CHDP PEDIATRIC VISION SCREENING

1 chdp PEDIATRIC VISION SCREENING Child Health and Disability Prevention ( chdp ) ProgramSystems of Care Division (SCD)California Department of Health Care ServicesAdapted by Los Angeles County chdp Program chdp VISION SCREENING Training 2019 Learning Objectives Understand the importance of VISION SCREENING duringchildhood. Become aware of eye problems that affect VISION . Describe and implement the chdp program guidelines forreferral and follow-up. Identify the steps of VISION SCREENING and VISION SCREENING Training 2019 Why Perform VISION SCREENING ? Recommended as part of the American Academy of Pediatrics BrightFutures Periodicity Schedule= Risk Assessment= Perform VISION SCREENING 3 chdp VISION SCREENING Training 2019 Why Perform VISION SCREENING ? Recommended as part of the American Academy of Pediatrics BrightFutures Periodicity Schedule= Risk Assessment= Perform VISION SCREENING 4 chdp VISION SCREENING Training 2019 INFANCY EARLY CHILDHOOD AGE NB 3-5 day By 1 mo 2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo 30 mo 3 y 4y VISION MIDDLE CHILDHOOD ADOLESCENCE AGE 5y 6y 7y 8y 9y 10y 11y 12y 13y 14y 15y 16y 17y 18y 19y 20y 21y VISION Bright Futures Pre-visit Questionnaire* Perform risk assessment using the Bright Futures Pre-visit Questionnaire on the following ages:-0 -35 months, 7y, 9y, 11y, 13-14y, and 16-21ySample Pre-visit Questionnaire for a 7-year-oldA positive risk assessment will require a VISION SCREENING * The following Bright Futures Tool and Resource Kitmaterials are available for download for review and reference purposes only.

2 For any other use, to make multiple copies of specific items, or to incorporate forms into an Electronic Medical RecordSystem, please contact VISION SCREENING Training 2019 Why Perform VISION SCREENING ?Primary Care Clinics and Schools: The first line of defense to detect preventable VISION lossin detection of amblyopia - lazy eye 6 chdp VISION SCREENING Training 2019 Amblyopia Amblyopia is the leading cause of VISION loss amongchildren. Eyes and brain are not working together. One eye sees a blurred view and the other a normal brain only processes the normal VISION SCREENING Training 2019 AmblyopiaAmblyopia can only develop during childhood. If not treated in childhood,amblyopia may result in permanentvision loss. The most common cause of visionloss in adults 20-70 years of age isuntreated childhood VISION SCREENING Training 2019 AmblyopiaCommon causes are: Untreated or unequal refractive errors (nearsighted,farsighted, astigmatism) Strabismus crossed eyes Obstruction ( ptosis, cataract)9 chdp VISION SCREENING Training 2019 Common Causes of of refractive nearsighted : does not see objects well atfar distances10 chdp VISION SCREENING Training 2019 Common Causes of of refractive errorsb.

3 Hyperopia farsighted : does not see objects wellat close distances11 chdp VISION SCREENING Training 2019 Common Causes of of refractive errorsc. Astigmatism: an irregular curve in the eye causingblurry VISION at all distances12 chdp VISION SCREENING Training 2019 Common Causes of Amblyopia crossed eyes : misalignment of theeyes One or both eyes turning inward One or both eyes turning outward One eye turning up or down May have double vision13 chdp VISION SCREENING Training 2019 Common Causes of : drooping of an eyelid due to a weak lid muscle. May obstruct VISION Look for chin elevation in these VISION SCREENING Training 2019 Common Causes of Cataract: condition in which the lens of the eyebecomes progressively cloudy, resulting in VISION SCREENING Training 2019 SCREENING Early is Best National Eye Institute (NEI) Amblyopia affects 2-3% of children in the United States.

4 About million children with preventable VISION loss. Amblyopia is harder to treat after 5 years of age. By 7 years of age, some VISION loss from amblyopia may VISION SCREENING Training 2019 Treatment for Amblyopia Correcting the refractive error with consistent use of glassesand/or contact lenses Enable child to see as clearly as possible ( removing acataract) Forcing the child to use the weaker eye (via patching or eye dropsto blur the better eye) chdp VISION SCREENING Training 201917 Visual Acuity SCREENING GuidelinesAmerican Academy of Pediatrics Policy StatementPediatricsJanuary 2016 Visual acuity SCREENING using eye charts remains the goldstandard. It can begin as early as 3 years of age. SCREENING with a tool such as a photoscreenerisrecommended for children 12 months of age and olderunlessthey can reliably perform visual acuity screeningwith eye VISION SCREENING Training 2019 Newborn to 35 Months (0-3 years)Procedures for the Evaluation of the Visual SystemPediatricsJanuary 2016 Take a health history: Are there eye problems in close relatives?

5 Check VISION (tracking), eye movement (motility) and alignment (strabismus) Check pupils and red reflexes (round, equal, bright)NOTE: This assessment can also be done on older children of any age with developmental VISION SCREENING Training 2019 Ages 3 through 5 yearsRecommended Chart TypesLEAS ymbols 21 Response cardCHDP VISION SCREENING Training 2019 Ages 3 through 5 yearsRecommended Chart TypesHOTV Chart 22 Response cardCHDP VISION SCREENING Training 2019 Age-Dependent Pass guidelines NewAAP guidelines : 3 years old: the critical line to pass SCREENING is the 20/50 (10/25)line. 4 years old: the critical line to pass SCREENING is the 20/40(10/20) line. 5 years and older: the critical line to pass SCREENING is 20/32 (10/16)or 20/30 (10/15) line depending on the chart VISION SCREENING Training 20193 Year Visit: 36 to 47 Months Must be able to identify themajority of the 20/50 (10/25)line with each eye.

