Spot Vision Screening Event a Team Effort to Improve Kids' Sight

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On Saturday July 28th, 2012, the Chicago Bears supported by Catholic Charities – Diocese of Joliet, Team Smile and Dr. Pepper Snapple Group hosted over 1,000 deserving students from Kankakee County at the annual Bears CareBack to School Fair at Olivet Nazarene University, Bourbonnais, IL. Students received a variety of free health services including free dental exams, school physicals, and vision screenings. Using the new and innovative technology of the Spot Vision Screener by PediaVision, School Health and PediaVision volunteers were able to screen over 300 students, quickly and accurately. Screening went so quickly, in fact, that what was planned to be an all day event ended hours early, and event planners had leftover food!

Spot's non-invasive design screened kids from about three-feet away, with a capture time of only one second. It delivered immediate, comprehensive and objective results in an easy-to-read touch-screen interface. Results were wirelessly transferred to a laptop computer, and the Pass or Refer report was printed out for referrals, records, and parent copies. Over 50 children were identified as requiring follow-up vision care, and were given gift certificates for an eye exam and 1 pair of complimentary glasses (generously provided by VSP and Transitions Optical). Kids were screened for seven major vision issues: Hyperopia: farsightedness Myopis: nearsightedness Astigmatism: blurred vision Anisometrohpia: unequal refractive power Gaze: eye alignment measurement Anisocoria: unequal pupil size

Since the Spot Vision Screener is objective, and requires no response from the student, it is ideal for screening young kids and special needs children, such as those with autism.

Good Vision is a Key Component to Academic Success

Vision screening is a critical part of health screenings for children. Eighty percent of a child’s early learning comes from vision and studies have consistently shown that vision and eye health have a direct impact on a child’s ability to learn (WAO, 2011).  About one in four school-aged children suffer from an undetected or untreated eye health or vision problem (AOA, 2011).  It is crucial children have their vision checked to ensure positive academic performance and growth.

Common signs that a child may have an undetected vision problem:

• Losing place while reading               
• Avoiding close work
• Rubbing eyes
• Headaches
• Turning or tilting head
• Making frequent reversals when reading or writing
• Using a finger to maintain place when reading
• Omitting or confusing small words when reading
• Consistently performing below potential
• Struggling to complete homework
• Behavioral problems
• Squinting while reading or watching television
• Holding reading material closer than normal

Closing the Gap

Every day, 12.5 million children go to school with an undetected or corrected vision issue. That's 25% of school-age children! Unfortunately, only 10% of those in need ever receive care. Schools are in a unique position to ensure vision screenings for a majority of American children. However, it can be inefficient and burdensome for schools to provide mass screenings using traditional methods such as vision charts. Also, vision charts may not be appropriate for very young children and those with special needs.

Using a tool such as the Spot Vision Screener can allow Schools (and even volunteer or non-profit organizations) to mass screen children, consistently and objectively, and in return, potentially reduce some of the academic and disciplinary issues that can result from poor vision. It utilizes Binocular screening, which means it screens both eyes simultaneously, thus only requiring a single screening for each child. The "cost per child" is low for this technology, only +/-$1.00 per student, and the procedure can be eligible for reimbursement using CPT code 99174.

If your school or organization could benefit from quick and objective vision screenings, contact us for a free consultation from one of our product experts! You will also be able to download a copy of the Palmetto Elementary Case Study.

3 New Must-Have Vision Screening Resources for Schools

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The American Association for Pediatric Ophthalmology and Strabismus (AAPOS), has partnered with the National Association of School Nurses (NASN) to develop resources to promote vision screening and to disseminate information about common eye diseases in children. A number of exciting new resources are now available as a result of this partnership including a tutorial DVD and an easy-to-use, portable vision screening kit for near and distance visual acuity. 

School Nurse Vision Screening Tutorial DVD

Kathy Lee, MD, PhD, a pediatric ophthalmologist practicing in Idaho, created a School Nurse Vision Screening tutorial DVD as a project for the American Academy of Ophthalmology’s Leadership Development Program.

