This fall, 2017, all public schools in Washington State will be including near visual acuity in their vision screening protocol. Schools must screen both distance and near vision at grades K, 1, 2, 3, 5 and 7. The required tools and referral criteria can be seen in the following table:
|Purpose of Screening||Grade||Screening Tools||Rescreening and Referral Criteria|
|Distance Vision||Kindergarten||LEA vision test: Single LEA symbol (at 5 feet), or HOTV letter||Visual acuity worse than 20/40 in either eye|
|Distance Vision||Grade one||LEA vision test: Single LEA symbol (at 5 feet), or HOTV letter||Visual acuity worse than 20/32 in either eye|
|Distance Vision||Grade two and above||LEA vision test: Single LEA symbol, or HOTV letter, or Sloan letters||Visual acuity worse than 20/32 in either eye|
|Near Vision Acuity||Kindergarten||LEA vision test: Single LEA symbol, or HOTV letters, or Sloan letters||Visual acuity worse than 20/40 in either eye|
|Near Vision Acuity||Grade one and above||LEA vision test: Single LEA symbol, HOTV, or Sloan letters||Visual acuity worse than 20/32 in either eye|
Welch Allyn SPOT Vision Screener
Many of the schools will use the new Washington State Vision Screening Kit by Good-Lite and School Health Corporation. The Optometric Physicians of Washington has sponsored a tutorial video to train school nurses how to use this kit. You can view this video in the SCHOOL section of this website.
The rules also allow schools to use an instrument based device, for example the Welch Allyn SPOT Vision Screener, in lieu of optotype based screening tools.
In addition to the minimum distance and near visual acuity mandates, some schools may choose to conduct other optional screenings, for example using hyperopia screening flippers to screen for latent hyperopia, or using a symptom survey such as the Convergence Insufficiency Symptom Survey to screen for the possibility of a subtle binocular instability such as convergence insufficiency.
If you are an eye doctor in Washington State you will likely see children referred by their school screening, and some of them may come to you with near vision issues, not only distance vision blur as they have in years past.
A teacher who recently viewed some of the EYE Research Group educational information for schools sent us this story and expressed her frustration that many children who seem to have obvious functional vision issues go to an eye doctor who doesn't find anything wrong.
I'm a veteran Middle School ELL teacher who spends a lot of time reading about neuroscience for fun and for work. I started talking with a school nurse about convergence insufficiency and that led me to Alderwood Vision Therapy's websites and questions for families. I simplified the language in their parent questionnaire and had my students respond in a digital form so they could translate the questions and understand them. Then I read up on how to do the Brock String test and tested all of the students who answered my vision survey questions in a concerning way. Almost every student who showed issues on the survey showed some anomaly on the test. I discovered that one of my 7th grade students sees double most of the time and had never mentioned it to his family because he "thought it was normal." I told parents of these students that I was absolutely not an expert but my observations of symptoms from the checklist in the classroom plus watching students close one eye or get dizzy or not be able to put an object into focus when asked to focus were causes for concern. One student went to the eye doctor and was told her eyes were more or less fine and that she just needed glasses to see far away. So now I have to remind her mom what she needs to ask them to check for! She closes her left eye when asked to focus, miscopies info in wildly inconsistent ways and is miserable if asked to read /view a computer screen for more than 5 minutes. So clearly something is amiss and has not been caught!
Words From Our Clinical Director
Sometimes it is teachers, occupational therapists, physical therapists, speech language pathologists, or other professionals working closely with students in schools who actually conduct more sophisticated probes of vision function, and more adeptly observe vision related dysfunctions in their student's activities of daily living and learning, than the professional eye doctors they refer these students to for answers and interventions.
The goal for this doctor section of the EYE Research Group website is to become a place eye doctors can access resources and tools for testing functional vision and providing effective interventions. Screenings work best when they are coordinated with accessible solutions to problems that are found. In order to provide access to the needed care in all communities, primary eye care doctors (not just specialty centers) will need to step up and offer adequate testing and treatment of basic functional issues such as convergence insufficiency. Here will be the place to find the evidence based best practices. Please return frequently for updates and contact us if your practice is ready to explore what can be done for students in your community.