6 Recommended screeningdistance is 10-feet using a10-foot chart. Opposite eye must be VISION SCREENING Training 20194 Year Visit: 48 to 59 Months Must be able to identify themajority of the 20/40 (10/20)line with each eye. Recommended screeningdistance is 10-feet using a10-foot chart. Opposite eye must be VISION SCREENING Training 20195 Years and OlderSloan Letters Chart (Preferred)Snellen Letters Chart26 chdp VISION SCREENING Training 20195 Years and Older Use Sloan or Snellen letters for children who know their letters. Sloan letters chart is preferred over the Snellen letters chartCHDP VISION SCREENING Training 2019275 Years and Older Must be able to identify witheach eye the majority of: 20/32 (10/16) or 20/30(10/15) line depending on the chart used. For children who do not know their letters, use the LEA symbols chart, or the HOTV chart.

7 chdp VISION SCREENING Training 20192820/325 Years and Older Recommended SCREENING distance is 10-feet using a 10-foot chart. Fully cover opposite eye. Repeat SCREENING every 1-2 years. Risk assessment should be done when SCREENING is not SCREENING AT 10 FEET29 chdp VISION SCREENING Training 2019 American Association for PEDIATRIC Ophthalmology and Strabismus (AAPOS) VISION SCREENING Kit Acuity charts for threshold orcritical line SCREENING : Sloan letters LEA symbols or HOTV chart Occluders: patches/glasses/paddle 10 foot measuring cord Matching response card Informational DVD30 chdp VISION SCREENING Training 2019 Threshold and Critical Line OptionsThresholdCritical Line31 chdp VISION SCREENING Training 2019 Threshold SCREENING Reading down the eye chart as faras possible. Threshold line is the smallest linechild can pass. Can identify two-line differencebetween the eyes.

8 Refer for two-line differencebetween the eyes, even within thepassing VISION SCREENING Training 2019 Critical Line SCREENING : FASTER Critical line is defined as the line a child is expected to see normally andpass for that age. Each chart has two boxed critical lines -one for each eye. The top lineof large symbols/letters is for practice before starting SCREENING . The child only reads a single critical line with each eye. This method cannot identify two-line difference between the VISION SCREENING Training 2019 VISION SCREENING Charts NOTR ecommendedTumbling E ChartKinder ChartAllen CardsHouse Apple Umbrella ChartLandolt C Chart34 chdp VISION SCREENING Training 2019 Occlude to Prevent PeekingAcceptableNot RecommendedOnly for age 10 years and olderRecommended*2-inch wide hypoallergenic tape* Assess for allergies to tape prior to placement35 chdp VISION SCREENING Training 2019 Key Points Crowding bars Crowding bars make individual symbols/letters more difficult to identify whenamblyopia is present.

9 Use eye charts with lines of symbols/letters or matching cards with lines(crowding bars) around each symbol/letter to obtain the most accurate visualacuity VISION SCREENING Training 2019 Key Points SCREENING line: marked at 10(or 20)-feet on the floor. SCREENING line is midline tochart. Child should stand with archof each foot on the line. VISION SCREENING area Out of traffic area Have adequate lightingSCREENING LINESCREENING LINE10 or 20 FEET37 chdp VISION SCREENING Training 2019 Key Points Adjust eye chart with the referral line close to the child s eye level. Each eye should be screened separately. Either critical line or threshold SCREENING may be VISION SCREENING Training 2019 Automatic Referral for Eye ExamChildren with the following disorders should bypass SCREENING and should be referred directly to an eye eye disorders ( strabismus, ptosis) neurodevelopmental disorders: Hearing impairment Motor abnormalities ( cerebral palsy) Down Syndrome Cognitive impairment Autism spectrum disorder Speech delay39 chdp VISION SCREENING Training 2019 Automatic Referral for Eye diseases present ( diabetes, sickle cell disease, hypertension) medications known to cause eye relative with strabismus or.

10 Less than 32 weeks of believes child has VISION problem40 chdp VISION SCREENING Training 2019 Visual Acuity Results Threshold Pass/Fail Criteria 41 chdp VISION SCREENING Training 2019 AGEPASSFAIL and REFER, or RESCREEN WITHIN 6 MONTHSDOCUMENTATION3 yearsLEA/HOTV:Correctly identified at least 3 of 5 symbols on 20/50 line or betterMissed 3 or more symbols on 20/50 line or worseTwo-line difference between the eyes, even within the passing range ( 20/20 and 20/32)Visual acuity to document is 20/63 or worse4 yearsLEA/HOTV:Correctly identified at least 3 of 5 symbols on 20/40 line or betterMissed 3 or more symbols on 20/40 line or worseTwo-line difference between the eyes,even within the passing range ( 20/20 and 20/32)Visual acuity to document is 20/50 or worse5 years and olderLEA/HOTV/Sloan:Correctly identified at least 3 of 5 symbols/letters on 20/32 (or 20/30) line or betterMissed 3 or more symbols/letters on 20/32 (or 20/30) line or worseTwo-line difference between the eyes, even within the passing range ( 20/20 and 20/32)Visual acuity to document is 20/40 or worseSnellen ONLY: Correctly identified one more than half the letters on the 20/30 line or betterSnellen ONLY.