 70 TEMPLATE LETTER PASSED SCREENING Health Authority Letterhead Date Dear Parent Guardian Good vision is important for learning Your child passed vision screening done at school today This is part of the school health program Screening is not a diagnostic procedure This screening does not replace regular check ups with your eye doctor If you have questions about the screening or concerns about your child s vision please contact the Public Health Nur
83. ugust 10 2010 HC docm Page 33 of 70 ANATOMY OF THE EYE AND THE VISION PROCESS Cont d How We See Light rays reflected from an object enter the eye and pass through the lens The lens projects an inverted image of the object onto the retina at the back of the eye Signals produced in the rod and cone cells in the retina pass through the optical nerve where they are sent to the brain to be interpreted Suspenso Ligament Object Object Position LIGHT RAYS CORNEA gt PUPIL gt LENS gt RETINA OPTIC NERVE gt VISUAL PATHWAY to the visual cortex of the brain left eye left optic nerve optic chiasm left optic tract left lateral geniculate nucleus left visual cortex Visual Pathway Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 34 of 70 BASIC ANATOMY OF THE EYE Cont d How Seeing Develops Vision is learned in the early years Babies are born able to see but their vision in not precise or sharp During the first few months babies learn to focus track see colors learn depth perception and eye hand coordination By six months of age infants should be using both eyes together binocular vision By about 12 month children have adult like vision They have more accurate eye movements and can follow moving objects with their eyes Any child with an observable abnormal turning in up o
84. uity in one eye at a time True or False False These techniques allow a child to easily peek especially if they have poor vision in the eye being tested The chosen method of occlusion must ensure that the child is not able to peek If a child is having a difficult time with the screening test have him or her return again for a repeat screening in 6 to 12 months as long as there are no signs of a vision problem True or false False It is important to detect and treat vision problems in children when they are young in order to prevent permanent visual loss Children who fail a vision screening need a timely referral to an ophthalmologist or optometrist If a child passes the visual acuity test in each eye tested separately he or she has passed the vision screening True or false False The vision screening protocol includes a test of stereopsis in addition to the visual acuity test A child must pass both the visual acuity refraction screening and the stereopsis screening to pass A child who fails either or both must be referred for a comprehensive eye examination by an ophthalmologist or optometrist If using a wall chart to test visual acuity 1t should be placed the standard 20 foot distance from the child True or false False Visual acuity testing in preschoolers is done at a distance of 10 feet When using a wall chart confirm the correct testing distance as indicated at the top of the chart Always have a child put o
85. umor AQUEOUS HUMOR A water like fluid which is manufactured by the ciliary body and which fills the anterior and posterior chambers of the eye located in front of the lens ASTIGMATISM A defect of curvature of the cornea or lens of the eye as a result of which a ray of light is not sharply focused BINOCULAR Using both eyes simultaneously BINOCULAR VISION The ability to use the two eyes simultaneously to focus on the same object and to fuse the two images into a single image BLINDNESS In Canada the legal definition of blindness is central visual acuity of 10 100 or less in the better eye after correction or visual acuity of more than 10 100 if there is a field defect in which the widest diameter of the visual field subtends an angle no greater than 20 degrees BLIND SPOT Physiological An area which has no nerve receptors located at the back of the eye where the optic nerve enters the eye to supply nerve fibers and blood vessels to the retina The blind spot in one eye does not correspond to the other so that the vision of one eye fills in the blind spot of the other and vice versa CANTHUS The angle at either end of the slit between the eyelids specified as outer or temporal and inner or nasal CHOROID The dark brown vascular coat of the eye between the sclera and the retina whose function it is to nourish the retina and lens and to absorb light rays not absorbed by the retina CILIARY BODY Portion of the
86. vascular coat between the iris and the choroid It consists of ciliary processes and the ciliary muscle This organ changes the convexity of the lens when a change of accommodation is required COCHLEA The sense organ that translates sound into nerve impulses to be sent to the brain COCHLEAR IMPLANTS A device that can be surgically implanted into a person s cochlea to stimulate it to cause hearing Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 63 of 70 CONCAVE LENS Lens having the power to diverge parallel rays of light also known as diverging reducing negative myopic or minus lens denoted by the sign CONES One of the two types of light sensitive nerve endings that are scattered over the surface of the retina making it possible to transmit visual impulses to the brain Cones perceive fine detail and colour and are more numerous at the macula CONGENITAL Present at birth CONJUNCTIVA Mucous membrane which lines the eyelids and covers the front part of the eyeball CONTACT LENSES A thin curved shell of plastic designed to float on tears above the cornea in order to correct refractive errors CONVERGENCE The process of directing the visual axes of the two eyes to a near point with the result that the pupils of the two eyes are closer together The eyes are turned inward CONVEX LENS Lens having power to converge parallel rays of light and to bring them to a focus also known as c
