05-071 C.M.R. ch. 45, § 4 - Vision Screening

Current through 2022-14, April 6, 2022

A. A school shall screen using evidence-based, optotype-based screening, or evidence- based, instrument-based screening.
B. Certain children should bypass vision screening and be referred directly to an eye specialist for a comprehensive examination because these children have a higher rate of vision problems. The school nurse may determine which children should be referred directly. Some reasons for bypass may include:
i. readily recognized eye abnormalities such as, but not limited to, strabismus or ptosis;
ii. a known diagnosis of a neurodevelopmental disorder such as hearing impairment, cerebral palsy, autism spectrum disorders, or speech delay;
iii. systemic diseases known to have associated eye disorders such as diabetes and juvenile rheumatoid arthritis.
C. Children who received a comprehensive eye examination from an eye care provider within the previous 12 months do not need to have a school vision screening.
D. Distance vision acuity
i. Shall be screened in preschool, kindergarten and grades, 1, 3, 5, 7, and 9.
ii. The screening tools recommended for preschool, kindergarten, and grade 1 unless students know their letters are:
1. HOTV chart (illuminated preferred, critical line screening is permissible;
2. LEA SYMBOLS® chart (illuminated preferred, critical line screening permissible);
3. Computer-based screening programs.
iii. Screening tools recommended for students in grades 3 and above are:
1. Sloan letter chart (illuminated preferred, charts exceeding 9x14 is permissible);
2. Computer-based screening programs.
iv. Screening distance between the chart and the child's eyes should be at the appropriate distance for the chart or tool used.
v. Referral guidelines
1. Age 3, unable to correctly identify at least 3 of 5 optotypes on 20/50 line;
2. Age 4-5, unable to correctly identify 3 of 5 optotypes on the 20/40 line;
3 Age 6 and older, unable to correctly identify at least 3 of 5 optotypes on the 20/32 line;
4 If using a full threshold screening method, children who have a 2-line difference between the eyes, even in the passing lines, are to be referred for an eye exam.
E. Near vision acuity
i. shall be screened in grade 1 and 3. It is recommended that public preschool and kindergarten students and students in grade 5 also be screened.
ii. Screening tools recommended depending on when the child knows their letters are.
1. Near vision acuity card with 16-inch cord to maintain screening distance using: HOTV chart, LEA SYMBOLS® chart, Sloan Letters chart.
iii. Referral guidelines: The same criteria used for distance vision, will be used to determine for near vision acuity cards.
F. Instrument-based screening may be used in place of visual acuity screenings with children ages 3, 4, and 5 years and children of any age when these children cannot participate in optotype-based vision screening. Using instrument-based screening with older students will be permissible as additional published research in this age group emerges.
G. For those students with prescription glasses, screening should occur with student wearing glasses.
H. Students who fail the vision screening will be referred to their parents and provided with a referral form to bring to their health care provider or eye specialist.


05-071 C.M.R. ch. 45, § 4

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