Guidelines for Vision Screening in Missouri Schools

Tests of distance visual acuity:

• Single, surrounded optotypes in wheels or flip charts at 5 feet.

• Flip charts with crowded lines of 5 optotypes per page at 10 feet in critical line or full threshold formats.

• 9 x 14 charts
• Tests of visual acuity screening software with single, surrounded optotypes at 10 feet.

LEA SYMBOLS or HOTV letters response panels for playing matching game.

3yo – 20/50 line

4 and 5yo – 20/40 line

6yo and older – 20/32 line

Screen annually.

Measure 10-foot screening distance between chart and child’s eyes.

Place arch of child’s foot on the line when measuring the 10-foot distance, not heels or toes.

Screen one eye at a time.

Rescreen as soon as possible and no later than 6 months with the same screening tool.

Refer to an eye doctor (pediatric optometrist, optometrist, pediatric ophthalmologist, or ophthalmologist) with experience examining young children.

Use 9 x 14 Sloan Letters chart in an illuminated cabinet (e.g., ESV1200 below) or place on a wall in a well-lit room.

Tests of visual acuity at 10 feet, using standardized format.

If you draw a line around the outside of the optotypes, the line will resemble an upside down pyramid and not a rectangle.

No more than 5 optotypes per line, unless using a 9” x 14” chart.

Test of visual acuity should be 10 feet, not 20 feet, AND should have a 20/32 (10/16) line, not a 20/30 line.

Sloan Letters

Response panel of Sloan Letters for students who use English as a second language and may need to match optotypes.

Bright Futures recommends vision screening for well-child medical visits at ages 8, 10, 12, and 15 years.

Measure 10-foot screening distance between chart and child’s eyes.

Place arch of child’s foot on the line when measuring the 10-foot distance, not heels or toes.

Screen one eye at a time.

Rescreen as soon as possible and no later than 6 months with the same screening tool.

Refer to an eye doctor (pediatric optometrist, optometrist, pediatric ophthalmologist, or ophthalmologist) with experience examining school-aged children.

Use 9 x 14 Sloan Letters chart in an illuminated cabinet (e.g., ESV1200 below) or place on a wall in a well-lit room.

Tests of visual acuity at 10 feet for threshold and critical line screening.

AAPOS Basic Vision Screening Kit

LEA SYMBOLS® and Sloan Letters

Also available with HOTV and Sloan Letters

• Measure 10-foot screening distance between chart and child’s eyes.
• Place arch of child’s foot on the line when measuring the 10-foot distance, not heels or toes.
• Screen one eye at a time.
• Rescreen as soon as possible and no later than 6 months with the same screening tool.
• Refer to an eye doctor (pediatric optometrist, optometrist, pediatric ophthalmologist, or ophthalmologist) with experience examining preschool- and school-aged children.

Welch Allyn® Spot™ Vision Screener

Plusoptix S12
(C model shown here)

Righton Retinomax

Vision screening instruments do not measure visual acuity.

Consult local eye care provider for referral criteria settings in programmable devices.

Insufficient data currently exists to support instrument-based screening for ages 6 years and older.

Monitor the Prevent Blindness website for additional approved devices: https://preventblindness.org/recommended-tools-and-tests/

LEA SYMBOLS LEA NUMBERS near chart with cord.

Sloan Letters near chart with cord.

Ages 3 to 6 years:
LEA SYMBOLS or HOTV letters

Ages 6 years and older:
Sloan Letters

3yo – majority of optotypes on 20/50 line with each eye separately or both eyes open

4yo – majority of optotypes on 20/40 line with each eye separately or both eyes open

5yo – majority of optotypes on 20/40 line with each eye separately or both eyes open

6yo and older – majority of optotypes on 20/32 line with each eye separately or both eyes open

Plus lens testing is not a near visual acuity test.

Can conduct full threshold screening (starting at top line and moving down the chart) one eye at a time OR critical line screening with each eye individually, or with both eyes open.

Hold cord at child’s temple. Ensure cord remains tight to prevent the child from moving closer to or farther away from the chart.

PASS Test™ 2.

3yo – pass Card B (no testing with Card C)

4yo – pass Card B (no testing with Card C)

5yo and older – pass Cards B and C

If student wears prescription glasses for distance viewing, remove prescription glasses and screen only with polarized glasses.

If student wears prescription glasses for near viewing, or full time, place polarized glasses over prescription glasses when screening. You may need a larger set of polarized glasses.

If student wears prescription glasses and you do not know the reason, place polarized glasses over prescription glasses when screening. You may need a larger set of polarized glasses. If the child cannot see the 3-D image, then try conducting the test without the child wearing their glasses.

Ensure no glare or shadow on cards. Hold cards with edges of fingertips.

Tilt cards slightly backward – about a 10-degree tilt.

Replace book every 7 years; colors desaturate over time.

Use cotton swab or brush for pointing or tracing the image as oil from fingertips will desaturate colors.

Adhesive patches, 2-inch wide hypoallergenic surgical tape, or occluder glasses.

Unacceptable occluders include:

Tissues, hands, paper or plastic cups, paper occluders, adults holding occluders over child’s eyes, and occluder paddles.

“Mardi Gras mask” or “Lollypop” occluders

Unacceptable occluders include:

Tissues, hands, paper or plastic cups, paper occluders, adults holding occluders over child’s eyes.

Hold “lollypop” occluders with handle toward temple, not chin.