Vision Screening Program

1. Vision Screening Program Cobb County School District 2014-2015

2. Vision Consultant • Dr. Ivo Horak • 735 Windy Hill Rd. Smyrna, GA 30080 • 770-436-9123 (office) • ivohorak@bellsouth.net • www.youreyesrus.com

3. MAP to Dr. Horak’s Office – pg. 2 Feel free to copy/share with parents.

4. Vision Screening Program • Supervisor Heidi.Evans@cobbk12.org • Education program specialists LeAnn.Barnes@cobbk12.org Teresa.Vento@cobbk12.org

5. What to do first? DISCARD ALL OF YOUR OLD SCREENING MANUALS AND USE ONLY THE CURRENT YEAR’S MANUAL.

6. DON’T USE THIS EYE CHART…….

7. Common Vision Terminology • 20/20 • You can see clearly at 20 ft what should normally be seen at 20 ft. • Average Vision – NOT Perfect Vision • 20/100 • You have to be at 20 ft to see clearly what should normally be seen at 100 ft. • 20/15 • Better than 20/20! • You can see clearly at 20 ft what should normally be seen at 15 ft.

8. Common Vision Problems Near Sightedness/Myopia Far Sightedness/Hyperopia • Objects up close are clear • Objects far away are blurry • Objects up close are blurry • Objects far away are clear

9. Common Vision Problems Astigmatism Presbyopia • All objects near and far are distorted • The eye can no longer focus up close

10. Amblyopia or Lazy Eye Vision in one eye is weaker than other. The brain suppresses the weaker eye and uses the good eye Usually develops before age 6 6,7 critical age for foveal development Tx: patching, Sx Strabismus or Crossed Eye One or both eyes turn in,out, up, or down due to weak muscle control Can develop as late as age 6 Common Vision Problems

11. Vision Screening Program • We are trying to detect students who may have a vision disorder to refer for further care. • It is estimated up to 25% of school age children have undetected, treatable vision problems that can interfere with learning. • A child with an undetected or untreated vision problem is more likely to develop social or emotional problems. Thus, a child's vision problems can affect not only their own learning, but that of their peers.  Vision screening empowers organizations to ensure children have the opportunity to reach their full potential

12. NOTE: • If a child has an excessively red eye (or eyes), or crusting on the eyelashes or eyelids • DO NOT SCREEN the child. Send home the V1 letter, and mark the child as “fail” for the vision screening. • Child needs medical attention.

13. Digital Eye Strain • Digital devices are putting stress on the visual system • Back lit LED screens • Smart phones started 6 years ago • Tablets are 3 years old • 40% of 3rd-12th grade own a tablet • 40% of college students use tablets as their main computer • 35% of US population own tablet and 60% own a smartphone • Causes children to constantly converge and diverge eyes while trying to focus on the screen--leads to starring --->decreased blink rate • Children are using technology at a younger age, and small children hold things closer to their eyes

14. Digital Eye Strain- con’t Symptoms of Digital Eye Strain -fluctuating vision, decreased concentration -dry eyes -red eyes -burning eyes, fatigue **Eyes get locked into over-focusing. Child may be wearing wrong Rx. ie: false myopia -exam often done after child playing on tablet/phone in waiting room Recommend the 20-20-20 rule

15. High Energy Blue Light Found in LED bulbs and also emitted from tablets -Different wavelengths of visible light focus on different parts of retina -Blue light stresses the focusing system Melatonin tells brain that we need to sleep Blue light suppress Melatonin->decreased sleep->disrupted circadian rhythms -->obesity, fluctuating moods-hormonal changes.-->decreased learning Recommend to stop using Tablets 1-2 hours before bedtime.

16. Vision Screening Program • Who do we screen (for the MASS screening)? • Grades 1, 4, 7, & 10

17. Vision Screening Program • NOT a substitute for routine vision care. • NOT a diagnostic procedure; does not determine whether glasses will be needed. • Children should see an Optometrist or Ophthalmologist before K. • Annual eye exams are recommended for kids with glasses and/or contacts. • Children who do not wear corrective eye wear should also have an eye exam every year.

18. Vision Screening Program • All new students need a completed Certificate of Ear, Eye, and Dental Examination (Form 3300) on file • Completing a 3300 form is NOT part of mass screening program –Parents should provide this (from the doctor or health department) • Remember – this is for NEW STUDENTS – only ONE From 3300 is required to be on file.

