Arkansas Department of Health is an approved provider
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Arkansas Department of Health is an approved provider of continuing nursing education by Midwest Accreditation Program, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 09: 5 6 09: 0 09: 1 09: 2 09: 3 09: 4 87 9 1 2 3 4 5
The planning committee & faculty attest that NO relevant financial, professional or personal conflict of interest exists, nor was sponsorship of commercial support obtained, in the preparation or presentation of this educational activity. 08: 5 6 08: 0 08: 1 08: 2 08: 3 08: 4 87 9 0 1 2 3 4 5
Arkansas Department of Health is an approved provider of continuing nursing education by Midwest Accreditation Program, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 07: 5 6 07: 0 07: 1 07: 2 07: 3 07: 4 87 9 0 1 2 3 4 5
To show respect for our speakers and participants, PLEASE place your cell phone on silent or vibrate. Should you need to answer a call, PLEASE go outside to hold your phone conversation. 06: 5 6 06: 1 06: 2 06: 3 06: 4 87 9 0 1 2 3 4 5
Arkansas Department of Health is an approved provider of continuing nursing education by Midwest Accreditation Program, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 05: 5 6 05: 0 05: 1 05: 2 05: 3 05: 4 87 9 0 1 2 3 4 5
Respect the speakers and other participants around you by refraining from side bar conversations during the session. If it is that important, please step outside!!!! 04: 5 6 04: 0 04: 1 04: 2 04: 3 04: 4 87 9 0 1 2 3 4 5
Arkansas Department of Health is an approved provider of continuing nursing education by Midwest Accreditation Program, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 03: 5 6 03: 0 03: 1 03: 2 03: 3 03: 4 87 9 0 1 2 3 4 5
To show respect for our speakers and participants, PLEASE place your cell phone on silent or vibrate. Should you need to answer a call, PLEASE go outside to hold your phone conversation. 02: 5 6 02: 0 02: 1 02: 2 02: 3 02: 4 87 9 0 1 2 3 4 5
Arkansas Department of Health is an approved provider of continuing nursing education by Midwest Accreditation Program, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 01: 5 6 01: 0 01: 1 01: 2 01: 3 01: 4 87 9 0 1 2 3 4 5 Please Be Seated
VISION SCREENING CERTIFICATION
School Nurse will be able to: • Assess knowledge of the vision law and responsibilities • Explain the importance of vision screening. • Identify the components of a vision screening and the pass/fail criteria for each. • Demonstrate operation of the approved vision screening instruments. • List age-appropriate vision screening procedures. • Identify components of the referral, follow-up and reporting process.
Vision Pre-test • CHNS will distribute to each participant a copy of the Vision Certification Pre-test.
Act 1438 of 2005 • An Act To Mandate Eye And Vision Screening Procedures And Tests For Children • ADE Rules Governing Eye & Vision Screening Report in AR Public Schools www. arkansascsh. org Arkansas Laws and School Health
Importance • One in 20 preschoolers has a vision problem. • One in 5 -10 school-aged children has a vision problem. • Impaired vision can seriously impede learning. • Early identification and treatment can prevent or at least alleviate many vision problems.
Purpose • To screen a large number of children in a short amount of time. • To separate those children likely to have vision problems from those not likely to. • To refer those children who do not pass the screening or who are suspect for vision problems.
Landmarks of Visual Development • 4 -12 wks – Binocular fixation • 12 -20 wks – 20/200 • 44 wks-12 mo – 20/50 - 20/100 – Full binocular vision – Amblyopia may develop • 6 -18 mo – Convergence developed • 18 mo-2 yrs – Accommodation developed – 20/40 • 2 -3 yrs – 20/30 • 5 yrs – Min. potential for amblyopia • 6 yrs – Approaches 20/20
Parts of the Eye
Common Ocular Abnormalities
Black Eye
Conjunctivitis
Blepharitis
Chalazion
Stye
Entropion Of upper eyelid due to scarring Of lower eyelid
Dacryocystitis
Ptosis
Coloboma
Coloboma
Cataract
Strabismus Types • Tropia – Eyes which are always improperly aligned • Phoria – Eyes which have a tendency to misalign when fusion is interrupted
Esotropia
Bilateral Esotropia
Exotropia
Hypertropia
Pseudostrabismus (also Pseudotropia or pseudoesotropia)
Refractive Errors • Myopia (Nearsightedness) • Hyperopia (Farsightedness) • Astigmatism
Myopia
Normal Vision
Astigmatism
Amblyopia: Definition • Vision that cannot be corrected to better than 20/40. • Unilateral or bilateral • Brain suppresses poor image • Normal appearance • Reversible if detected and treated early
Amblyopia Predisposing Factors • Poor clarity – Cataract • Poor focus – Nearsightedness – Farsightedness • Poor aim – Strabismus Treatment – Clearing the media – Cataract removal • Focusing the image – Corrective lenses • Correcting aim – Occlusion therapy – Drops
Amblyopia Therapy
Usher’s Syndrome • Hearing Loss and Retinitis Pigmentosa • Screen children with hearing loss
Resource Arkansas School for the Blind PO Box 668 Little Rock, AR. 72203 1 -800 -362 -4451 501 -683 -5104
Vision Screening
Children to Screen Grades Pre K, K, 1, 2, 4, 6, 8 and all transfer students Note: Pre K is only 4 year olds on a school campus.
