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

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

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

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

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

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

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

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

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

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

VISION SCREENING CERTIFICATION

School Nurse will be able to: • Assess knowledge of the vision law and

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

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

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

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

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

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

Parts of the Eye

Common Ocular Abnormalities

Common Ocular Abnormalities

Black Eye

Black Eye

Conjunctivitis

Conjunctivitis

 Blepharitis

Blepharitis

Chalazion

Chalazion

Stye

Stye

Entropion Of upper eyelid due to scarring Of lower eyelid

Entropion Of upper eyelid due to scarring Of lower eyelid

Dacryocystitis

Dacryocystitis

Ptosis

Ptosis

Coloboma

Coloboma

Coloboma

Coloboma

Cataract

Cataract

Strabismus Types • Tropia – Eyes which are always improperly aligned • Phoria –

Strabismus Types • Tropia – Eyes which are always improperly aligned • Phoria – Eyes which have a tendency to misalign when fusion is interrupted

Esotropia

Esotropia

Bilateral Esotropia

Bilateral Esotropia

Exotropia

Exotropia

Hypertropia

Hypertropia

Pseudostrabismus (also Pseudotropia or pseudoesotropia)

Pseudostrabismus (also Pseudotropia or pseudoesotropia)

Refractive Errors • Myopia (Nearsightedness) • Hyperopia (Farsightedness) • Astigmatism

Refractive Errors • Myopia (Nearsightedness) • Hyperopia (Farsightedness) • Astigmatism

Myopia

Myopia

Normal Vision

Normal Vision

Astigmatism

Astigmatism

Amblyopia: Definition • Vision that cannot be corrected to better than 20/40. • Unilateral

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 –

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

Amblyopia Therapy

Usher’s Syndrome • Hearing Loss and Retinitis Pigmentosa • Screen children with hearing loss

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

Resource Arkansas School for the Blind PO Box 668 Little Rock, AR. 72203 1 -800 -362 -4451 501 -683 -5104

Vision Screening

Vision Screening

Children to Screen Grades Pre K, K, 1, 2, 4, 6, 8 and all

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

Screening Procedure

Observation • Appearance • Behavior • Complaints

Observation • Appearance • Behavior • Complaints

Appearance • • • Whites Iris Pupil Lids Lashes Immediate referral if abnormal

Appearance • • • Whites Iris Pupil Lids Lashes Immediate referral if abnormal

Behavior • • Head tilt or turn Blinking or rubbing Avoiding close work Squinting/frowning

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

Complaints • Headaches • Nausea • Dizziness • Burning or itching • Blurring

Visual Acuity • Screen one eye at a time. – If a child wears

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

Wall Charts • Screen at 20 feet – Snellen Chart – Literate children •

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

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

Instrument Screenings • Titmus • Optec • Keystone

Lateral & Vertical Muscle Balance-Far (Titmus & Optec) • Right eye on; left eye

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

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

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

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 –Near Optec

Lateral Muscle Balance-Far Titmus & Optec

Lateral Muscle Balance-Far Titmus & Optec

Vertical 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 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

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

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

Vertical Muscle Balance Keystone Pass

Lateral Muscle Balance-Near Keystone • Use slide labeled ‘Lateral phoria – use at near

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

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

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

Binocular or Fusion-Far Titmus OV 7, Stereo Optec 2000

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 –

Binocular or Fusion. Far Titmus OV 7, Stereo Optec 2000 Both eyes open – screen pass

Binocular or Fusion-Far Titmus 2

Binocular or Fusion-Far Titmus 2

Binocular Vision - Far Titmus 2 A correct response with this screen is for

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

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

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 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

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

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

Color-Keystone

Color-Keystone

Re-screening

Re-screening

Why Rescreen? • Cuts down on over-referral. • Adds validity and parent confidence •

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

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

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

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

Data Entry • Vision screening data is entered into APSCNe. School+ • Data queries

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

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. ,

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

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

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.

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

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

RESOURCES Free resources: • http: //www. nei. nih. gov

Northwest Darren Brodie O. D. Boozman-Hof Eye Clinic P. O. Box 1353 Rogers, AR

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,

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

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,

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

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

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

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

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.

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.

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

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

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? ? ? ? ? ? ?

Wrap-Up • Post-test • A-TRAIN Instructions • Questions? ? ? ? ? ? ?