19. Screening Procedures • Methods: HOTV or Titmus or Lea Symbols • If student initially fails, retest within 2 weeks • Fails a 2nd time, parents notified with letter V-1 • Parents can • Take child for eye exam • Take child for re-screening with Dr. Horak, Dr. Davison, Dr. Mobley, or Dr. Schirack at no charge • PARENTS ARE RESPONSIBLE FOR COSTS OF FULL EXAM

20. Form V1. Pg 18 & 19 (spanish) V-1 Form

21. ABC’s of Detection Appearance Signs: Eyes crossed Droopy lids or Swollen lids Unequal pupils Pink eye / watery eyes Eyes in constant motion Behavior Signs: Rigid body while viewing distant objects Tilting head Rubbing eyes Excessive blinking Squinting Complaint Signs: Eyes burn / itch Seeing double Unusual light sensitivity Headaches Letters jump together

22. Screening Procedures If a child wears glasses perform the screening with the glasses on. If child fails WITH glasses, the glasses may be for reading – try screening without glasses. Screening Challenges Shy or Frightened Learning disability First Language not English Hearing Loss Malingering vs Hysteria

23. Screening Techniques Titmus Machine HOTV and LEA Charts • Screens for distance vision only • Overlooks farsightedness • Efficient • Less costly • Can screen for both distance & near vision • Can Test muscle coordination • Can test color vision • More time consuming • ONLY DISTANCE IS REQUIRED FOR MASS SCREENING

24. Form V2 Page 16 in Manual Spanish version on Page 17

25. HOTV Testing (Preferred method) • If you need more charts: • HOTV charts available at www.bernell.com or www.macgill.com or • www.preventblindness.org • EACH eye must pass in order for student to pass the screening.

26. FYI Schedule visual screenings early to maximize learning potential. Use index cards as occluders (not hands) Cut a curved edge on index cards, so as not to poke students in the eye! Make sure both eyes are open to prevent squinting Check each wall chart for proper screening distance. Be aware of potential letter memorization (Allow only one student in the screening area at a time) Create a comfortable environment with adequate lighting to minimize distraction Minimize cross-contamination (use a fresh index card for each student, then discard the card.)

27. HOTV Testing • Child points to matching stimulus card (or simply says the name of the letter) as adult points to each letter in the row. • Place chart at eye level from floor (eye level depends on the age/height of the students being screened) • 20/40 line – K & 1st Grade • 20/30 – 2nd thru 12th • Must identify 3 out of 5 letters to pass • EACH eye must pass

28. HOTV Testing • Fail once, retest 2 weeks • Fail twice, send V1 • If no response in 30 days from parents, V2 • ALL TESTING IS CONFIDENTIAL

29. Letters V1 & V2 (also in Spanish)

30. Form V1. Pg 18 & 19 (spanish) V-1 Form

31. Titmus Testing • Titmus machines available at www.schoolhealth.com; Telemetrics • 1-800-523-8583 • www.macgill.com • Special Student Services at 678-581-7400 has some machines for check out • Must pass only distance portion for MASS screening

32. Titmus Testing • Prior to testing kids, check your Titmus manual • Student should wear glasses • The 20/40 slide (ex: Boy, Girl, Bird, Rabbit) is passing for Grades K – 1 - Must respond correctly with EACH eye • The 20/30 slide is passing for grades 2 – 12. Must respond correctly with EACH eye

33. Titmus Recording Form Page 11-13 in Manual PLEASE CHECK GRADE LEVEL AT TOP OF PAGE.

34. PLEASE NOTE • KG/1st Grade Sample Form (page 11) • Do the first 6 slides

35. Screening Authorizations • Parent permission is NOT required for students: • Grades 1, 4, 7, & 10 • If you feel any other student needs a screening – form V3 (page 18) needs to be signed by parent or, in the case of a Special Education referral, the Special Education 2102 form may be used.

36. Screening Procedures • General Education Students • Can be corrected to 20/30 or better & takes general ed courses • Use standard screening/authorization procedures • Special Education Students • If student has adequate comprehension but is unable to pass – follow standard screening procedures • If student does not comprehend – try LEA chart. If still no results do not retest  send V1 and a copy of Cobb Co. School Eye Report for Children with Vision problems to parents (Page 24/25 in Manual) • Visually Impaired students- DO NOT SCREEN STUDENTS ARLEADY IDENTIFIED / SERVED by VI PROGRAM • Their vision needs are already documented • Vision cannot be corrected better than 20/70 • Part of the Visually Impaired Program • Contact Heidi Evans

37. Eye Exam Resource Guide • Cobb County School System does NOT pay for eye examinations….. (though we do provide re-screenings for students who fail their school screening – at no charge to families.) • Medicaid • PeachCare • Sight for Students (VSP Vouchers) • Lions Lighthouse

38. Total Reporting (page 20)- Due Jan 16, 2015

39. Schools with Titmus - bring your machines to check out sessions, please!

40. Thank you! (Please take the quiz now)

41. THANK YOU SO MUCH!