Chdp Pediatric Vision Screening
CHDP PEDIATRIC VISION SCREENINGChild Health and Disability Prevention (CHDP) ProgramSystems of Care Division (SCD)California Department of Health Care ServicesAdapted by Los Angeles County CHDP ProgramCHDP Vision Screening Training 2019Learning Objectives Understand the importance of vision screening duringchildhood. Become aware of eye problems that affect vision. Describe and implement the CHDP program guidelines forreferral and follow-up. Identify the steps of vision screening and documentresults.CHDP Vision Screening Training 20192
Why Perform Vision Screening? Recommended as part of the American Academy of Pediatrics BrightFutures Periodicity Schedule Risk Assessment Perform VisionScreeningCHDP Vision Screening Training 20193Why Perform Vision Screening? Recommended as part of the American Academy of Pediatrics BrightFutures Periodicity ScheduleINFANCYAGE 3-5dayNBBy 1mo2mo4moEARLY CHILDHOOD6mo9mo12mo15mo18mo24mo30moVisionMIDDLE CHILDHOODAGE5y6yVision 7y8y 9y3y4y ADOLESCENCE10y 11y12y 13y14y15y16y17y18y19y20y21y Risk Assessment Perform VisionScreeningCHDP Vision Screening Training 20194
Bright Futures Pre-visit Questionnaire* Perform risk assessment using the Bright Futures Previsit Questionnaire on the following ages:- 0 - 35 months, 7y, 9y, 11y, 13-14y, and 16-21ySample Pre-visit Questionnaire for a 7-year-oldA positive risk assessment will require a vision screening* The following Bright Futures Tool and Resource Kit materials are available for download for review and reference purposesonly. For any other use, to make multiple copies of specific items, or to incorporate forms into an Electronic Medical RecordSystem, please contact institutions@aap.org.CHDP Vision Screening Training 20195Why Perform Vision Screening?Primary Care Clinics and Schools:– The first line of defense to detect preventable vision lossin children.Early detection of amblyopia - “lazy eye”CHDP Vision Screening Training 20196
Amblyopia Amblyopia is the leading cause of vision loss amongchildren. Eyes and brain are not working together. One eye sees a blurred view and the other a normal view.The brain only processes the normal view.CHDP Vision Screening Training 20197CHDP Vision Screening Training 20198AmblyopiaAmblyopia can onlydevelop during childhood. If not treated in childhood,amblyopia may result in permanentvision loss. The most common cause of visionloss in adults 20-70 years of age isuntreated childhood amblyopia.
AmblyopiaCommon causes are: Untreated or unequal refractive errors (nearsighted,farsighted, astigmatism) Strabismus “crossed eyes” Obstruction (e.g. ptosis, cataract)CHDP Vision Screening Training 20199Common Causes of Amblyopia1. Types of refractive errorsa. Myopia “nearsighted”: does not see objects well atfar distancesCHDP Vision Screening Training 201910
Common Causes of Amblyopia1. Types of refractive errorsb. Hyperopia “farsighted”: does not see objects wellat close distancesCHDP Vision Screening Training 201911Common Causes of Amblyopia1. Types of refractive errorsc. Astigmatism: an irregular curve in the eye causingblurry vision at all distancesCHDP Vision Screening Training 201912
Common Causes of Amblyopia2. Strabismus “crossed eyes”: misalignment of theeyes– One or both eyes turning inward– One or both eyes turning outward– One eye turning up or down– May have double visionCHDP Vision Screening Training 201913Common Causes of Amblyopia3. Obstructiona. Ptosis: drooping of an eyelid due to a weak lid muscle. May obstruct vision Look for chin elevation in these children.CHDP Vision Screening Training 201914
Common Causes of Amblyopia3. Obstructionb. Cataract: condition in which the lens of the eyebecomes progressively cloudy, resulting in blurredvision.CHDP Vision Screening Training 201915Screening Early is Best National Eye Institute (NEI)– Amblyopia affects 2-3% of children in the United States.– About 4.5 million children with preventable vision loss. Amblyopia is harder to treat after 5 years of age. By 7 years of age, some vision loss from amblyopia may becomepermanent.CHDP Vision Screening Training 201916
