Going Green This educational offering is joining others in an effort to save our environment by...
-
Upload
allen-jacob-hamilton -
Category
Documents
-
view
216 -
download
1
Transcript of Going Green This educational offering is joining others in an effort to save our environment by...
Going Green
This educational offering is joining others in an effort to save our environment by making the
handouts available on our website
www.arkansascsh.org.
To show respect for our speakers and participants,
PLEASE place your cell phone on silent or vibrate.
Should you need to answer a call, PLEASE go outside to
hold your phone conversation.
Respect the speakers and other participants around you
by refraining from side bar conversations during the
session.
If it is that important, please step outside!!!!
The planning committee & faculty attest that NO relevant
financial, professional or personal conflict of interest
exists, nor was sponsorship of commercial support obtained,
in the preparation or presentation of this educational
activity.
VISION SCREENING
CERTIFICATION
• One in 20 preschoolers has a vision problem.
• One in 5-10 school-aged children has a vision problem.
• Impaired vision can seriously impede learning.
• Early identification and treatment can prevent or at least alleviate many vision problems.
Importance of Vision Screening
Purpose of Vision Screening
• To screen a large number of children in a short amount of time.
• To separate those children likely to have vision problems from those not likely to.
• To refer those children who do not pass the screening or who are suspect for vision problems.
Landmarks of Visual Development
• 4-12 wks– Binocular fixation
• 12-20 wks– 20/200
• 44 wks-12 mo– 20/50 - 20/100– Full binocular
vision– Amblyopia may
develop
• 6 -18 mo– Convergence
developed
• 18 mo-2 yrs– Accommodation
developed– 20/40
• 2-3 yrs– 20/30
• 5 yrs– Min. potential for
amblyopia
• 6 yrs– Approaches 20/20
Parts of the Eye
Common Ocular Abnormalities
Blepharitis
Chalazion
Stye
Entropion
Of upper eyelid due to scarring
Of lower eyelid
Dacryocystitis
Ptosis
Coloboma
Coloboma
Cataract
Strabismus Types
• Tropia– Eyes which are always
improperly aligned
• Phoria– Eyes which have a tendency to
misalign when fusion is interrupted
Esotropia
Bilateral Esotropia
Exotropia
Hypertropia
Pseudostrabismus(also Pseudotropia or
pseudoesotropia)
Refractive Errors
• Myopia (Nearsightedness)• Hyperopia
(Farsightedness)• Astigmatism
Astigmatism
Amblyopia: Definition
• Vision that cannot be corrected to better than 20/40.
• Unilateral or bilateral• Brain suppresses poor image• Normal appearance• Reversible if detected and
treated early
Amblyopia
Predisposing Factors
• Poor clarity– Cataract
• Poor focus– Nearsightednes
s– Farsightedness
• Poor aim– Strabismus
Treatment– Clearing the
media– Cataract removal
• Focusing the image– Corrective lenses
• Correcting aim– Occlusion therapy– Drops
Amblyopia Therapy
Usher’s Syndrome
• Hearing Loss and Retinitis Pigmentosa
• Screen children with hearing loss
VisionScreening
Screening Procedure
Observation
• Appearance
• Behavior
• Complaints
Appearance
•Whites•Iris•Pupil•Lids•Lashes•Immediate
referral if abnormal
Behavior
• Head tilt or turn• Blinking or rubbing• Avoiding close work• Squinting/frowning• Closing or covering eye• Reading problems• Frustration/poor attention
Complaints
• Headaches• Nausea• Dizziness• Burning or itching• Blurring
Visual Acuity-Far
• Screen one eye at a time.– If a child wears glasses, perform the
screening with the child wearing the glasses.
• Screen at 20 feet – Snellen Chart – Literate children
• Screen at 10 feet – Age Appropriate Chart– Allen Chart/Tumbling E’s– Pre-literate children/non-English speaking
• Any eye with vision poorer than 20/40 is a screen failure.
Plus 2 (+2.00) Visual Acuity
• Test for farsightedness.• Perform exactly as the distance
visual acuity except;• Hold a +2.00 lens in front of
the tested eye (fellow eye covered).
• Any eye that improves 2 lines of vision with the +2.00 lens is a screen failure.
Instrument Screenings
• Titmus• Optec• Keystone
Lateral & Vertical Muscle Balance-Far (Titmus &
Optec)• Right eye on; left eye off.• Give instructions:
– “Here is a box. I will throw a red ball. Tell me where the ball lands.”
• Turn left eye on.• Need immediate answer.
– If not, repeat test.– To pass the child should report the ball
landing ‘in the box’ or ‘on the line’.
A B
Titmus 2
Titmus OV7 & Optec
Right Eye
Right Eye
Left Eye
Left Eye
Lateral & Vertical Muscle Balance-Far
Titmus & Optec
Lateral Muscle Balance-NearTitmus
• At completion of Muscle Balance Far screening switch lever to ‘near’ setting.
• Procedure is the same now as the Lateral Muscle Balance Far screening.