87. ver Pictures are arranged in order of decreasing disparity so that the appreciation of stereopsis becomes increasingly more difficult and can be graded While wearing special stereopsis glasses the child is asked to match pictures on the left side of a stereotest booklet with those on the right side of a stereotest booklet Each stereotest booklet measures different levels of stereopsis gt Stereotest Booklet 1 measures stereopsis at 200 and 100 seconds of arc gt Stereotest Booklet 2 measures stereopsis at 60 and 40 seconds of arc omit do not use gt Stereotest Booklet 3 measures stereopsis at 800 and 400 seconds of arc Provincial Vision Screening Training Manual_August 10 2010 HC docm Page 8 of 70 Vision Charts to Test Acuity Vision charts are composed of letters or symbols The size of all letters in a row on an eye chart 1s the same The size of all the letters in a row 1s smaller than the row above Beside each row is a fraction When screening for visual acuity the person is asked to look at chart symbols of varying sizes from a distance of 10 or 20 feet Correctly identifying the 10 sized symbol at 10 feet is considered normal vision This can be abbreviated by writing the visual acuity similar to a fraction The top number corresponds to the distance in feet separating the individual from the symbols The bottom number denotes the size of the symbol The visual acuity of the normal seeing i
88. vices e g Kindergarten Hearing screening health teaching etc The individual school principals will be contacted by public health staff to arrange a suitable date and schedules and parent notices will be sent to the teachers prior to the visit It takes from October until May to schedule all the schools in the school districts so some schools may not hear from us for a while Each kindergarten child will receive a notice to inform the parent that their child was screened and to provide some helpful hints on keeping their child s teeth and eyes healthy Parents of children requiring follow up will be contacted by public health staff The Ministry of Education and Ministry of Healthy Living and Sport endorse an integrated strategy to address vision and dental concerns in the early childhood years Specifically they support the provision of vision and dental screening for children in kindergarten in order to identify children whose health and learning may be affected by undetected or untreated conditions Schools are asked to assist public health staff by providing a copy of the class list with the children s names parent s names child s birth date telephone number and address and indicate whether a child is of aboriginal ancestry Section 79 of the School Act permits persons providing health services access to information in the student record required to carry out that service We are requesting aboriginal ancestry information in supp
89. vincial Vision Screening Training Manual_August 10 2010 HC docm Page 18 of 70 The following chart gives the corresponding degree of stereopsis to the responses Randot Preschool Stereotest Stereopsis Results The following chart gives the corresponding degree of stereopsis to the responses Stereotest booklet Test Panel Position Disparity seconds of arc Stereotest booklet 1 Top Panel 200 Stereotest booklet 1 Bottom Panel 100 Stereotest booklet 2 Top Panel 60 omit do not use Stereotest booklet 2 Bottom Panel 40 omit do not use Stereotest booklet 3 Top Panel 800 Stereotest booklet 3 Bottom Panel 400 Please note The Provincial Training Manual s Stereotest instructions are different from the instruction on the Stereotest product package Screeners are to follow the Provincial Training Manual process The intent of beginning with Stereotest booklet 3 is to provide a practice session for the child Care and Cleaning Instructions for the Randot Preschool Stereotest and Glasses Use a regular eye glass cleaning cloth dry or dampened with water glass cleaner to clean the Randot booklet and glasses Plain soap and water may be used to clean glasses in exceptional circumstances e g contact with purulent discharge Alcohol wipes or any other chemical cleaner should NOT be used as it would compromise the vectographic and polarizing materials Provincial Vision Screening Training Manual_August 10 2010 HC

Download Pdf Manuals

Related Search

Related Contents

Product User Manual - H-SAF  Body Composition Monitor  Canon FY8-23AV-000 Photo Scanner User Manual  electrical impedance computer mammograph meik ® 5.6    Samsung SGH-F500 Керівництво користувача    Android Benutzerhandbuch  Neb-u-Tyke RR Manual.qxp  Galopin n°22 - Entre-Sambre-et  

Copyright © All rights reserved. Failed to retrieve file