The School Nurse Vision Screening Tutorial DVD covers the following topics:

• Rationale for effective school vision screening
• Information regarding refractive errors, amblyopia, and strabismus
• Elements of a successful screening program
• Pearls and pitfalls of traditional vision screening
• Examples of preferred and non-preferred charts
• Demonstration of the proper use of objective vision screening devices (i.e., photorefractors)
• Presentation of other elements of vision screening, including color, stereoacuity, and near vision
• Effective screening of children with disabilities

Watch Susan Proctor, RN, DNS (PhD), author of To See or Not To See in the video clip below!

To preview additional tutorials online, go to:

http://www.aapos.org/ahp/nurse_video_tutorials/

New Portable Vision Screening Kit for Schools

To support the video, AAPOS, Good-Lite, and School Health entered into a formal agreement to distribute the School Nurse Vision Screening Tutorial DVD within a new vision screening kit that includes eye charts for conducting near and distance visual acuity screening with children from preschool age through senior high.

The kit experienced incredible success at its debut at NASN 2011 in Washington, D.C. All 200 kits that were shipped to the booth were sold to nurses attending lectures given by AAPOS and vision screening expert P. Kay Nottingham Chaplin, Ed.D.  Additional nurses signed up to have a kit shipped to them after the conference. 

The kit includes a bag for lightweight, portable transportation and these items:

• School Nurse Vision Screening Tutorial DVD
• 4 double-sided distance charts* in one spiral-bound booklet
• 4 double-sided near charts* in a separate spiral-bound booklet
• Response panel and individual cards for matching
• Occluder glasses
• Directions

*Optotypes used in charts are LEA Symbols, LEA Numbers, HOTV, and Sloan Letters.

For more information on the kit, go to www.schoolhealth.com/visionkit

Download Vision Screening Presentations from NASN

You can download a free copy of Dr. Kathy Lee's Powerpoint presentation from the NASN 2010 conference, titled Efficient and Effective School Vision Screening.  It is available, along with many other resources mentioned above at this AAPOS landing page:

http://www.aapos.org/ahp/resources_for_school_nurses/

To those of you who received a kit during or after the NASN 2011 conference, please post a comment or e-mail our Vision Screening Expert, Dr. Kay at kay@good-lite.com with your thoughts about the DVD and eye charts.   

Ask the Expert: What is referral criteria for near vision screening?

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Ask the Expert with P. Kay Nottingham Chaplin, Ed.D.

Director – Vision and Eye Health Initiatives – School Health Corporation and The Good-Lite Company

Q: I screen students in middle school who range in age from 11 to 15. I am using a Sloan Letters Near Vision Card.  Is passing for this age group 20/20 or better?

A: The referral criteria for near point visual acuity charts is the same as distance charts.

Children 3-5 Years: Correctly identify 3 of 5 optoptypes on the 20/40 line.

Children 6 Years and Up: Correctly 3 of 5 optotypes on the 20/32 line.

This is according to a policy statement from the American Academy of Pediatrics, the American Association of Certified Orthoptists, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology.¹

Bonus Question

Q: This vision screening chart has "1" inch on one side and "2" inch logMAR sizes on the other. Which side should I use? 

A: The “CHART 1 IN” on one side of the chart and the “CHART 2 IN” on the other side of the chart is confusing to many front-line screeners. “IN” does not refer to inches, as one could easily assume. The “IN” means that the charts are in logMAR format. Line sizes progress up and down the chart in 0.1 log units.

The numbers “1” and “2” simply indicate charts 1 and 2.

Having 2 sides of Sloan Letters on one chart provides screening options. For example, you could screen one eye with one side of the chart and the other eye with the other side of the chart. Or, you could use one side for both eyes and the other side for rescreening if the child did not pass the initial screen.

E-mail your questions to our expert, Dr. Kay at vision@schoolhealth.com or post a comment in the comment section below. 

Request a FREE Vision Screening Consultation & Download 5 Eye Chart Recommendations By a Vision Screening Expert >> 

REFERENCES:

¹Eye examination in infants, children, and young adults by pediatricians. (2003). Committee on Practice and Ambulatory Medicine, Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology. Pediatrics,111(4 Pt 1):902-907.

175 Years Later...Is Your Eye Chart Standardized?

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By P. Kay Nottingham Chaplin, Ed.D.

