going green this educational offering is joining others in an effort to save our environment by...

Going Green

This educational offering is joining others in an effort to save our environment by making the

handouts available on our website

www.arkansascsh.org.

To show respect for our speakers and participants,

PLEASE place your cell phone on silent or vibrate.

Should you need to answer a call, PLEASE go outside to

hold your phone conversation.

Respect the speakers and other participants around you

by refraining from side bar conversations during the

session.

If it is that important, please step outside!!!!

The planning committee & faculty attest that NO relevant

financial, professional or personal conflict of interest

exists, nor was sponsorship of commercial support obtained,

in the preparation or presentation of this educational

activity.

VISION SCREENING

CERTIFICATION

• One in 20 preschoolers has a vision problem.

• One in 5-10 school-aged children has a vision problem.

• Impaired vision can seriously impede learning.

• Early identification and treatment can prevent or at least alleviate many vision problems.

Importance of Vision Screening

Purpose of Vision Screening

• To screen a large number of children in a short amount of time.

• To separate those children likely to have vision problems from those not likely to.

• To refer those children who do not pass the screening or who are suspect for vision problems.

Landmarks of Visual Development

• 4-12 wks– Binocular fixation

• 12-20 wks– 20/200

• 44 wks-12 mo– 20/50 - 20/100– Full binocular

vision– Amblyopia may

develop

• 6 -18 mo– Convergence

developed

• 18 mo-2 yrs– Accommodation

developed– 20/40

• 2-3 yrs– 20/30

• 5 yrs– Min. potential for

amblyopia

• 6 yrs– Approaches 20/20

Parts of the Eye

Common Ocular Abnormalities

Black Eye

Conjunctivitis

Blepharitis

Chalazion

Stye

Entropion

Of upper eyelid due to scarring

Of lower eyelid

Dacryocystitis

Ptosis

Coloboma

Coloboma

Cataract

Strabismus Types

• Tropia– Eyes which are always

improperly aligned

• Phoria– Eyes which have a tendency to

misalign when fusion is interrupted

Esotropia

Bilateral Esotropia

Exotropia

Hypertropia

Pseudostrabismus(also Pseudotropia or

pseudoesotropia)

Refractive Errors

• Myopia (Nearsightedness)• Hyperopia

(Farsightedness)• Astigmatism

Astigmatism

Amblyopia: Definition

• Vision that cannot be corrected to better than 20/40.

• Unilateral or bilateral• Brain suppresses poor image• Normal appearance• Reversible if detected and

treated early

Amblyopia

Predisposing Factors

• Poor clarity– Cataract

• Poor focus– Nearsightednes

s– Farsightedness

• Poor aim– Strabismus

Treatment– Clearing the

media– Cataract removal

• Focusing the image– Corrective lenses

• Correcting aim– Occlusion therapy– Drops

Amblyopia Therapy

Usher’s Syndrome

• Hearing Loss and Retinitis Pigmentosa

• Screen children with hearing loss

VisionScreening

Screening Procedure

Observation

• Appearance

• Behavior

• Complaints

Appearance

•Whites•Iris•Pupil•Lids•Lashes•Immediate

referral if abnormal

Behavior

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

Complaints

• Headaches• Nausea• Dizziness• Burning or itching• Blurring

Visual Acuity-Far

• Screen one eye at a time.– If a child wears glasses, perform the

screening with the child wearing the glasses.

• Screen at 20 feet – Snellen Chart – Literate children

• Screen at 10 feet – Age Appropriate Chart– Allen Chart/Tumbling E’s– Pre-literate children/non-English speaking

• Any eye with vision poorer than 20/40 is a screen failure.

Plus 2 (+2.00) Visual Acuity

• Test for farsightedness.• Perform exactly as the distance

visual acuity except;• Hold a +2.00 lens in front of

the tested eye (fellow eye covered).

• Any eye that improves 2 lines of vision with the +2.00 lens is a screen failure.

Instrument Screenings

• Titmus• Optec• Keystone

Lateral & Vertical Muscle Balance-Far (Titmus &

Optec)• Right eye on; left eye off.• Give instructions:

– “Here is a box. I will throw a red ball. Tell me where the ball lands.”

• Turn left eye on.• Need immediate answer.

– If not, repeat test.– To pass the child should report the ball

landing ‘in the box’ or ‘on the line’.

A B

Titmus 2

Titmus OV7 & Optec

Right Eye

Right Eye

Left Eye

Left Eye

Lateral & Vertical Muscle Balance-Far

Titmus & Optec

Lateral Muscle Balance-NearTitmus

• At completion of Muscle Balance Far screening switch lever to ‘near’ setting.

• Procedure is the same now as the Lateral Muscle Balance Far screening.

