Annual Vision Health Program Evaluation Checklist (Page 2 of 7) in pdf

Source: 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.

Notes: _______________________________________________________________________________

_____________________________________________________________________________________

3. We screen children’s vision with age-appropriate and evidence-based tools and procedures,

including optotypes (pictures) and/or instruments.

a. Follow national referral and rescreening guidelines.

b. Include vision screening training for your staff that leads to state and/or national

certification in evidence-based vision screening procedures.

c. Ensure that contracted screening organizations use evidence based-tools and

procedures, utilize national referral and rescreening guidelines, and clearly state that a

screening does not replace an eye exam nor provide a diagnosis.

Check Yes or No

Point of evaluation

Yes

If we use devices for instrument-based screening, the devices include software

upgrades recommended by the National Center for Children’s Vision and Eye Health

at Prevent Blindness.

Yes

If we use devices, the referral criteria is set according to recommendations from the

National Center for Children’s Vision and Eye Health at Prevent Blindness or our local

eye care providers.

If we use devices, we have an age-appropriate and evidence-based test of visual

Yes

acuity as a backup (in the event that the device malfunctions, we forgot to charge

the batteries, or we cannot achieve a reading.)

If we do optotype-based vision screening as a backup to instrument-based screening,

we use an “eye chart” that meets national/international design guidelines for

Yes

standardized eye charts, an approved optotype booklet, or a single, crowded LEA

Symbols booklet or system.

If we use an “eye chart” as a test of visual acuity for optotype-based screening, the

Yes

eye chart meets national/international design guidelines for standardized eye charts.

We use appropriate occluders when screening the vision of our children with tests of

visual acuity.

Yes

If an outside person or agency screens the vision of our children, we have a process

to review tools used.

Yes

We follow national guidelines for when to rescreen children.

Yes

We follow national guidelines for when to refer children.

Yes

We follow the National Center for Children’s Vision and Eye Health at Prevent

Blindness’ vision screening training program, we receive face-to-face training from

our local Prevent Blindness affiliate program, or we participate in a state-approved

training program.

Yes

We ensure new staff members are formally trained within 3 months of employment,

through the National Center for Children’s Vision and Eye Health at Prevent

Blindness, our local Prevent Blindness affiliate program, or a state-approved training

program.

Yes

We “refresh” training every 3 to 5 years through the National Center for Children’s

Vision and Eye Health at Prevent Blindness , our local Prevent Blindness affiliate

Annual Vision Health Program Evaluation Checklist Page 2

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