Director – Vision and Eye Health Initiatives – School Health Corporation and The Good-Lite Company

Introduction

Standardized eye charts help to ensure the visual acuity task is equal on any line of a chart. Though one of the earliest attempts at eye chart standardization occurred in 1835 or 1836 (no, this is not a typo), did you know many front line screeners today use eye charts that are not standardized?

A Brief History

Heinrich Küchler, a physician from Darmstadt, Germany, is credited with creating the first symbol eye chart in 1835 or 1836 (Runge, 2000). In a creative effort, Küchler cut small figures from calendars, think almanacs, and glued the figures to paper in decreasing size. Figures included people, cannons, guns, birds, farm equipment, camels, and frogs.

However, he recognized two possible problems with his symbol eye chart. First, his figures lacked consistency in size. Küchler also noted that the frogs, camels, and other figures in his eye chart lacked uniformity in optotype legibility or discriminability. What does this mean? When optotypes lack legibility consistency, some optotypes are easier to distinguish (or even guess), at different points of an eye chart, even on the same line.

To review equal optotype legibility as one of six components of a standardized eye chart, refer to "Selecting an Eye Chart - Sloan Letters of Snellen?">>

Apparently not one to give up pursuing his standardization goal, Küchler, 7 or so years later, published an eye chart using letters arranged in a graduated series. The eye chart consisted of 12 lines with larger letters on the top line. Lines decreased in size to the bottom line. Though the concept remains with us in 2011, Küchler’s chart was not widely used and accepted. It was published only once in 1843.

Photo courtesy of Colenbrander (2008):

Incredibly, 175 years later, some eye charts are still not standardized! 

Non-Standardized vs. Standardized

If you look closely at the optotypes on the Kindergarten Eye Chart (a.k.a. Sailboat chart) you will notice that the optotypes are inconsistent in size.  Look specifically at the hand and star on the 20/30 line.  This is an example of a current non-standardized eye chart. 

Two choices for screening the vision of all ages using standardized eye charts include:

Sloan Letters (pictured left) for older children and 10-line LEA Symbols (pictured right) eye chart for younger children who do not yet know their letters.

Have you recently switched from a non-standardized eye chart to a standardized eye chart?  We would love to hear from you, either in the comments below or offline via e-mail to Dr. Kay at vision@schoolhealth.com

When you respond, please tell us the following:

• Non-standardized chart used
• Standardized chart now using
• Good referrals vs. bad referrals with the non-standardized chart
• Good referrals vs. bad referrals with the standardized chart

Request a FREE Vision Screening Consultation & Download 5 Eye Chart Recommendations By a Vision Screening Expert >> 

REFERENCES:

Colenbrander, A. (2008). The historical evolution of visual acuity measurement. Visual Impairment Research, 10, 57-66.

Runge, P. E. (2000). Eduard Jaeger’s test-types (Schrift-Scalen) and the historical development of vision tests. Transactions of the American Ophthalmological Society, 98, 375-438.

Vision Screening Tutorial for School Nurses and Head Starts

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Effective & Efficient Vision Screening Methods

Children's vision screening is essential to ensure a successful learning experience. School nurses, head starts, preschools and early learning programs will all benefit from watching this 30-minute, easy-to-follow video tutorial on children's vision screening.

The Vision Screening Tutorial video:

• Explains different vision disorders that can be identified during vision screenings
• Identifies the advantages and disadvantages of current vision screening techniques
• Clearly demonstrates how get a reliable vision screen using wall charts, vision screening machines, autorefractors, and more.
• Provides suggestions on which vision screening techniques to use on younger children, older children, and special needs children.
• Provides vision screening guidelines, including when to rescreen test failures.

In addition, the video identifies the 3 goals of every vision screening program, what every competent vision screener should know, the consequences of leaving a vision disorder untreated, and when the critical period of vision development occurs for a child. 

The information in this tutorial is presented by pediatric ophthalmology experts and is brought to you by the National Association of School Nurses, the American Association for Pediatric Ophthalmology and Strabismus, School Health and Good-Lite. It covers everything you need to know about screening children's vision.