Treatment for Amblyopia Correcting the refractive error with consistent use of glassesand/or contact lenses Enable child to see as clearly as possible (e.g. removing acataract) Forcing the child to use the weaker eye (via patching or eye dropsto blur the better eye)CHDP Vision Screening Training 2019Visual Acuity Screening Guidelines17
American Academy of PediatricsPolicy StatementPediatrics January 2016 Visual acuity screening using eye charts remains the goldstandard. It can begin as early as 3 years of age. Screening with a tool such as a photoscreener isrecommended for children 12 months of age and olderunless they can reliably perform visual acuity screeningwith eye charts.CHDP Vision Screening Training 201919Newborn to 35 Months (0-3 years)Procedures for the Evaluation of the Visual SystemPediatrics January 2016 Take a health history: Are there eye problems in close relatives? Check vision (tracking), eye movement (motility) and alignment (strabismus) Check pupils and red reflexes (round, equal, bright)NOTE: This assessment can also be done on older children of any age withdevelopmental delays.CHDP Vision Screening Training 201920
Ages 3 through 5 yearsRecommended Chart TypesLEA Symbols Response cardCHDP Vision Screening Training 201921Ages 3 through 5 yearsRecommended Chart TypesHOTV ChartResponse cardCHDP Vision Screening Training 201922
Age-Dependent Pass Guidelines New AAP guidelines: 3 years old: the critical line to pass screening is the 20/50 (10/25) line. 4 years old: the critical line to pass screening is the 20/40 (10/20) line. 5 years and older: the critical line to pass screening is 20/32 (10/16)or 20/30 (10/15) line depending on the chart used.CHDP Vision Screening Training 2019233 Year Visit: 36 to 47 Months Must be able to identify themajority of the 20/50 (10/25)line with each eye. Recommended screeningdistance is 10-feet using a10-foot chart. Opposite eye must be fullycovered.20/50CHDP Vision Screening Training 201924
4 Year Visit: 48 to 59 Months Must be able to identify themajority of the 20/40 (10/20)line with each eye. Recommended screeningdistance is 10-feet using a10-foot chart. Opposite eye must be fullycovered.20/40CHDP Vision Screening Training 2019255 Years and OlderSloan Letters Chart(Preferred)Snellen Letters ChartCHDP Vision Screening Training 201926
5 Years and OlderUse Sloan or Snellen letters forchildren who know their letters. Sloan letters chart is preferredover the Snellen letters chartCHDP Vision Screening Training 2019275 Years and Older Must be able to identify witheach eye the majority of: 20/32 (10/16) or 20/30(10/15) line depending onthe chart used. For children who do notknow their letters, use theLEA symbols chart, or theHOTV chart.20/32CHDP Vision Screening Training 201928
5 Years and Older Recommended screening distance is 10-feet using a 10-foot chart.Fully cover opposite eye.Repeat screening every 1-2 years.Risk assessment should be done when screening is not required.FOR SCREENING AT 10 FEETCHDP Vision Screening Training 201929American Association for Pediatric Ophthalmologyand Strabismus (AAPOS) Vision Screening Kit Acuity charts for threshold orcritical line screening:– Sloan letters– LEA symbols or HOTV chart Occluders: patches/glasses/paddle 10 foot measuring cord Matching response card Informational DVDCHDP Vision Screening Training 201930
Threshold and Critical Line OptionsThresholdCritical LineCHDP Vision Screening Training 201931Threshold Screening Reading down the eye chart as faras possible. Threshold line is the smallest linechild can pass. Can identify two-line differencebetween the eyes. Refer for two-line differencebetween the eyes, even within thepassing range.CHDP Vision Screening Training 201932
