Vision Screening Basics for Health Assistants - PowerPoint PPT Presentation

Loading...

PPT – Vision Screening Basics for Health Assistants PowerPoint presentation | free to download - id: 57909e-NTIzO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Vision Screening Basics for Health Assistants

Description:

Vision Screening Basics for Health Assistants Charlotte Branch-Briggs, BSN, RN NMDOH NE Region School Health Advocate 505-476-2714 charlotte.branchbri_at_state.nm.us – PowerPoint PPT presentation

Number of Views:381
Avg rating:3.0/5.0
Slides: 49
Provided by: lau8238
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Vision Screening Basics for Health Assistants


1
Vision Screening Basics for Health Assistants
  • Charlotte Branch-Briggs, BSN, RN
  • NMDOH NE Region School Health Advocate
  • 505-476-2714
  • charlotte.branchbri_at_state.nm.us

2
Vision Development
  • By about 4-6 months of age, a child should be
    using both eyes together (binocular vision). At
    7 ½ to 8 years of age, the eye reaches optimum
    size for seeing and the brain has learned to
    interpret the information that the eye gives it.

3
NM School Health Manual, Section III
  • Recommended Screening Equipment
  • Room Set Up and Screening Environment
  • Recommended grades to screen
  • Recommended tests to perform

4
Who can do vision screening?
  • A school nurse trained in vision screening
    assessment
  • A Primary Care Health Provider
  • School nurse designee or lay eye screener trained
    in vision screening techniques

5
New Mexico Law
  • House Bill 1283 and Senate Bill 1149 passed into
    law in 2007
  • Defines who can perform vision screening
  • Targets screening for pre-kindergarten,
    kindergarten, first grade, third grade and for
    all transfer and new students unless a parent
    prohibits vision screening.

6
New Mexico Law cont
  • Created the Save Our Childrens Sight Fund for
    expenditures related to vision exams and glasses
    regardless of family income
  • Designated the Department of Health as
    responsible for the development and
    implementation of screening practice guidelines
    for children ages pre-k through 12th grade

7
EARLY DETECTION
  • The purpose of a vision screening program is
    early detection of common vision disorders such
    as refractive errors, amblyopia and strabismus.

8
Parent Permission for Screening
  • Always get parent permission or notify parents
    that their child will be screened.
  • Parents may request that child not be screened.

9
Vision Screening Guidelines
  • Grade levels to be screened yearly are
  • Pre-kindergarten
  • Kindergarten
  • 1st grade
  • 3rd grade
  • All students new to the district
  • Sp Ed. Students with IEP evaluations
  • SHM recommends 8th grade screening
  • Tests to be performed at screening
  • Far Vision any grade level
  • Random Dot E or Stereopsis only required once
    in target populations
  • Color Vision only required once in target
    populations

10
Creating a Screening Environment
11
Screening Room Set Up
  • Make sure the room has adequate light
  • The wall behind the chart should be plain white
    or a neutral color - a busy pattern behind the
    chart can distract the child while testing
  • Keep other students quiet while waiting to be
    screened to minimize distractibility of children
    being screened
  • Clearly mark where student should stand or sit
    for testing 10 feet from a 10 foot chart
  • The charts passing line should be placed at eye
    level

12
Equipment to Use for Screening
  • Pre-kindergarten and Kindergarten can use an HOTV
    or Lea symbol chart.
  • 1st grade can use letter chart or HOTV chart
    depending on their ability to accurately identify
    the letters.
  • All other grades should use letter charts.

13
Distance Charts
For testing at 10 feet
Actual 10 foot
Equivalent 20 foot
14
Equipment to use cont.
  • Random Dot E
  • Butterfly or fly stereopsis
  • Eye occluders

15
Before testing begins.....
  • Note if the child is wearing glasses
  • Are their eyes equal in appearance
  • Are their eyes clear are they red?
  • Crusty discharge?
  • Swollen/puffy eyelids?
  • Droopy eyelids?
  • Keyhole pupils?
  • Do the eyes move together?
  • Excessive tearing?
  • Jerky eye movements?
  • Pupil constricted or dilated?

Notify your school nurse if you see any of these
visual signs so that additional assessment can be
done!
16
Distance Screening
  • The child stands or sits 10 feet from the chart
    the childs heels should be on the 10 ft mark if
    standing, the back of chair should be at 10 ft
    line if sitting
  • For younger children, functional acuity should be
    done using both eyes to review testing procedures
    with the child
  • Ask the child if they wear glasses or contacts to
    help with distance or near vision test them
    with their glasses ON. Be sure to mark on the
    testing sheet that the child was tested WITH
    CORRECTION if wearing glasses
  • Start at the top of the chart and work your way
    down the chart you may skip lines if the child
    is moving along and understanding the directions.