Lateral Muscle Balance-nearTitmus & Optec
A B
Titmus 2
Titmus OV7 and Stereo Optec
Right Eye
Right Eye
Left Eye
Left Eye
Lateral Muscle Balance –NearOptec
Lateral Muscle Balance-FarTitmus & Optec
Vertical muscle balance-farTitmus & Optec
Lateral Muscle Balance-FarKeystone
• Right eye on; left eye on.• Place slide ‘Lateral Phoria – use at far
point’.• Give instructions
– “Here is a row of numbers, 1 to 15, and an arrow/pointer. What numbers) does the arrow point most closely to?”
• Need immediate answer– If not, repeat test.– To pass the child should report the arrow
pointing to a number(s) between 8 and 11. Any other answer is a screen failure.
Lateral Muscle Balance-FarKeystone
– 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 -
fail
pass
fail
Vertical Muscle Balance-Far
• Performed at ‘far’.• Keystone
– Right eye sees a column of figures with a central circle and 2 figures above and below.
– Left eye sees a horizontal line.– To pass the child should see the
line passing through the circle or just above or below the circle.
Vertical Muscle Balance
Keystone
Pass
Lateral Muscle Balance-NearKeystone
• Use slide labeled ‘Lateral phoria – use at near point’ (place at the near point).
• Again a row of numbers (2 -10) and an arrow are present.
• A response of the arrow pointing between 4.5 and 6.5 is a screen pass – outside this is a screen failure.
– 2 3 4 5 6 7 8 9 10 -
fail
pass
fail
Lateral Muscle Balance-Near Keystone
Binocularity(fusion) at far Optec/Titmus
• Can use whichever of three slides you have—only need to use one.
• Pass criteria depends on the slide.
• Test in far position.• Test with both eyes ‘on’.
Titmus OV7, Stereo Optec 2000
Binocular Vision-Far
Titmus OV7, Stereo Optec 2000
E E E
Both eyes open – screen pass
Binocular Vision-Far
Titmus 2 (Optional)
A correct response with this screen is for the child to see all 4 boxes/objects when both eyes are ‘on’.
Binocular Vision - Far
Binocular
Keystone
A correct response with this screen is for the child to see 3 circles with both eyes. The circles should be in a vertical line or only minimally separated (if minimally separated it is acceptable to see 4 circles).
red
whitewhite
blue
Right eye Left eye
Binocular Vision - Far
Keystone
A correct response with this screen is for the child to see 3 circles with both eyes. The circles should be in a vertical line or only minimally separated (if minimally separated it is acceptable to see 4 circles).
red
whitewhite
blue
red
blueblue
red
white
pass pass pass
Binocular Vision - Far
Keystone
Four circles widely separated is a screen failure.
fail
Binocular Vision - Far
Binocularity(fusion) at Near
• This screen is performed as was fusion at far except the instrument is switched to the ‘near’ setting. Or the ‘near’ slide is place in the instrument.
Color
• Performed with both eyes open.
• Use a standard instrument slide or a standard hand held red/green color testing card.
• To pass the student should be able to read/recognize the numbers presented.
Color
Re-screening
Why Rescreen?
• Cuts down on over-referral.• Adds validity and parent
confidence• Improves follow-up.• Saves time by decreasing
amount of follow-up needed.
Referral
• Immediate referral if do not pass:– Observation (Appearance)
• Re-screen in four to six weeks if do not pass:– Visual Acuity– +2.00 test– Instrument screenings
• Refer if do not pass any part of re-screen
• Color vision deficit does not require a referral.
Tips
• Observation with glasses on and off.
• Glasses on for machine screening.
• Keep child’s head in place on machine—no peeking with “good” eye!
• Adjust machine to child’s height.
Data Entry
Data Entry
• Vision screening data is entered into APSCN
• Data queries will be pulled on Nov. 15 and April 15.
• Training for APSCN will be provided at your Ed. Cooperative.
Data Entry
• No forms needed except for screening form
• Parent Notification/Doctor Report Form will be generated through APSCN
Screening FormGrade 1, room A
Obs Va +2 LMBf LMBn
VMB Ff Fn C P/F ?
Stu.A
p p P p p p p p p P
Stu.B p p F p p p p p p R
escreen
Stu.C P p P p p p p p f PStu.D F p P p p p p p p R
efer
School District Mailing Address City, State, Zip
Phone Fax
Administrator School Nurse
Student’s Screening Referral Parent/ Guardian Mailing Address Name Date Date(s) Name
Paula Smith, State School Nurse ConsultantArkansas Department of Education, Office of Coordinated School Health2020 West 3rd St., Suite 320Little Rock, AR.72205
RESOURCES
• www.brandonburlsworthfoundation.org
Examinations and Eye glasses
• [email protected] 501-661-7675 411 S. Victory, Suite 206, Little
Rock, AR 72201To borrow Titmus vision screeners
Vision Machine Repair
• BSI--Jack Stone --in Little Rock (501) 416-1232• 2M Eye Instruments-- Mike
Shivley-- in West Memphis (870) 735-0604