The National Center for Children’s Vision and Eye Health at Prevent Blindness has partnered with the NASN to provide national guidance for school nurses and others involved in front-line vision screening. The goal is to standardize approaches to vision health, facilitate follow-up eye care for students who do not pass vision screening, provide family/caregiver friendly educational information, and consult with leading pediatric eye care providers to promote best practices.
The content on this page is organized according to the 12 Components of a Strong Vision Health System of Care.
Vision impairments in children are common and uncorrected vision problems can impair child development, lead to behavior problems in the classroom, interfere with early literacy and learning, and lead to permanent vision loss.i,ii,iii,iv,v Early detection, treatment, and ongoing care is critical.vi,vii,viii,ix,x Additionally, visual functioning is a strong predictor of academic performance in school-age children,xi,xii and vision disorders of childhood may continue to affect health and well-being throughout the adult years.xiii
With the focus on prevention, the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health Report Recommendations (2010), directs registered nurses to provide care within the full scope of their license. A comprehensive vision health program is a school nurse intervention that makes a significant measurable difference in a student’s overall health and learning.
12 Components of a Strong Vision Health System of Care
1. Family Education
All parents/caregivers should receive culturally competent educational materials with appropriate reading levels. The materials explain why scheduling and attending an eye examination when a student does not pass his/her vision screening is important for good vision now and in the future, and the increased risk for vision problems in defined high-risk populations.
A Glossary of Eye and Vision Terms: English
A Glossary of Eye and Vision Terms: Spanish
Parent/Caregiver Resources: Small Steps for Big Vision: An Eye Health Information Tool Kit
Vision Screening Is Key to Healthy Development! English
Vision Screening is Key to Healthy Development! Spanish
Focus on Eye Health and Culturally Diverse Populations
Signs of Possible Vision Problems in Children: English
Signs of Possible Vision Problems in Children: Spanish
The Affordable Care Act and Your Child’s Eyes: English
The Affordable Care Act and Your Child's Eyes: Spanish
Star Pupils Eye Health and Safety Curriculum (grades K-2, 3-5, and 6-8)
Developing Eyes Video (A parent discusses the importance of vision screening.)
2. Comprehensive Communication/Approval Process
Facilitate parents’/caretakers’ completing and signing a HIPAA/FERPA-compliant release permitting exchange of vision screening and eye examination information among appropriate healthcare providers to support reciprocal access to and follow-up from eye care. This release will help school nurses ensure vision treatment plans are implemented at school and to talk to eye care providers when treatment plans are unclear.
Referral for an Eye Examination letter with release of information: English
Referral for an Eye Examination letter with release of information: Spanish
3. Vision Screening Tools and Procedures
Screen student’s vision with age-appropriate, evidence-based tools and procedures, including optotypes (symbols, letters, or numbers) and/or instruments.
Considerations for Children's Vision Screening Programs During the Covid-19 Pandemic
Presentation: Why Do We Screen Vision in Young Children?
Common Early Childhood Vision Disorders: English
Common Early Childhood Vision Disorders: Spanish
Signs of Possible Vision Problems in Children: English
Signs of Possible Vision Problems in Children: Spanish
Ages at Which Vision Screening Should Occur
Characteristics of Tests of Recognition of Visual Acuity for Screening the Vision of Children Ages 3-5 years (36 to <72 months)
Tips for Appropriate Eye Chart Design
Evidence-based Vision Screening Tools and Procedures: English
Evidence-based Vision Screening Tools and Procedures: Spanish
Referral Criteria for Optotype-Based Screening
Prevent Blindness Position Statement on School-Aged Vision Screening and Eye Health Programs
18 Vision Development Milestones From Birth to Baby’s First Birthday: English
18 Vision Development Milestones From Birth to Baby’s First Birthday: Spanish [Spanish]
4. Vision Health for Children with Special Health Care Needs (CSHCN)
Implementing policies and procedures for referral and support for visual health of children with special health care needs.
Children Who Should Bypass Vision Screening for an Eye Examination
Children with ADHD at Higher Risk for Vision Disorders
5. Standardized Approach for Re-Screening
Establish standards for the vision health program that directs the re-screening or referral of difficult-to-screen (untestable or unable) children.
Flowchart for Children Who Receive a Vision Screening
Referral for an Eye Examination: English (letter with release of information)
Referral for an Eye Examination: Spanish (letter with release of information)
6. Comprehensive Vision Screening Results
Provide parents/caregivers with vision screening results in easy-to-understand language, which respects cultural and literacy needs and provides clearly defined next steps and timelines. Results should be communicated in writing and verbally; parents/caregivers may lack time to review all backpack documents.
Mattey, B., Zein, W.M., O’Malley, D., & Naron, C. (2013). Preventing vision loss among students through eye safety and early detection. NASN School Nurse, 28(5), 233-236. doi:10.1177/1942602X13497062
7. Systemized Approach to Follow-Up
Implement/facilitate a follow-up system with parents/caregivers following a failed vision screening, which includes creating a system to monitor whether eye examinations occurred and identifying barriers to follow-up eye care and ways to overcome those barriers, such as lack of transportation or assistance with paying the cost of an eye examination.
