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 children who do not pass vision screening, provide family-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 are common and affect 1 in 20 preschool-aged children and 1 in 4 school-aged children (U.S. Preventive Task Force, 2004). A recent report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes (Holmes, et al., 2011). In addition, optical correction of significant refractive error may be related to child development (Ibironke, 2011) and improve school readiness (Roch-Levecq, Brody, Thomas, & Brown, 2008, Atkinson, et al., 2002).
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 child’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 exam when a child 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.
Vision and Eye Health Glossary
Vision Screening is Key to Healthy Development!
Focus on Eye Health and Culturally Diverse Populations
Signs of Possible Eye Trouble in Children [
The Affordable Care Act and Your Child’s Eyes
Star Pupils Eye Health and Safety Curriculum
(grades K-2, 3-5, and 6-8)
Sample social media messages
Vision screening and eye health posters
Video: Parent discussing the importance of vision screening
2. Comprehensive Communication/Approval Process
Facilitate parents’/caretakers’ completing a signed 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.
Referral for an Eye Examination letter with release of information [Spanish]
3. Vision Screening Tools and Procedures
Screen children’s vision with age-appropriate, evidence-based, tools and procedures, including optotypes (symbols, letters, or numbers) and/or instruments.
Why Do We Screen Vision in Young Children
Common Vision Terms Defined
Ages at Which Vision Screening Should Occur (2017)
Tips for Appropriate Eye Chart Design (2014)
Referral Criteria (2016)
Children’s Vision Screening Table (2015)
Prevent Blindness Position Statement on School-aged Vision Screening and Eye Health Programs
4. Vision Health for Children with Special Healthcare Needs (CSHCN)
Implementing policies and procedures for referral and support for visual health of children with special healthcare needs.
Vision Health for Children on the Autism Spectrum
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 (2014)
Referral for an Eye Examination letter with release of information [
6. Guidelines for Vision Screening Programs
Guidelines for Vision Screening Programs: Kindergarten Through Grade 12
(2015, Colorado Department of Education).
Vision Referral (Colorado Department of Education) [
Word version ] [
PDF version ]
7. 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.
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.
Family Fact Sheet on Children’s Vision (2013) [
8. Systemized Approach to Follow-Up
Implement/facilitate a follow-up system with parents/caregivers following a failed vision screening.
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
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
See Jane See! Parental Advice for Healthy Vision in Kids (2016)
9. 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.
VSP Sight for Students Program
Financial Assistance Information (2014) [
Find an eye care provider:
American Academy of Ophthalmology
American Optometric Association
American Association for Pediatric Ophthalmology and Strabismus
College of Optometrists in Vision Development
10. Effective Communication with the Medical Home
Keep the medical home informed by sending a copy of eye exam results to the child’s primary care provider.
The Role of the Medical Home in Vision and Eye Health
11. Adherence to Treatment
Have a process in place to facilitate the eye care treatment plan prescribed for a child.
Information for parents about their role as part of the eye care health team.
Eye Patch Choices
The Eye Patch Club
– Family amblyopia treatment adherence program
12. Evaluate Your Vision Health Program
Annual Vision Health Program Evaluation Checklist (2014)
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. Retrieved from
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. Retrieved from
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. Retrieved from
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. Retrieved from
U.S. Preventive Services Task Force. (2004). Screening for visual impairment in children younger than age 5 years: An update of the evidence from randomized controlled trials, 1999-2003. Annals of Family Medicine, 2(3), 263-266. doi: 10.1370/afm.193. Retrieved from
Challenges with Commonly Used Tests of Visual Acuity (Eye Charts) for Optotype-Based Screening
Building a Strong Vision Health System of Care: Components and Resources
. An educational presentation from the Year of Children’s Vision initiative.
Lions Clubs Assistance Requests
Vision Screening Tutorial
from the American Association for Pediatric Ophthalmology and Strabismus
Pink Eye Resources from American Academy of Ophthalmology
Eye Smart resources
Nottingham Chaplin, P.K., Ramsey, J.E., & Baldonado, K. (2014).
Children’s vision health: How to create a strong vision health system of care
. Exchange, 36(3), 36-41. https://www.childcareexchange.com/catalog/product/217-may-june-2014/4321700/ [fee applies]
Nottingham Chaplin, P. K., Ramsey, J. E., & Baldonado, K. (2014). Children who should bypass vision screening and go directly to eye exam. Exchange, 36(3), 38.
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
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. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274336/pdf/opx-92-06.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
Special thanks and appreciation to P. Kay Nottingham Chaplin, Kira Baldonado 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; 211 W. Wacker Dr.; Suite 1700 Chicago, IL 60606; 312-363-6038; firstname.lastname@example.org
Page last updated May 2017.