Screening Procedure
Observation • Appearance • Behavior • Complaints
Appearance • • • Whites Iris Pupil Lids Lashes Immediate referral if abnormal
Behavior • • Head tilt or turn Blinking or rubbing Avoiding close work Squinting/frowning Closing or covering eye Reading problems Frustration/poor attention
Complaints • Headaches • Nausea • Dizziness • Burning or itching • Blurring
Visual Acuity • Screen one eye at a time. – If a child wears glasses, perform the screening with the child wearing the glasses. • Any eye with vision less than or equal to 20/40 shall result in a screen failure. (Means student must be able to read most of the 20/30 line)
Wall Charts
Wall Charts • Screen at 20 feet – Snellen Chart – Literate children • Screen at 10 feet – Age Appropriate Chart – Allen Chart/Tumbling E’s – Pre-literate children/non-English speaking
Plus 2 (++2. 00) Visual Acuity • Test for farsightedness. • Perform exactly as the distance visual acuity except; • Hold a +2. 00 lens in front of the tested eye (fellow eye covered). • Any eye that improves 2 lines of vision with the +2. 00 lens is a screen failure.
Instrument Screenings • Titmus • Optec • Keystone
Lateral & Vertical Muscle Balance-Far (Titmus & Optec) • Right eye on; left eye off. • Give instructions: – “Here is a box. I will throw a red ball. Tell me where the ball lands. ” • Turn left eye on. • Need immediate answer. – If not, repeat test. – To pass the child should report the ball landing ‘in the box’ or ‘on the line’.
Lateral & Vertical Muscle Balance-Far Titmus & Optec Titmus 2 A Right Eye B Left Eye Titmus OV 7 & Optec Right Eye Left Eye
Lateral Muscle Balance-Near (Titmus) • At completion of Muscle Balance Far screening switch lever to ‘near’ setting. • Procedure is the same now as the Lateral Muscle Balance Far screening.
Lateral Muscle Balance-near Titmus & Optec Titmus 2 A Right Eye B Left Eye Titmus OV 7 and Stereo Optec Right Eye Left Eye
Lateral Muscle Balance –Near Optec
Lateral Muscle Balance-Far Titmus & Optec
Vertical muscle balance-far Titmus & Optec
Lateral Muscle Balance-Far Keystone • Right eye on; left eye on. • Place slide ‘Lateral Phoria – use at far point’. • Give instructions – “Here is a row of numbers, 1 to 15, and an arrow/pointer. What numbers) does the arrow point most closely to? ” • Need immediate answer – If not, repeat test. – To pass the child should report the arrow pointing to a number(s) between 8 and 11. Any other answer is a screen failure.
Lateral Muscle Balance-Far (Keystone) – 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 fail pass
Vertical Muscle Balance-Far • Performed at ‘far’. • Keystone – Right eye sees a column of figures with a central circle and 2 figures above and below. – Left eye sees a horizontal line. – To pass the child should see the line passing through the circle or just above or below the circle.
Vertical Muscle Balance Keystone Pass
Lateral Muscle Balance-Near Keystone • Use slide labeled ‘Lateral phoria – use at near point’ (place at the near point). • Again a row of numbers (2 -10) and an arrow are present. • A response of the arrow pointing between 4. 5 and 6. 5 is a screen pass – outside this is a screen failure.
Lateral Muscle Balance-Near Keystone – 1 2 3 4 5 6 7 8 9 10 fail pass
Binocular or Fusion at far Optec/Titmus • Can use whichever of three slides you have—only need to use one. • Pass criteria depends on the slide. • Test in far position. • Test with both eyes ‘on’.
Binocular or Fusion-Far Titmus OV 7, Stereo Optec 2000
Titmus OV 7, Stereo Optec 2000
Binocular or Fusion. Far Titmus OV 7, Stereo Optec 2000 Both eyes open – screen pass
Binocular or Fusion-Far Titmus 2
Binocular Vision - Far Titmus 2 A correct response with this screen is for the child to see all 4 cubes when both eyes are ‘on’.
Binocular Vision - Far Right eye Keystone Left eye red white blue A correct response with this screen is for the child to see 3 circles with both eyes. The circles should be in a vertical line or only minimally separated (if minimally separated it is acceptable to see 4 circles).
Binocular Vision - Far Keystone red red white blue pass white pass A correct response with this screen is for the child to see 3 circles with both eyes. The circles should be in a vertical line or only minimally separated (if minimally separated it is acceptable to see 4 circles).
Binocular Vision - Far Keystone fail Four circles widely separated is a screen failure.
Binocular or fusion- Near This screen is performed as was fusion at far except the instrument is switched to the ‘near’ setting. Or the ‘near’ slide is placed in the instrument.
Color • Performed with both eyes open. • Use a standard instrument slide or a standard hand held red/green color testing card. • To pass the student should be able to read/recognize 75% of the numbers or objects presented.