Marsh-Tootle, W.L., Russ, S.A., & Repka, M.X. (2015). Vision and eye health in children 36 to <72 months: Proposed data definitions. Optometry and Vision Science, 92(1), 17-23. doi: 1040- 5488/15/9201- 0017/0 17Y23. Retrieved from https://www.researchgate.net/publication/270663059_Vision_and_Eye_Health_in_Children_36_to_72_Months
Hartmann, E.E., Block, S.S., & Wallace, D.K. (2015). Vision and eye health in children 36 to 72 months: Proposed data system. Optometry and Vision Science, 92(1), 24-30. doi: 1040-5488/15/9201-0024/0. Retrieved from https://www.healthit.gov/sites/default/files/comments_upload/vision_and_eye_health_in_children_36_to_72.98810.pdf
See Jane See! Parental Advice for Healthy Vision in Kids (NOTE: prevalence is 1 in 17 -- resource states 1 in 20)
8. Resources for Eye Care
Link parents/caregivers with resources for eye care and seek out eye care providers who specialize in the care and treatment of young children.
Sight for Students® Gift Certificate Program
Learn more about Sight for Students®.
Enroll in Sight for Students® to receive gift certificates. (NASN member login required.)
Financial Assistance Information: English
Financial Assistance Information: Spanish
How to Schedule an Eye Examination: English
How to Schedule an Eye Examination: Spanish
9. Collect Eye Examination Results
Collect eye examination results to help ensure treatment plans are implemented at school and share treatment plans with teachers who may need to make classrooms accommodations.
Template for Collecting Eye Examination Results: English 2nd page
Template for Collecting Eye Examination Results: Spanish 2nd page
10. Effective Communication with the Medical Home
Keep the medical home informed by sending a copy of eye examination results to the child’s primary care provider.
Vision Screening is Key to Healthy Development: English
Vision Screening is Key to Healthy Development: Spanish
Vision Screening is Key to Healthy Development: Chinese
11. Adherence to Treatment
Have a process in place to facilitate the eye care treatment plan prescribed for a student. For example, if a student with patching for amblyopia is required to patch at school, you need to know when and duration. Share this information with the student's teacher(s).
The Eyes That Thrive program to support vision treatment adherence in the classroom.
Information to share with parents/caregivers about their role as part of the eye care health team:
Eye Patch Choices
12. Annual Vision Health Program Evaluation
Evaluating the vision health program annually includes comparing screening and eye examination results to determine whether over-referrals are excessive and screening tools and/or procedures should be reviewed.
Annual Vision Health Program Evaluation Checklist
Atkinson, J., Anker, S., Nardini, M., Braddick, O., Hughes, C., Rae, S., Wattam-Bell, J., & Atkinson, S. (2002). Infant vision screening predicts failures on motor and cognitive tests up to school age. Strabismus, 10(3), 187–198. http://lynnhellerstein.com/wp-content/uploads/2013/03/Infant-vision-screening-predicts-failures.pdf
Cotter, S.A., Cyert, L.A., Miller, J.M., & Quinn, G.E. (2015). Vision Screening for Children 36 to <72 Months: Recommended Practices. Optometry and Vision Science, 92(1), 6-16. doi: 1040- 5488/15/9201- 0006/0. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274336/pdf/opx-92-06.pdf
Donahue, S.P., Baker, C.N., Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology (2016). Procedures for the evaluation of the visual system by pediatricians. Pediatrics, 137(1), e20153597. http://pediatrics.aappublications.org/content/pediatrics/early/2015/12/07/peds.2015-3597.full.pdf; [Note, this citation contains preferred practices for vision screening in the clinical setting, not the educational setting. Use caution when deciding to use these recommendations in a non-clinical setting.]
Holmes, J.M., Lazar, E.L., Melia, B.M., Astle, W.F., Dagi, L.R., Donahue, S.P., Weise, K.K. (2011). Effect of age on response to amblyopia treatment in children. Archives of Ophthalmology, 129(11), 1451-1457. doi: 10.1001/archophthalmol.2011.179. http://archopht.jamanetwork.com/article.aspx?articleid=1106477
Ibironke, J.O., Friedman, D.S., Repka, M.X., Katz, J., Giordano, L., Hawse, P., & Tielsch, J.M. (2011). Child development and refractive errors in preschool children. Optometry & Vision Science, 88(2), 181-187. doi:10.1097/OPX.0b013e318204509b. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079532/pdf/nihms259842.pdf
Nottingham Chaplin, P. K., Baldonado, K., Hutchinson, A., & Moore, B. (2015). Vision and eye health: Moving into the digital age with instrument-based vision screening . NASN School Nurse, 30(3), 154-60. doi: 10.1177/1942602X15581054
Nottingham Chaplin, P.K. & Bradford, G.E. (2011). A historical review of distance vision screening eye charts: What to toss and what to keep, and what to replace . NASN School Nurse, 26(4), 221-222. doi: 10.1177/1942602X11411094
Roch-Levecq, A.C., Brody, B.L., Thomas, R.G., Brown, S.L. (2008). Ametropia, preschoolers' cognitive abilities, and effects of spectacle correction. Archives of Ophthalmology, 126(2), 252- 258. doi: 10.1001/archophthalmol.2007.36. http://archopht.jamanetwork.com/article.aspx?articleid=420351
U.S. Preventive Services Task Force. (2017). Vision in children aged 6 months to 5 years: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/vision-in-children-ages-6-months-to-5-years-screening
Challenges with Commonly Used Tests of Visual Acuity (Eye Charts) for Optotype-Based Screening
Pink Eye Resources from American Academy of Ophthalmology:
Eye Smart resources
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health; Welp A, Woodbury RB, McCoy MA, et al., editors. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington (DC): National Academies Press (US); 2016 Sep 15. 7, Toward a High-Quality Clinical Eye and Vision Service Delivery System. https://www.ncbi.nlm.nih.gov/books/NBK402378/.