Lateral Muscle Balance-nearTitmus & Optec

A B

Titmus 2

Titmus OV7 and Stereo Optec

Right Eye

Right Eye

Left Eye

Left Eye

Lateral Muscle Balance –NearOptec

Lateral Muscle Balance-FarTitmus & Optec

Vertical muscle balance-farTitmus & Optec

Lateral Muscle Balance-FarKeystone

• Right eye on; left eye on.• Place slide ‘Lateral Phoria – use at far

point’.• Give instructions

– “Here is a row of numbers, 1 to 15, and an arrow/pointer. What numbers) does the arrow point most closely to?”

• Need immediate answer– If not, repeat test.– To pass the child should report the arrow

pointing to a number(s) between 8 and 11. Any other answer is a screen failure.

Lateral Muscle Balance-FarKeystone

– 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 -

fail

pass

fail

Vertical Muscle Balance-Far

• Performed at ‘far’.• Keystone

– Right eye sees a column of figures with a central circle and 2 figures above and below.

– Left eye sees a horizontal line.– To pass the child should see the

line passing through the circle or just above or below the circle.

Vertical Muscle Balance

Keystone

Pass

Lateral Muscle Balance-NearKeystone

• Use slide labeled ‘Lateral phoria – use at near point’ (place at the near point).

• Again a row of numbers (2 -10) and an arrow are present.

• A response of the arrow pointing between 4.5 and 6.5 is a screen pass – outside this is a screen failure.

– 2 3 4 5 6 7 8 9 10 -

fail

pass

fail

Lateral Muscle Balance-Near Keystone

Binocularity(fusion) at far Optec/Titmus

• Can use whichever of three slides you have—only need to use one.

• Pass criteria depends on the slide.

• Test in far position.• Test with both eyes ‘on’.

Titmus OV7, Stereo Optec 2000

Binocular Vision-Far

Titmus OV7, Stereo Optec 2000

E E E

Both eyes open – screen pass

Binocular Vision-Far

Titmus 2 (Optional)

A correct response with this screen is for the child to see all 4 boxes/objects when both eyes are ‘on’.

Binocular Vision - Far

Binocular

Keystone

A correct response with this screen is for the child to see 3 circles with both eyes. The circles should be in a vertical line or only minimally separated (if minimally separated it is acceptable to see 4 circles).

red

whitewhite

blue

Right eye Left eye

Binocular Vision - Far

Keystone

A correct response with this screen is for the child to see 3 circles with both eyes. The circles should be in a vertical line or only minimally separated (if minimally separated it is acceptable to see 4 circles).

red

whitewhite

blue

red

blueblue

red

white

pass pass pass

Binocular Vision - Far

Keystone

Four circles widely separated is a screen failure.

fail

Binocular Vision - Far

Binocularity(fusion) at Near

• This screen is performed as was fusion at far except the instrument is switched to the ‘near’ setting. Or the ‘near’ slide is place in the instrument.

Color

• Performed with both eyes open.

• Use a standard instrument slide or a standard hand held red/green color testing card.

• To pass the student should be able to read/recognize the numbers presented.

Color

Re-screening

Why Rescreen?

• Cuts down on over-referral.• Adds validity and parent

confidence• Improves follow-up.• Saves time by decreasing

amount of follow-up needed.

Referral

• Immediate referral if do not pass:– Observation (Appearance)

• Re-screen in four to six weeks if do not pass:– Visual Acuity– +2.00 test– Instrument screenings

• Refer if do not pass any part of re-screen

• Color vision deficit does not require a referral.

Tips

• Observation with glasses on and off.

• Glasses on for machine screening.

• Keep child’s head in place on machine—no peeking with “good” eye!

• Adjust machine to child’s height.

Data Entry

Data Entry

• Vision screening data is entered into APSCN

• Data queries will be pulled on Nov. 15 and April 15.

• Training for APSCN will be provided at your Ed. Cooperative.

Data Entry

• No forms needed except for screening form

• Parent Notification/Doctor Report Form will be generated through APSCN

Screening FormGrade 1, room A

Obs Va +2 LMBf LMBn

VMB Ff Fn C P/F ?

Stu.A

p p P p p p p p p P

Stu.B p p F p p p p p p R

escreen

Stu.C P p P p p p p p f PStu.D F p P p p p p p p R

efer

School District Mailing Address City, State, Zip

Phone Fax

Administrator School Nurse

Student’s Screening Referral Parent/ Guardian Mailing Address Name Date Date(s) Name

Paula Smith, State School Nurse ConsultantArkansas Department of Education, Office of Coordinated School Health2020 West 3rd St., Suite 320Little Rock, AR.72205

RESOURCES

• www.brandonburlsworthfoundation.org

Examinations and Eye glasses

• vicki@arkansasoptometric.org 501-661-7675 411 S. Victory, Suite 206, Little

Rock, AR 72201To borrow Titmus vision screeners

Vision Machine Repair

• BSI--Jack Stone --in Little Rock (501) 416-1232• 2M Eye Instruments-- Mike

Shivley-- in West Memphis (870) 735-0604