Prevent Blindness America Pediatric Vision Screening Program Protocol

Prevent Blindness America sponsors a unique national certification program for children's vision screening and vision screening training. Protocols for certification are determined by the Prevent Blindness America Board of Directors, based on the recommendations of its Pediatric Vision Advisory Committee, which is made up of leading experts in child health and vision care from across the country.

This certification is a central element to Prevent Blindness America's program offerings, and as such the designated minimum protocols must be strictly followed in order to maintain certification. If a program does not meet the minimum standards, it can no longer be referred to as a Prevent Blindness America-certified screening.

While all Prevent Blindness America affiliates are expected to conduct Prevent Blindness America-certified screenings, it is recognized that under certain circumstances (such as testing new systems, funding opportunities, etc.) an affiliate may need to explore and utilize non-certified protocols. In such cases, the affiliate shall submit to Prevent Blindness America a notification of its intent to deviate from the established standards, detailing the proposed changed program protocol(s) and list the justification for deviation from each area of the Prevent Blindness America format. These will be reviewed by staff and selected members of the Community Programs Committee, with comments and recommendations returned to the affiliate. Programs deemed as significantly different from the Prevent Blindness America protocols will not be considered Prevent Blindness America-certified screening programs.

Prevent Blindness America Screening/Training Minimum Protocols

The minimum protocols discussed below are further detailed in Prevent Blindness America's screening and training manuals.

Prevent Blindness America maintains three levels of certification. Each must be renewed, based upon Prevent Blindness America-approved standards, every three years.

• Screeners are certified to conduct Prevent Blindness America-certified screenings (adult and children's programs require separate certifications).
• Trainers are certified to teach individuals to become screeners (must be a certified screener).

• Instructors are certified to teach screeners to become trainers (must be a certified trainer and Prevent Blindness America-affiliated staff, board member, or individual designated by Prevent Blindness America). Instructor courses are taught by a designated Prevent Blindness America staff member (currently the Director of Screening Initiatives).

A Prevent Blindness America-certified children's vision screening must be led by a certified screener (non-certified volunteers may assist) and include:

• Observation (ABCs: Appearance signs, Behavior signs, Complaint signs)
• Distance visual acuity screening (utilizing Prevent Blindness America-approved screening tools) - approved passing line for 3 year olds is 20/50; for 4 and 5 year olds is 20/40; and for 6+ year olds is 20/30.
  • Preschool age: HOTV or Lea symbols 10' distance visual acuity chart
  • School age: Snellen or ETDRS distance visual acuity charts
• Stereopsis screening through 3rd grade or age 9 (utilizing Prevent Blindness America-approved screening tools)
• Random Dot E or Stereo Smile stereopsis tool
• Follow-up

While the above screenings are preferred, the Photoscreener has also been approved for use with pre-verbal and special needs children and autorefraction (specifically the SureSight Vision Screener, the RetinoMax autorefractor and the PlusOptix Vision Screener) has been approved for use in screening 3-5 year old children, when used as recommended by the manufacturer and with the failed criteria approved by Prevent Blindness America. When using these instruments (SureSight, RetinoMax and PlusOptix), stereopsis testing does not need to be done.

Further, Prevent Blindness America allows for affiliate use of a 5' testing distance for preschool age children utilizing HOTV or Lea symbols in linear or single-surround with crowding bars formats; though it recognizes limited validation of this testing distance to date.

Prevent Blindness America also recognizes that computer-based testing of visual acuity for child vision-screening purposes is now available. Thus, Prevent Blindness America endorses the use of such technology if programmed to present testing methods that have been validated in children of similar ages that meet Prevent Blindness America approved standards based upon ATS, VIP, or AAP protocol.

Data Tracking

Prevent Blindness America has established a National Vision Screening Database, which is available for use by all Prevent Blindness America-certified programs. Affiliates not entering their screening data into this database risk losing eligibility to receive Prevent Blindness America grant funds.