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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 3, Chapter 9:  Manual Exhibit 3-9-C

Vision Screening Procedures for School Age Children

I.  Eye Screening.

Eye screening programs serve to identify those persons not now under professional care or who need professional reevaluation.  In addition, eye screening programs may act to help regulate the priorities in eye care delivery when funding is limited.

  1. School Eye Screenings Program.  While the primary responsibility for the health of a child is with the parents, a health care system must do all it can to assure that each child has an equitable chance at an education.  When the vision system does not function effectively, the learning process becomes compromised.

    The rationale for school eye screening programs is sound.  The type of individual eye screening programs will be dictated by a number of factors such as, age of the child, availability of personnel, funding to conduct the screenings, and alternate programs or resources.

    Screening is essential in detecting ocular conditions which are amenable to treatment at this age and in establishing a definitive knowledge of the child's ocular well-being before entry into grade school.  Ideally, these screenings should use the testing procedures recommended in these guidelines or consider the use of other accepted methods of vision screening.

    The functional pattern of seeing clearly has nearly reached its completion by kindergarten age.  It is, therefore, critical that each child have a thorough screening or exam at or before this age in order to detect amblyopia and other visual and ocular anomalies.  This screening also provides a baseline assurance that the total visual system is functioning normally.

    After this age most aspects of a child's visual system change little.  Screening after this age is geared primarily towards detecting clinically significant refractive errors which do change, sometimes dramatically.

    When manpower and resources are available, the following is offered as a model school vision screening program:

    1. School Responsibility.  The basic responsibility for school vision screening lies with the school administration and the school health representative.  Generally, the School Nurse is the individual directly responsible for development and implementation of the school vision screening program.  In a given location, the School Nurse, Community Health Nurse, Optometric Community Health Representative (CHR) or technician may be involved in this screening.  In addition, at least one person from the school staff should be involved.  Where an eye care program exists, the screening should be coordinated between the eye care provider and the school or community health nurse, as appropriate.
    2. Vision Care/Screenings Schedule.

      1. Infants to 6 Months.  Examining infants is recommended.  Major anomalies can be identified such as retinoblastoma, high myopia, and other significant congenital problems.
      2. Six Months to Age 3.  Children this age are often uncooperative during examination.  Full eye examinations should be provided to all three-year-old children.  Cooperation in most cases is adequate for visual acuities with the tumbling "E" chart or symbols.  An external exam, Ocular Motility, Retinoscopy, and Ophthalmoscopy should all be performed.
      3. Ages 4 and 5.  At ages 4 and 5, only those students who are new to the area or those who did not participate in the program the previous year should be provided a full exam.  It would also be prudent to recheck those children who were identified as having a vision problem the previous year.
      4. School-age children.  Once children enter elementary school annual visual acuity and Stereopsis testing should occur through high school.  If this cannot be done due to limited resources, screening on alternate years should occur.
    3. Referral Letters.  The school or community health nurse should identify those students who need further testing and should coordinate referral letters to parents of children failing the screening.  In addition, coordination with the eye clinic or contract health clerk for appointment time or authorizations for followup care will be necessary.
    4. Absence.  When children are absent or otherwise miss an organized pre-school or Headstart screening, all efforts should be made to assure that these children receive appropriate testing at an eye clinic, if necessary, at a later date.
    5. Color Vision.  Color vision testing is optional.  It is of interest to the individual and to the teacher (for occupational counseling) but does not generally effect the visual acuity or the general ocular health.
    6. Reporting.  The results of all screenings on non-selected populations should be reported to the Area Optometry Consultant by the Service Unit Chief Optometrist.


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