Color
Color-Keystone
Re-screening
Why Rescreen? • Cuts down on over-referral. • Adds validity and parent confidence • Improves follow-up. • Saves time by decreasing amount of follow-up needed.
Referral • Immediate referral if do not pass: – Observation (Appearance) • Re-screen in one month if do not pass: – Visual Acuity – +2. 00 test – Instrument screenings • Refer if do not pass any part of rescreen • Color vision deficit does not require a referral.
Tips • • Observation with glasses on and off. Glasses on for wall chart (*note) Glasses on for machine screening. Keep child’s head in place on machine—no peeking with “good” eye! • Adjust machine to child’s height.
Suggestions for Screening • NOT the first week of school • Children entering school for the first time – Have 90 days to screen – Need time to adjust to school environment • Don’t wait too long – Cold and Flu season – Need time for follow-up • Recommend screening in September – Start with older children ( Sp. Ed. -need to screen before IPE)
Data Entry
Data Entry • Vision screening data is entered into APSCNe. School+ • Data queries will be pulled on Nov. 15 and April 15. • Training for APSCNe. School+ will be provided at your Ed. Cooperative.
Data Entry • No forms needed except for screening form • Parent Notification/Doctor Report Form will be generated through APSCNe. School+
Paula Smith, State School Nurse Consultant Arkansas Department of 4815 West Markham St. , Slot 63 Little Rock, AR 72205 -3867
RESOURCES • Examinations and Eye glasses www. brandonburlsworthfoundation. org • To borrow Titmus vision screeners vicki@arkansasoptometric. org • Medicaid Reimbursement forms: http: //www. armits. org/index. php? o ption=com_content&task=view&id =27
Referral to Special Education Services for the Visually Impaired When a medical report from a ophthalmologist or optometrist indicates that the student’s vision is 20/70 or less in the better eye with correction or that the student’s visual field is 20 degrees or less, a request for vision consultation/services should be submitted to CIRCUIT.
CIRCUIT • Service requests are submitted online at http: //arksped. k 12. ar. us. • Click on Direct Services to access CIRCUIT and begin process. • Submission of necessary documentation • Consultation by trained professionals
Vision Machine Repair • BSI--Jack Stone --in Little Rock (501) 416 -1232 • 2 M Eye Instruments-- Mike Shivley -- in West Memphis (870) 7350604 • AAA Audiometrics --Loyd E. Ussery, M. A. – in Conway (501) 329 -3860
RESOURCES Free resources: • http: //www. nei. nih. gov
Northwest Darren Brodie O. D. Boozman-Hof Eye Clinic P. O. Box 1353 Rogers, AR 72757 479. 246. 1700 office 479. 631. 2629 fax dlbrodie@cox. ne
Crowley’s Ridge Kerry Childers O. D. Childers Eye Center P. O. Box 562 Wynne, AR 72396 870. 238. 9407 office 870. 238. 4320 fax childers 2020@sbcglobal. net
Southwest William Coffee O. D. William C. Coffee, O. D. P. O. Box 597 Hope, AR 71802 870. 777. 3443 office 870. 777. 3266 fax coffee@arkansas. net
Arch Ford Shane Ford O. D. Arkansas Eye Care Group 1102 Deer St. Conway, AR 72032 501. 329. 9851 office 501. 329. 9854 fax sfordod@msn. com
South Central Chuck Pope O. D. Dr. Charles Pope Eye Care Clinic 333 Elaine Ave. Camden, AR 71701 870. 836. 6886 office 870. 836. 2345 fax cpope 2020@sbcglobal. net
Pulaski (Maumelle) Beatrice Reed O. D. Reed Vision Center 5506 W. Markham St. Little Rock, AR 72205 501. 663. 1131 office 501. 663. 1413 fax eyereed@sbcglobal. net
Dawson Scott Seller O. D. Family Eye Clinic 103 Ridgeway Hot Springs, AR 71901 501. 321. 2473 office 501. 321. 3592 fax scottseller@prodigy. net
Wilbur D. Mills Patricia Westfall O. D. Searcy Eye Care Center 410 W. Race Ave. Searcy, AR 72143 501. 268. 3577 office 501. 268. 5631 fax drweye@swbell. net
Ozark • • Sabre Wright O. D. Hubbard Eye Clinic 710 W. Nicholson Ave. Harrison, AR 72601 870. 741. 2787 office 870. 741. 6714 fax eyedoc 1@windstream. net
Western • Wanda Vaughn, O. D. • Arkansas Vision Development center • 1301 S. Waldron Rd Suite B • Fort Smith, AR 72903 • 479 -478 -8860 office • 479 -478 -8890 fax • arkansasvision@cox-internet. com
Northcentral • • • Kenny Wyatt, O. D. PO Box 1520 Mountain View, AR 72560 870 -269 -3191 phone 870 -269 -6820 fax eyeman@mvtel. net
PRACTICUM • CHNS will demonstrate the steps of the vision screening process • Return demonstration by each school nurse • Chance to ask questions (don’t be shy!) Now is the time to ask!
Wrap-Up • Post-test • A-TRAIN Instructions • Questions? ? ? ? ? ? ?
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