The video tutorial is brought to you in 2 parts and is free to view. 

Register to Watch the Vision Screening Tutorial >>

Selecting an Eye Chart - Sloan Letters or Snellen?

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5 Reasons To Use Sloan Letters, Even When Snellen is Recommended

By P. Kay Nottingham Chaplin, Ed.D., Director – Vision and Eye Health Initiatives – School Health Corporation and The Good-Lite Company

School Health Corporation and The Good-Lite Company recommend Sloan letters instead of the "Snellen” chart because Sloan Letters adhere to national and international eye chart design guidelines and “Snellen” charts do not.

5 Reasons To Adhere to these Standards:

1. Optotypes of almost equal legibility. This ensures that optotypes or letters are almost equal in the ability to recognize them. Some letters on the Snellen chart are more difficult to recognize than others.

2. Same number of optotypes per line (5 is the recommended number). Some lines on the Snellen chart have 2 optotypes, others have 6, 7, 8, or 9. To pass vision screening, the child must correctly identify the majority of optotypes on a line. Identifying the majority on a line of 2 or 3 optotypes is different, and less difficult, from identifying the majority on lines of 6, 7, 8, or 9 optotypes.

3. Horizontal between-letter spacing should be equal to the width of the optotypes on that line. If you were to cut out a letter on the line, you should be able to paste the cut out letter between 2 optotypes. This is not always the case on a Snellen chart because the chart design is not standardized and may vary across manufacturers.

4. Vertical between-line spacing should be equal to the height of the optotypes on the next line down the chart. This is not always the case on a Snellen chart. Standardized spacing helps to ensure the visual task is equal on all chart lines.

5. Optotype size progresses geometrically up or down the chart by 0.1 log units. This does not occur on a Snellen chart, which means the visual acuity measurement may be over- or under-estimated.

Additionally, the “Snellen” chart is non-standardized. Thus, “Snellen” charts may differ among manufacturers in font, letters, and spacing ratios. Sloan Letter charts are standardized and designed specifically to meet the international and national guidelines. The typical “Snellen” chart does not.

If you want to use a standardized letter chart that meets international and national eye chart design recommendations, you will want to use a Sloan letter chart. For younger children, LEA Symbols would be the recommended choice. 

Read more: 5 Problems That Occur When Your Eye Charts Aren't Standardized

or

contact Dr. Chaplin at vision@schoolhealth.com.

References

Bailey, I. L., & Lovie, J. E. (1976). New design principles for visual acuity letter charts. American Journal of Optometry and Physiological Optics, 53(11), 740–745.

Candy, T. R., Mishoulam, S. R., Nosofsky, R. M. & Dobson, V. (in press). Adult discrimination performance for pediatric acuity test optotypes. Investigative Ophthalmology & Visual Science.

Committee on Vision. (1980). Recommended standard procedures for the clinical measurement and specification of visual acuity. Report of working group 39. Assembly of Behavioral and Social Sciences, National Research Council, National Academy of Sciences, Washington, DC. Advances in Ophthalmology, 41, 103–148.

Eye examination in infants, children, and young adults by pediatricians. (2003). Committee on Practice and Ambulatory Medicine, Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology. Pediatrics,111(4 Pt 1):902-907.

Ferris, F. L., Kassoff, A., Bresnick, G. H., & Bailey, I. (1982). New visual acuity charts for clinical research. American Journal of Ophthalmology, 94(1), 91-96.

Kaiser, P. K. (2009). Prospective evaluation of visual acuity assessment: a comparison of Snellen versus ETDRS charts in clinical practice (An AOS Thesis). Transactions of the American Ophthalmological Society,107:311-324.

International Council of Ophthalmology. (1984). Visual acuity measurement standard.

Nottingham Chaplin, P. K., & Bradford, G. E. (2011). A historical review of distance vision screening eye charts: What to toss, what to keep, and what to replace. NASN School Nurse, 26(4), 221-228.

World Health Organization. (2003). Consultation on development of standards for characterization of vision loss and visual functioning.

5 Problems That Occur When Your Eye Charts Aren't Standardized

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Does Your Chart Adhere to the 6 Standardization Guidelines?