Critical Line Screening: FASTER Critical line is defined as the line a child is expected to see normally andpass for that age. Each chart has two boxed “critical lines” - one for each eye. The top lineof large symbols/letters is for practice before starting screening. The child only reads a single “critical” line with each eye. This method cannot identify two-line difference between the eyes.CHDP Vision Screening Training 201933Vision Screening ChartsNOT RecommendedKinder ChartTumbling E ChartLandolt C ChartHouse Apple Umbrella ChartCHDP Vision Screening Training 2019Allen Cards34
Occlude to Prevent PeekingRecommended*AcceptableNot Recommended2-inch widehypoallergenic tapeOnly for age 10years and older* Assess for allergies to tape prior to placementCHDP Vision Screening Training 201935Key Points Crowding bars make individual symbols/letters more difficult to identify whenamblyopia is present. Use eye charts with lines of symbols/letters or matching cards with lines(crowding bars) around each symbol/letter to obtain the most accurate visualacuity assessment.Crowding barsCHDP Vision Screening Training 201936
Key Points Screening line: marked at 10(or 20)-feet on the floor. Screening line is midline tochart. Child should stand with archof each foot on the line. Vision screening area– Out of traffic area– Have adequate lightingSCREENING LINE10 or 20 FEETSCREENING LINECHDP Vision Screening Training 201937Key Points Adjust eye chart with the referral line close to the child’s eye level. Each eye should be screened separately. Either critical line or threshold screening may be used.CHDP Vision Screening Training 201938
Automatic Referral for Eye ExamChildren with the following disorders should bypass screeningand should be referred directly to an eye specialist:1. Recognized eye disorders (e.g. strabismus, ptosis)2. Known neurodevelopmental disorders: Hearing impairment Motor abnormalities (e.g. cerebral palsy) Down Syndrome Cognitive impairment Autism spectrum disorder Speech delayCHDP Vision Screening Training 201939Automatic Referral for Eye Exam3. Systemic diseases present (e.g. diabetes, sickle cell disease, hypertension)4. Taking medications known to cause eye disorders5. First-degree relative with strabismus or amblyopia6. Prematurity: less than 32 weeks of gestation7. Parent believes child has vision problemCHDP Vision Screening Training 201940
Visual Acuity Results Threshold Pass/Fail CriteriaAGEPASSFAIL and REFER,or RESCREEN WITHIN 6 MONTHSDOCUMENTATION3 yearsLEA/HOTV:Correctly identified at least3 of 5 symbols on20/50 line or betterMissed 3 or more symbols on20/50 line or worseVisual acuity todocument is20/63 or worse4 years5 yearsand olderLEA/HOTV:Correctly identified at least3 of 5 symbols on20/40 line or betterLEA/HOTV/Sloan:Correctly identified at least3 of 5 symbols/letters on20/32 (or 20/30) line or betterSnellen ONLY:Correctly identified one more than half theletters on the 20/30 line or betterTwo-line difference between the eyes,even within the passing range(e.g. 20/20 and 20/32)Missed 3 or more symbols on20/40 line or worseTwo-line difference between the eyes,even within the passing range(e.g. 20/20 and 20/32)Missed 3 or more symbols/letters on20/32 (or 20/30) line or worseTwo-line difference between the eyes,even within the passing range(e.g. 20/20 and 20/32)Visual acuity todocument is20/50 or worseVisual acuity todocument is20/40 or worseSnellen ONLY:Missed one more than half the letters on20/30 line or worseTwo-line difference between the eyes,even within the passing range(e.g. 20/20 and 20/32)CHDP Vision Screening Training 201941Barriers to Screening Poor cooperation of young children Takes time to perform Staff not adequately trained Poor reimbursement for physiciansCHDP Vision Screening Training 201942