17
Distance screening
  • Once you get to the passing line, move all the
    way across the line
  • Passing is when the child can correctly identify
    one more than half the letters on the line
  • Test one eye at a time by securing a cover over
    the left eye first using an occluder, disposable
    eye patch, small Dixie cup or paper cut out.
  • ALWAYS praise their response with great job ,
    good or yes
  • Do not let them know they missed a letter or ask
    them to try again
  • If they fail a line, move back up the chart until
    they can identify one more than have the line
    correctly.

18
What to look for in distance testing
  • Is the child turning their head or trying to look
    around the occluder?
  • Are they squinting?
  • Do they become easily distracted, anxious or
    fidgety when testing?
  • Are their eyes watery or tearing during testing?
  • Are they rubbing their eyes?

THESE ARE SIGNS THE CHILD IS STRUGGLING TO SEE
AND YOU SHOULD MOVE BACK UP THE CHART UNTIL THE
CHILD CAN PASS THE LINE WITHOUT SHOWING THESE
SIGNS.
19
Isolators
  • Using linear isolators is OK if the child is
    having difficulty focusing on the vision chart
    during screening
  • Letter isolators are not recommended as this
    increases the chance of missing amblyopia
  • SEE EXAMPLE NEXT SLIDE

20
Isolators
21
Random Dot E or Stereopsis
  • For children 3years to 3rd grade
  • Used to check for problems with depth perception
    indication of strabimus
  • Use Random Dot E when available
  • Place polarized glasses on child do not remove
    any prescription glasses if the child wears them,
    place to polarized glasses over the prescription
    glasses
  • Make sure the location is well lit and glare free
  • Be sure the child keeps their head straight no
    tilting to one side or allowing polarized glasses
    to tilt.

22
Random Dot E cont
  • At 20 inches away from the child, hold up the
    sample model E and ask child to identify object.
    If they can not identify letter, point at the
    figure and say thats an E
  • With the glasses still on, practice using the
    sample card and the blank card mixing up the
    cards behind your back, and present to the child
    4-5 times, asking them to identify the E each
    time.
  • Then replace the sample card with the stereo E
    card, repeat the steps above (you may need to
    rotate the cards up and down to pick up the light
    to give optimal viewing of the stereo image)
  • Move back 40 inches from the child and repeat
    last step.

23
Random Dot E cont
  • Pass if the child is able to point to the correct
    stereo E card at least 4 times at 20 inches and
    40 inches
  • Rescreen/Refer is the child can not distinguish
    the E figure in the RDE card at all, or can only
    see it when the card is approximately 20 inches
    or closer
  • ANY rescreens should be performed by the school
    nurse

24
Stereo Butterfly or Fly
  • For children 3 years to 3rd grade
  • Place polarized glasses on child over
    prescription glasses if applicable
  • Make sure child keeps head straight when viewing
    test plate.
  • Present the plate at a normal reading distance.
  • Ask the child what the figure is, if they can not
    identify the figure, ask the child to touch the
    butterflys wings

25
Stereo Butterfly or Fly cont
  • Pass the student is able to point to the
    butterfly wings above the page
  • Rescreen/Refer The child can not distinguish
    the butterfly figure in the stereo butterfly card
    or touches the page when trying to touch the
    wings
  • ANY rescreens should be performed by the school
    nurse

26
Color Vision Ishihara Plates
  • Test for Red/Green deficiencies, Blue/Yellow
    deficiencies more rare
  • Full test consists of 39 plates, but deficiency
    become apparent after just a few
  • No treatment for color blindness
  • Adequately lit room using day light
  • Hold about 30 inches from subject
  • Answers within 3 seconds
  • With both eyes uncovered, ask the student to
    identify the numbers or trace them with the Q-tip
    (Ishihara).
  • With the double numbers and small children, you
    may need to cover one and identify only one at a
    time.
  • Passing is a correct response on each slide.
  • McDowell is matching block colors in sequence.
  • Creamer color charts present 2 figures (star and
    circle) which may be easier for preschool or
    preliterate kids to identify.