By P. Kay Nottingham Chaplin, Ed.D., Director – Vision and Eye Health Initiatives – School Health Corporation and The Good-Lite Company

Let’s say a child does not pass a vision screening performed by a school nurse or Head Start staff member because the program uses a poorly designed eye chart. Then, the child passes the test conducted by a technician using a well-designed eye chart that conforms to recommended standards. If this scenario occurs regularly, 5 problems can occur:

1. The screener’s over-referral rate of children with normal vision increases.
2. The eye care professional may begin to mistrust the accuracy of the screener’s referrals.
3. The child’s parent/caregiver may become upset as a result of taking time away from work, household responsibilities, or siblings for an eye exam that was normal.
4. Health care dollars are unnecessarily expended.
5. Children with vision problems are under-referred.

Want to help ensure that your vision screening program is appropriately referring children for follow-up eye exams? Begin by reviewing your eye charts. Does your eye chart meet national and international eye chart design recommendations?

Examples of appropriate eye charts include: Sloan Letter Folding Wall Chart or the LEA Symbols Folding Chart.

Need help determining if your eye charts meet current recommendations?

For recommendations on eye charts and illuminated boxes that hold eye charts such as the Insta-Line or ESV1200: 

Request a FREE Vision Screening Consultation & Download 5 Eye Chart Recommendations By a Vision Screening Expert >> 

or

contact Dr. Chaplin at vision@schoolhealth.com.

View More Evidence-Based Vision Screening Products >>

New Version of SureSight Designed For Preschool Vision Screening

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Study Shows Welch Allyn SureSight Effective Vision Screening Tool For Screening 3- 5-Year-Olds

In 2004, a group of licensed eye care professionals compared 11 preschool vision screening tests in a study commonly known as the VIP, or Vision in Preschoolers, study. This study consisted of a sample of 3- to 5-year-old children enrolled in Head Start programs.

One of the instruments evaluated by the group was the Welch Allyn SureSight Vision Screener, a handheld autorefractor that measures refractive error one eye at a time. Using this instrument, the screener looks through a viewfinder and instructs the child to fixate on the red lights at the front of the machine.  The screener will then center the cross hairs on the child’s right pupil.  The SureSight will alert the screener to adjust the testing distance and when the measurement is complete. The screener will have to repeat the process for the left eye and then a refractive error and reliability rating is printed for each eye.

The standard SureSight (Version 2.04) utilizes referral criteria which yields screening results of 98% sensitivity and 62% specificity.  Ophthalmologists working on the Vision in Preschoolers Study requested a more specific screening protocol which would decrease the number of potential vision problems identified. The reason is for this request was they wanted to reduce the number of false referrals which can bog down the healthcare system.

In response, Welch Allyn created SureSight version 2.23, which adjusts the default referral results to 80% sensitivity and 94% specificity for amblyopia. 

When the screeners used the new SureSight version 2.23 during the study, they found that it was among the most accurate tests for detection of amblyopia, strabismus, significant refractive error, and reduced VA.

Learn more about this exclusive version of the SureSight - including viewing copies of the study >>

10 Resources For Succeeding in Preschool Vision Screening

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How Much is at Stake when Screening Preschoolers’ Vision?

During a School Health sponsored NASN and NHSA Radio Show, Dr. Susan Proctor, DNS, RN, FNASN, stated "The most important age group to really be looking at are the very young children. The earlier we can pick up problems...the better we are going to be able to help them, not only their learning but their quality of life."

If certain vision disorders are not detected early and treated early, they can even lead to permanent visual loss says Dr. Jean Ramsey, Pediatric Ophthalmology Service Director at Boston Medical Center.

But as important as it is to catch vision problems early, it can be equally as difficult to get an accurate screening on the very young. Young children might not feel like cooperating or may have trouble understanding the directions. Additionally, according to Dr. Proctor, “Many of the [wall charts] that are regrettably currently in use…are outdated, are not the best, and really should not be used.” 

It is important to use evidence-based vision screening products when screening young children. You want to make sure the products you are using to screen preschoolers have been proven successful for that age group so you can get the most accurate screening possible for this important age group.

Find 10 more resources specifically for preschool vision screening here >>