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The Missouri Department of Health and Senior Services is pleased to provide the attached vision screening protocols, preschool through grade 12, for school districts throughout Missouri. The Children’s Vision Commission, experts from the ophthalmology, optometry and school nursing professions, along with representatives from the Missouri Department of Elementary and Secondary Education and the Missouri School Boards Association, has established these standardized vision screening guidelines. The recommendations described in this manual represent evidence-based methodology and current best practice in the field of vision screening. They are intended to facilitate the identification of children with common vision problems as early as possible, when treatment is most effective, thus supporting educational achievement.

Purpose

The ability to see greatly impacts a student’s ability to learn. Screening for vision problems is an appropriate and important part of school health services, largely carried out by the school nurse. The objective of a vision-screening program is to identify children with possible visual defects at the earliest possible stage. This allows ample time to refer children for diagnosis and treatment. Screening should be done in schools for the following reasons:

• Large numbers of children of many ages are readily accessible
• Can be accomplished in a short period of time with relative ease
• Far less expensive than a comparable service performed in another sector of the health care
  system
• Allows an ongoing opportunity to observe, assess, and investigate potential areas of concern
• Provides the opportunity to screen children who have been previously identified
   

Characteristics of Screening Programs

Screening is a brief or limited evaluation of a group of individuals presumed to be normal. The value of early detection of a problem must be weighed against the time and human resources required to conduct the screening. The value of the screening process depends on how well the program is carried out and how the findings are used. Results must be communicated, and follow- up on referrals for those “at risk” must be continued until the problem is resolved in some manner.

Screening program results must be evaluated in terms of:

• Validity – ability to identify those individuals who have the condition and which do not
• Reliability – consistency of results of screening process
• Yield – number of persons identified to be “at-risk”
• Cost – personnel and equipment]
• Acceptance – informed parents agree to the value of screening
• Follow-up – communicating results to parents and assuring the family has resources for
  diagnosis and treatment

Evaluation of Vision Screening Programs

To determine the effectiveness of the vision-screening program, careful evaluation ofthe planning, implementation, referral process
and referral outcomes must be completed with each vision screening. Much of this information is essential for reports to the board of
education and the school health advisory committee. Evaluation is an on-going process. Keeping outcome data about the vision-
screening program and referrals helps the school nurse evaluate the effectiveness of the program.

Many questions can be answered from the acquired data. Information that can be gathered in the evaluation process includes the number of students screened, the number of referrals, the types of vision problems identified and utilization of vision insurance.