Special thanks and appreciation to P. Kay Nottingham Chaplin, EdD, Kira Baldonado, MPH, and Prevent Blindness through the National Center for Children’s Vision and Eye Health.
Technical Assistance available from the National Center for Children’s Vision and Eye Health at Prevent Blindness; 225 West Wacker Drive; Suite 400 Chicago, IL 60606; 1-800-331-2020; firstname.lastname@example.org
Background Information References
iCollins, M. E., Mudie, L. I., Inns, A. J., & Repka, M. X. (2017). Pediatric ophthalmology and childhood reading difficulties: Overview of reading development and assessments for the pediatric ophthalmologist. Journal of AAPOS, 21(6), 443-436. Abstract available at https://www.ncbi.nlm.nih.gov/pubmed/?term=Overview+of+reading+development+and+assessments+for+the+pediatric+ophthalmologist
iiNational Academies of Sciences, Engineering, and Medicine (2016). Making eye health a population health imperative: Vision for tomorrow. Washington, DC: The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK385157/
iiiPeterseim, M. M., Papa, C. E., Parades, C., Davidson, J., Sturges, A., Oslin, C., Merritt, I., & Morrison, M. (2015). Combining automated vision screening with on-site examinations in 23 schools: ReFocus on Children Program 2012 to 2013. Journal of Pediatric Ophthalmology & Strabismus, 52(1), 20-24. https://doi.org/10.3928/01913913-20141124-01
ivNational Center for Children's Vision and Eye Health at Prevent Blindness. (2020). Children’s vision and eye health: A snapshot of current national issues (2nd ed.). Chicago, IL: National Center for Children’s Vision and Eye Health at Prevent Blindness. https://preventblindness.org/wp-content/uploads/2020/07/Snapshot-Report-2020condensedF.pdf
vVIP-HIP Study Group, Kulp, M. T., Ciner, E., Maguire, M., Moore, B., Pentimonti, J., . . . Ying, G. (2016). Uncorrected hyperopia and preschool early literacy: Results of the Vision in Preschoolers – Hyperopia In Preschoolers (VIP-HIP) Study. Ophthalmology, 123(4), 681-689. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808323/
viWen G, McKean-Cowdin R, Varma R, et al. (2011) General Health-Related Quality of Life in Preschool Children with Strabismus or Amblyopia. Ophthalmology, 2011;118(3):574-580. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017225/
viiRoche-Levecq A, Brody BL, Thomas RG, Brown SI. (2008) Ametropia, Preschoolers’ Cognitive Abilities, and Effects of Spectacle Correction. Archives of Ophthalmology, 2008;126(2):252-258. https://doi.org/10.1001/archophthalmol.2007.36
viiiAtkinson J, Anker S, Nardini M, et al. (2002) Infant Vision Screening Predicts Failures on Motor and Cognitive Tests up to School Age. Strabismus, 2002;10(3);187-198. https://doi.org/10.1076/stra.10.3.187.8125
ixIbironke JO, Friedman DS, Repka MX, et al. Child Development and Refractive Errors in Preschool Children. (2011) Optometry and Vision Science, 2011;88(2):181-187.
xJonas, D. E., Amick, H. R., Wallace, I. F., Feltner, C., Vander Schaaf, E. B., Brown, C. L., & Baker, C. (2017). Vision screening in children ages 6 months to 5 years: Evidence report and systematic review for US Preventive Services Task Force. Evidence Synthesis No. 153. AHRQ Publication No. 17-05228-EF-1. Rockville, MD: Agency for Healthcare Research and Quality. https://jamanetwork.com/journals/jama/article-abstract/2652656
xiMaples WC. Visual Factors That Significantly Impact Academic Performance. Optometry, 2003;74(1):35-49. https://pubmed.ncbi.nlm.nih.gov/12539891/
xiiBasch CE. Vision and the Achievement Gap among Urban Minority Youth. Journal of School Health, 2011;81(10);599-605. https://doi.org/10.1111/j.1746-1561.2011.00633.x
xiiiDavidon S, Quinn GE. The Impact of Pediatric Vision Disorders in Adulthood. Pediatrics, 2011;127(2):334-339. https://doi.org/10.1542/peds.2010-1911
Page last updated September 2021.