Guidelines for Vision Screening in Missouri Schools

Distance Acuity, Near Acuity and Stereopsis

Rescreening, Referral, and Follow-Up Rescreening

• Rescreening is indicated for any child who fails any part of the initial screening (distance acuity, near point, or binocularity).
• Rescreening is performed to eliminate those children who failed the initial screening due to factors such as fatigue, illness, anxiety, misunderstanding, or distractions during the initial screening.
• The number of students rescreened will typically be about 20% of those initially screened.
• Rescreening should be done within 14-21 days after the initial screening.
• Procedures for rescreening are the same as those for the initial screening.

Referral

• A referral is indicated if the child fails any portion of the rescreening.
• The nurse should notify the parent/guardian in person or by telephone prior to sending a written referral.
• A written referral, using a form that communicates the findings of the screening as well as any additional observations made in the school setting, should be sent to the parent/guardian within one week after the rescreening.
• The referral form should request a written report from the eye care professional with the results of the examination and any recommendations for the school setting.
• A sample referral letter and medical release information form (HIPPA compliant) can be found in Appendix C.
• It is important to notify the classroom teacher if a referral is sent so that classroom accommodations can be implemented.
• To better assist families, the school nurse should be familiar with community resources available for exams and glasses and be able to assist in reminding the parent about follow-up visits, if recommended.

Follow-Up and Tracking

• Most important component of any screening program.
• A tracking system is essential to follow-up those who are referred in order to assure that the child receives the appropriate treatment/services.
• If information about the referral is not received in 3-4 weeks following the referral, a phone call should be made to the parent/guardian.
• The parent/guardian should be contacted periodically until the nurse knows the disposition of the referral.
• The nurse should be aware of community resources for those who need financial assistance.
• All pertinent information regarding the screening results, referral, and results of the professional evaluation as well as recommendations must be documented in the child’s health record.
• It may be determined by the professional examiner that the child does not presently need glasses or other specific treatment. This would not invalidate the referral if a problem were confirmed.
• Following professional diagnosis and treatment, further planning may be needed for the child whose vision cannot be brought to within normal limits. The special education director should be notified so that the student may be evaluated for special programming.

Referral Resources

The school nurse’s role is to identify whether there is a need for financial assistance for those students with incomplete referrals.

MO HealthNet

If a parent indicates there is a financial problem, the first step is to determine if the student is financially eligible for assistance through MO HealthNet. MO HealthNet is based on a national child health insurance for uninsured children. This is a program for medical, dental and vision insurance.

Access to these programs is through the Family Support Division (FSD) of the Department of Social Services. Children eligible for free and reduced lunch programs may often meet the financial criteria. If the parent/guardian does not have a Medicaid card for the student and is interested in exploring their eligibility for MO HealthNet, they should be referred to MO HealthNet for Kids.

For More information, call 855- FSD-INFO (855-373-4636) to speak with a team member; or visit myDSS.mo.gov to start a chat.

These programs will provide an eye exam every two years, and frames and lenses if needed. New lenses may be obtained on an annual basis if there is a medical necessity. Some schools have personnel who have been trained to facilitate an application for MO HealthNet.

Prevention of Blindness Program

A resource available to all citizens in Missouri is the Prevention of Blindness Program (POB). This program is entirely funded by the State of Missouri, and all funds are expended through a coordinator in the state office. All individuals in the state who are legal residents, regardless of age, are provided eye care services when they meet the eligibility requirements.

Eligibility requirements include:

• Financial – dependent upon net monthly income, number of individuals in the household, cash and resources other than the family residence. All income generated in the household is taken into consideration.
• Visual – eligibility is based on a visual acuity of 20/200 or worse without correction in at least one eye, a progressive eye disease, or a malformation or malfunction of the eye. Visual eligibility determination for the Prevention of Blindness Program can be made after a report is filed in the POB office by an eye care professional that has completed an examination of the client. This examination is to determine the existence or nonexistence of disease of the eye, to check for ocular muscle functions, and to determine whether any other ocular problems exist.

The program provides for the purchase of the following:

• Glasses
• Routine and follow-up eye examinations
• Surgery
• Hospitalization
• Anesthetic fees

Other services include:

• Referrals to other agencies (public and private)
• Counseling
• Purchase of some medication

The Prevention of Blindness Program accepts referrals from any source, utilizing a form that may be obtained from the county Family Support Division office. The nurse may need to assist the parent/guardian in completing the form to avoid unnecessary delays in getting approval for care.

Community-based Programs

• Lions Clubs
  
  In many communities, the Lions Club International provides assistance for vision problems. Some clubs sponsor community eye-screening programs and assistance for adults as well as children.
  
  The nurse has a responsibility to be an advocate for the school-age population and to communicate the need for a resource in the community. If your area has a Lions Club, check with a member to determine if the club has resources available to students in your district and what the procedure is to access the resources.
• National Association of School Nurses / Vision Service Plan
  
  The National Association of School Nurses (NASN) collaborates with Vision Service Plan (VSP) Sight for Students program for low-income students not eligible for government programs. Members of NASN can obtain materials for providing up to ten “gift certificates” for vision care. In exchange, they agree to ensure the child is financially eligible, assist the family with completing the application, and assure the family keeps the appointment.
  
  http://www.nasn.org
• Informal Community Resources
  
  In addition to these resources, local school health advisory councils often identify informal resources within the community by communicating the need for financial assistance for vision care. School nurses play an important role in collecting the data to identify the needs and advocating for the development of resources.