216 R.I. Code R. 216-RICR-20-10-4.13

Current through November 21, 2024

Section 216-RICR-20-10-4.13 - Vision Screening

4.13.1General Vision Screening Requirements

A. Pursuant to R.I. Gen Laws §§ 16-21-14 and 16-21-14.1, vision screening is required for all students upon entry to school, and in preschool programs operated by public school districts, and first (1^st), second (2^nd), third (3^rd), fourth (4^th), fifth (5^th), seventh (7^th) and ninth (9^th) grades.

B. If evidence is presented to the school physician or school nurse that an eye examination was completed within the preceding twelve (12) months of the initial screening by the student's ophthalmologist, optometrist, pediatric ophthalmologist, pediatric optometrist or primary care provider, the student may be exempt from this screening requirement for that school year.

C. A school must screen vision using evidence-based, optotype-based screening, or evidence-based, instrument-based screening, depending on the age of the student in accordance with the National Center for Children's Vision and Eye Health's Vision Screening Recommendations ( https://nationalcenter.preventblindness.org/vision-screening-recommendations) incorporated by reference at § 4.2(L) of this Part.

1. Certain students who have a higher rate of vision problems should bypass vision screening in accordance with the National Center for Children's Vision and Eye Health's Vision Screening Recommendations and be referred directly to an eye specialist for a comprehensive examination. The school nurse may determine which children should be referred directly.

D. It is recommended that vision screening occur early in the school year. Preschool and kindergarten screening must be completed within thirty (30) administrative days of the start of school.

E. Vision screening outside of the grade level required for screening must occur upon referral from teachers, parents/caregivers, or with presentation of signs or symptoms of a vision problem.

F. Students transferring to a school without record of previous vision screening must be screened.

G. When a trained, unlicensed individual, or individuals from an outside entity, conducts the initial screening, the school nurse must rescreen the student before making a referral.

1. Rescreening for all vision tools, except instrument-based screening, will occur as soon as possible, but no later than six (6) months following the initial screen.

H. Students who do not pass vision screening must be referred to their parents/caregivers and provided with a referral form to bring to their health care provider or eye specialist.

I. Periodic reporting of vision screening results to RIDE and/or RIDOH may be required.

4.13.2Distance Visual Acuity

A. Students in preschool, kindergarten, and grades one (1) through five (5), seven (7), and nine (9) must be screened for distance visual acuity.

B. For those students required to wear prescription glasses, screening must occur with student wearing glasses.

C. Screening tools recommended for preschool and kindergarten (and grade one (1) if students cannot identify letters in random sequence) are:

1. LEA SYMBOLS® chart (illuminated preferred, critical line screening permissible; five (5) foot and ten (10) foot charts or booklets are permissible); and

2. HOTV chart (illuminated preferred, critical line screening is permissible;

3. Computer-based screening programs using either HOTV or LEA SYMBOLS® optotypes.

D. Screening tools recommended for students in grades one (1) (if students can identify letters in random sequence) and grades two (2) through five (5), seven (7), and nine (9) are:

1. Sloan Letters chart (illuminated preferred if using nine inch by fourteen inch (9"x14") charts, charts exceeding nine inches by fourteen inches (9"x14") are permissible);

2. Computer-based screening programs using Sloan Letters.

E. Instrument-Based Screening may be used as an alternative to distance visual acuity screening for:

1. Children ages three (3), four (4), and five (5) years

2. Children ages six (6) years and older when children cannot participate in optotype-based vision screening.

3. If conducting instrument-based screening, record pass or refer.

4.13.3Near Visual Acuity

A. Students in preschool, kindergarten, and grades one (1) through five (5), seven (7), and nine (9) must be screened for near visual acuity.

B. For those students required to wear prescription glasses, screening should occur with student wearing glasses.

4.13.4Referral Requirements

A. Referral of students to qualified vision professionals, such as an ophthalmologist, optometrist, pediatric ophthalmologist, or pediatric optometrist, must occur in the following circumstances:

1. Age three (3) years, unable to correctly identify at least three (3) of five (5) optotypes on 20/50 line with each eye individually if using threshold method.

2. Ages four (4) and five (5) years, unable to correctly identify three (3) of five (5) optotypes on the 20/40 line with each eye individually if using threshold method.

3. Ages six (6) years and older, unable to correctly identify at least three (3) of five (5) optotypes on the 20/32 line with each eye individually if using threshold method.

4. Refer students who have a two (2) line difference between the eyes, even in the passing lines (e.g., 20/20 and 20/32), if using threshold method.

5. If using threshold screening, record the visual acuity value for each eye.

6. If using critical line screening, use the age line per the chart manufacturer's instructions and record pass or refer.

B. The school nurse will follow up with the parents/caregivers of students referred to determine the outcome of the referral.

C. The school nurse will follow up with students referred for further evaluation by an eye care provider (pediatric ophthalmologist, pediatric optometrist, ophthalmologist, or optometrist) to ensure treatment plans are implemented at school, if necessary.

4.13.5Stereoacuity Screening

A. Stereoacuity screening - to determine how well eyes work together - is optional and if used for students in preschool, kindergarten, and grades one (1) through five (5), seven (7), and nine (9), will be used in conjunction with optotype-type based screening, but not instrument-based screening.

B. Preschool Assessment of Stereopsis with a Smile (PASS) II is the recommended tool for stereoacuity screening with all students. Manufacturer's instructions must be followed for use of any tools used for stereoacuity screening.

4.13.6Color Vision Deficiency Screening

A. Color Vision Deficiency Screening is optional. If such screenings are conducted, recommended age for use is in preschool, kindergarten, and upon entry to the school.

B. Books with pseudoisochromatic plates should be used. Options include:

1. HRR Standard Pseudoisochromatic Test, 4^th Edition;

2. Good-Lite ColorCheck Complete Vision Screener; and

3. Waggoner Color Vision Testing Made Easy.

C. Manufacturer's instructions must be followed for use of any tools used for color vision deficiency screening.

4.13.7Personnel && Training Requirements

A. The school vision screening must be conducted by a formally trained school nurse, trained in the administration of these tools to ensure uniformity across procedures.

B. Trained volunteers or other school personnel who are directly supervised on-site by a school nurse may be utilized in the vision screening program.

4.13.8Follow-up && Documentation Requirements

A. A student who does not pass vision screening must be rescreened on a different day and as soon as possible but no longer than six (6) months before the parents/caregivers are notified of the results of the screening.

1. Students who fail the screening criteria set must be re-screened by the school nurse.

2. Parents of students who fail to meet the minimal visual requirements on the second screening must be notified in accordance with the requirements of § 4.19 of this Part in order to arrange for a comprehensive vision examination by an eye care provider.

B. If the corrected visual acuity of the student is found to be in the range of 20/70 - 20/200 in the better eye after an eye examination, the school nurse in charge of the screening must, within thirty (30) days, report the result of the eye examination to the administrator of the Division of Services for the Blind and to the Special Education Supervisor, indicating that specialized services may be indicated.

1. Students identified with a visual impairment must be referred for specialized services and follow-up in accordance with the provisions of the 200-RICR- 20-30-6, Regulations Governing the Education of Children with Disabilities.

C. A student's vision screening results must be recorded in the "Vision Screening" section of the school health record.

216 R.I. Code R. 216-RICR-20-10-4.13

Amended effective 4/11/2022