27
Additional thoughts on Vision Screening
  • If a kindergartener fails vision screening at
    mass screening, bring child back to health office
    2 weeks later to rescreen privately
  • If any child fails the vision screen do not
    tell them YOU FAILED your vision test, instead
    say, Im going to have the nurse check my
    results and send them to the rescreening
    station, or call them back down to the health
    office at a later date.
  • Investigate whether or not the child is currently
    supposed to be wearing prescription glasses and
    where they are if the child did not bring them to
    screening.

28
Passing Guidelines
Passing Guidelines Vision If vision in either eye is WORSE that the limits below OR if the student has a 2 line difference or greater - then REFER for vision exam. Passing Guidelines Vision If vision in either eye is WORSE that the limits below OR if the student has a 2 line difference or greater - then REFER for vision exam. Passing Guidelines Vision If vision in either eye is WORSE that the limits below OR if the student has a 2 line difference or greater - then REFER for vision exam. Passing Guidelines Vision If vision in either eye is WORSE that the limits below OR if the student has a 2 line difference or greater - then REFER for vision exam. Passing Guidelines Vision If vision in either eye is WORSE that the limits below OR if the student has a 2 line difference or greater - then REFER for vision exam.
Grade Distance Distance Other Testing Other Testing
PK 20/40 20/40 Random Dot E and Color Vision required only once in any of the target population grades. Random Dot E and Color Vision required only once in any of the target population grades.
K 20/30 20/30 Random Dot E and Color Vision required only once in any of the target population grades. Random Dot E and Color Vision required only once in any of the target population grades.
1 20/30 20/30 Random Dot E and Color Vision required only once in any of the target population grades. Random Dot E and Color Vision required only once in any of the target population grades.
3 20/30 20/30 Random Dot E and Color Vision required only once in any of the target population grades. Random Dot E and Color Vision required only once in any of the target population grades.
Passing Guidelines - Hearing Passing Guidelines - Hearing Passing Guidelines - Hearing Passing Guidelines - Hearing Passing Guidelines - Hearing
1000 Hz 20 dB 1000 Hz 20 dB 2000 Hz 20 dB 2000 Hz 20 dB 4000 Hz 20 dB
29
(No Transcript)
30
Recheck and Referrals
  • A school nurse should recheck all vision fails
  • If the child has glasses that are broken or lost,
    there is no need for a second screening just
    have the nurse refer the student
  • Follow up with referrals after 4 weeks and again
    in 8 weeks
  • The school nurse may need to provide parent
    education and vision resources if they are
    non-compliant in taking their child for an exam.

31
RESOURCES for Glasses
  • Save Our Childrens Sight Fund thru DOH
  • Medicaid will pay for one eye exam and one pair
    of glasses per year
  • Childrens Medical Services for children w/o
    Medicaid and meet certain criteria
  • New Mexico Lions Operation KidSight active in
    certain communities and has limited resources for
    exams and glasses or uninsured or needy students.

32
RESOURCES cont
  • New Mexico School for the Blind and Visually
    Impaired fund for eyeglasses for children who
    are diagnosed with a visual impairment. This
    funding must be approved by legislature each
    year.
  • Pasty Irene Bennett Memorial Endowment Vision
    Care Program Fund only for APS students, pays
    for exams and glasses for APS students.
  • Sight for Students gift certificates through
    the NASN for exams and glasses. Only school nurse
    with current membership in NASN can receive gift
    certificates. There are financial qualifiers to
    use certificates.

33
Follow-up to Referrals
  • THE most important part of process.
  • THE most difficult part of process.
  • Make at least 2 phone calls.
  • Offer resources.
  • Document.

34
QUESTIONS?
35
Dental Screening
  • Section XIII of NM School Health Manual
  • Optional (as directed by district)

36
Dental Caries looks like......
37
(No Transcript)
38
Gum Disease looks like......
39
(No Transcript)
40
Oral Herpes (Cold Sore)
41
Canker Sore
42
Avulsed Tooth
43
Mouth lesions from chewing tobacco
44
Height and Weight Screening
  • Section XII of NM School Health Manual
  • Optional (as directed by district)

45
Growth Charts
  • If measuring, be consistent (remove shoes, hats,
    coats, sweatshirts, etc) and provide privacy.
  • When looking at heights and weights compare
    percentiles on the growth charts.
  • Use CDC growth charts which can be found at
  • www.cdc.gov/growthcharts/

46
CDC BMI Charts
47
(No Transcript)
48
Referrals for Elevated BMI
  • Does your district have a policy regarding BMI
    referrals?
  • Follow district guidelines.
About PowerShow.com