Untestable (“Uncooperative”) Children If child is unable to cooperate during the screening, make asecond attempt the same day (i.e. later during the same visit). Ifsame day rescreening is not possible, reschedule as soon aspossible, but no later than 6 months. Schedule follow-up appointment prior to the patient leavingprovider office. If you cannot screen a child during the follow-up appointment,then refer to an ophthalmologist or optometrist experienced inthe care of children for an eye examination.CHDP Vision Screening Training 201943Follow-Up Maintain referral log to track status of referral. Follow-up with parent/guardian as needed.REFERRAL PATIENT’SDATENAME0107-20-17Doe, JanetD.O.B.3-6-10PROVIDER SPECIALITY DATE OFDATE7 DAY30 DAYAPPT CONSULT FOLLOW- UP 79-10-17Exam Done10-3-17GlassesRec’d0203040506CHDP Vision Screening Training 201944
Instrument-Based Vision Screening Instrument-based screening is the process of using an instrumentsuch as a photoscreener, autorefractor or other device, to screenfor risk factors for vision problems. Does not replace visual acuity screening with eye charts. Endorsed by American Academy of Pediatrics (AAP).CHDP Vision Screening Training 201945Common Vision Screening InstrumentsWelch Allyn SureSightPlusOptix S12RRighton RetinomaxiScreenWelch Allyn“Spot”CHDP Vision Screening Training 201946
What is the Difference Between VisionScreening with Eye Charts and VisionScreening with Devices? Vision screening with eye charts measure the actual visualacuity (e.g. 20/20). Vision screening devices DO NOT measure visual acuitydirectly.– Screening instruments test for eye conditions or risk factors that areknown to cause decreased vision or amblyopia.CHDP Vision Screening Training 201947Instrument Screening is Useful For: All children ages 1-3 years– Usually unable to perform visual acuity screening Older children who are non-verbal, developmentallydelayed. Other children who are untestable using the visual acuitychart.CHDP Vision Screening Training 201948
CHDP Vision ScreeningCertification Requirements Screeners must attend Vision Screening Trainingprovided by CHDP staff (or another agency approvedby local CHDP). Renew certification every four years.CHDP Vision Screening Training 201949County of Los Angeles CHDPNorth Regional Office9320 Telstar Ave., Suite 226El Monte, CA 91731(855) 272-6820Southwest Regional OfficeMLK Jr., Multi-ServiceAmbulatory Care Center12012 S. Compton Ave., Room 4-212Los Angeles, CA 90059(424) 338-1186Southwest Regional Satellite OfficeHarbor-UCLA Medical Center1000 W. Carson St., Box 475Torrance, CA 90509(424) 338-1186East Regional OfficeAdministrative Office9320 Telstar Ave., Suite 226El Monte, CA 91731(626) 569-3750WEBSITE: www.publichealth.lacounty.gov/cms/CHDP.htmCHDP Vision Screening Training 201950
Acknowledgments These guidelines are based on recommendations from the AmericanAcademy of Pediatrics (AAP) and the National Expert Panel of theNational Center for Children’s Vision and Eye Health (NCCVEH) atPrevent Blindness. These slides have been adapted from the American Association forPediatric Ophthalmology and Strabismus (AAPOS) with their permission.CHDP Vision Screening Training 201951References and Links Visual System Assessment in Infants, Children and Young Adults byPediatricians– American Academy of Pediatrics Policy Statement– Pediatrics. January 2016. Volume 137. Issue 1 Procedures for the Evaluation of the Visual System by Pediatricians– American Academy of Pediatrics Clinical Report– Pediatrics. January 2016. Volume 137. Issue 1CHDP Vision Screening Training 201952
References and Links Bright Future and Preventative Medicine Coding Fact Sheet– American Academy of Pediatrics– AAP.org Professional Resources Practice Transformation Coding at the AAP– Updated January 2016 Vision Screening for Children 36 to 72 Months: Recommended Practices– National Expert Panel to the National Center for Children’s Vision andEye Health– Optometry and Vision Science. January 2015. Volume 92. No. 1– CHDP Health Assessment Guidelines Vision Screening 2017CHDP Vision Screening Training 201953CHDP Vision Screening Training 201954THE END
