CCSS Guidelines for Individual Student Vision Screening

Purpose: To test acuityof vision at a distance; to detect possible myopia, hyperopia,

amblyopia, astigmatism, or other anomalies

Equipment needed:

Snellen Chart,or Tumbling “E” chart,or Primary Lea chart, (charts may either

be 10ft. or 20ft.)

Paper cup or large spoon

Masking tape

Pen

SST vision screening form, if applicable, with Dept. of Ed. Parental permission to

test signed form (SST manual, page 31)

Hyperopia glasses: grades pre-K through 3 use +2.25 lens

Grades 4 and above use +1.75 lens

Procedures and Passing Criteria and Failure Procedures:

  1. Explain the procedure to the child according to the functional level of understanding. With that level in mind, decide which test should be used for that child. Allow the student to practice the procedure at a distance close enough to see the test chart without difficulty. Be sure the room has adequate lighting; the student and the chart should be away from the sunlight glare. Instruct the student who wears glasses to keep glasses on, unless the student states sight is better without the glasses or if the glasses are for reading purposes only.
  2. Measure from the chart 10ft. or 20ft. accordingly; place a piece of tape on the floor to mark the spot where the child should place their heels. Place the chart on the wall at the average eye level of the students.
  3. Ask the student to stand at the tape and cover his/her left eye with the spoon or cup. Assistance may be necessary to accomplish proper vision occlusion. Reverse the procedure when testing the left eye.
  4. Instruct the student to keep both eyes open during the procedure and begin to read where you are pointing (pointing should be done below the letter or symbol).
  5. Start at the top of the chart and progress downward. Allow the child a maximum of 5 seconds per letter or symbol.
  6. Note the last line that is read correctly (correctly means that the majority of the letters on the line were read correctly). The last line read correctly is the outcome for that eye.
  7. Repeat the procedure for the left eye. Allow a brief period of pupil adjustment (about 10 seconds should be adequate.)
  8. Repeat the procedure for both eyes, again allowing for pupil adjustment.
  9. 20/20 or 20/30 is passing; anything less than that is considered failing.If the student has a passing result in one eye, but fails the other eye, or with both eyes, the student is still considered failing. To be considered passing, the student must have 20/20 or 20/30 in both eyes together and individually. (The exception to this rule is for pre-K and Kindergarten; 20/40 is acceptable as long as there is not more than one line of difference between the two eyes.)
  10. Do not allow the student to squint or to uncover the covered eye. If the student is obviously struggling to see the chart, progress upward again until the student is comfortable.
  11. If the student passes in both eyes and individually (without corrective glasses on), test for hyperopia using the appropriate lens.
  12. Use the same procedure as above except have the student put on the hyperopia lens prior to covering the left eye. Repeat the procedure for the left eye and both eyes.
  13. If the student can read the 20/30 or the 20/20 line with either eye or both eyes WITH the hyperopia lens on, there may be hyperopia; the student would then be considered failing. (the hyperopia lens should make the chart unreadable)
  14. If the student fails the test, tell the student that his/her eyes did not do as well as expected. You will have the school nurse recheck them at a later date

using a different type of vision test. (Younger children may be told that they are playing a vision game rather than a test).

  1. Document results on the appropriate form. If the student failed the test, give the school nurse the SST vision screening form and a copy of the parent signed permission form. Be sure the student’s name, date of initial screening,and grade is on the referral.
  2. The school nurse will recheck the student within two weeks using a Titmus vision screener. The nurse will test for: visual acuity, amblyopia, muscle balance, accommodation, and an assessment for strabismus and pterygium, etc.
  3. If the student fails the SECOND vision test, a physician’s referral form will be completed and a letter to the parents will be sent with the physician’s referral.

Referral Criteria:

-each eye must see at least the 20/30 line (20/40 for pre-K and K)

-more than one line of difference between the two eyes must be referred

-if student is unable to comprehend instructions

-when using the hyperopia lens, the student is able to read the 20/30 or the 20/20 line with either eye.

Abbreviations:

O.D. = Ocular Dexter = Right Eye

O.S. = Ocular Sinister = Left Eye

O.U. = Ocular Unitas = Both Eyes

References:

Vision Screening Guidelines for School Nurses, NASN, Inc., 1995, pg. 6-9

To See or Not To See, NASN, 2005, pg 97, pg 116

Clinical Guidelines for School Nurses, School Health Alert, 5th edition, 2002, pg. 215-219

School Health Resource Manual, Children’s Healthcare of Atlanta, 2002, pg.9.1-9.6

SST Manual, Georgia Department of Education, 2001.

Updated 1/20/2015