How Do I Earn the VisionScreening Training Certificate?1. A PHN must visit your site/clinic within 2 weeks upon completion oflistening to the Vision Screening Training video. The visit will consistof review, practice session, and certification.2. To receive your certificate, you must be able to correctly demonstratethe Vision Screening method with accurate documentation ofscreening results.CHDP Vision Screening Training 201955Your feedback is important to us, please take amoment to complete our online evaluation.CHDP Vision Screening Training 201956
blurry vision at all distances CHDP Vision Screening Training 2019 12. Common Causes of Amblyopia 2. Strabismus "crossed eyes": misalignment of the eyes -One or both eyes turning inward -One or both eyes turning outward -One eye turning up or down -May have double vision
Vision screening with eye charts measure the actual visual acuity (e.g. 20/20). Vision screening devices DO NOT measure visual acuity directly. Screening instruments test for eye conditions or risk factors that are known to cause decreased vision or ambl
Communication Skills Learning Tools for the Pediatric Clerkship 37 Pediatric History Taking Approach to the Pediatric Patient 38-39 Explanation of Pediatric H&Ps/Pediatric Database 40-43 Example H&Ps (older child and infant) 44-52 Pediatric Physical Examination Benchmarks for Pediatric Physical Examination 53 54-65
The physicians at Albany Med's Bernard & Millie Duker Children's Hospital are specially trained in more than 40 pediatric fields, including pediatric pulmonary disease, pediatric surgery, pediatric gastroenterology, pediatric anesthesia and pediatric neurology. Albany Med houses the region's only Pediatric Intensive Care Unit (PICU) and
4.4 Emerging and re-emerging infections 43 4.5 Clinically insignificant transfusion-transmissible infections 44 5 Blood screening, quarantine and release 45 5.1 Blood screening process 45 5.2 Approaches to blood screening 45 5.3 Pooling for serological assays 47 5.4 Sequential screening 47 5.5 Blood screening and diagnostic testing 48 5.6 Emergency screening 48 5.7 Screening plasma for .
Spot Vision Screener Sample Results Vision screening does not replace a complete eye examination by a vision care specialist. This material, trademarks & property are copyrighted 2014 by PediaVision Holdings, LLC.File Size: 3MBPage Count: 15Explore furtherA quick guide to interpreting eye test results - The Eye .www.theeyepractice.com.auHow to Read Your Vision Screening Results - hospitalninojesuswww.hospitalninojesus.comHow to 101: Interpreting Spot Vision Screening Resultsdepisteo.com10 Best Free Printable Preschool Eye Charts - printablee.comwww.printablee.comThe Different Types of Eye Charts and 20/20 Vision - Eyecarewww.optometristoakville.caSnellen Eye Chart Eye Charts - EyeGlass Guidewww.eyeglassguide.comRecommended to you b
Revised January 2013 Page 2 of 21 Child Health & Disability Prevention (CHDP) Program Oral Health Educational Resources For Infants and Children (Birth - 5 years) A healthy mouth is part of a healthy body.
The appropriate screening distance is noted at the top of the vision chart. Age Appropriate Occluders . Occlusion equipment temporarily obstructs vision in the eye not being screened during vision . Plus Lens (Near Vision Screening) Ages 5 and Older 2.50 glasses, also known as reading glasses or cheaters are used for near vision screening of .
ACCOUNTING 0452/22 Paper 2 May/June 2019 1 hour 45 minutes Candidates answer on the Question Paper. No Additional Materials are required. READ THESE INSTRUCTIONS FIRST Write your Centre number, candidate number and name on all the work you hand in. Write in dark blue or black pen. You may use an HB pencil for any diagrams or graphs. Do not use staples, paper clips, glue or correction fluid. DO .
