Our Vision Screening Protocol© is designed to answer one simple question, “Is there a vision concern that requires further examination by a pediatric eye doctor?”

The Protocol includes a Parent Questionnaire©, Objective Testing (e.g., fixation, tracking, pupillary reflex, corneal light reflection), discussion with a child's caregivers regarding possible concerns, and Scoring Guidance©. The goal is to identify children who may require further evaluation. Non-medical professionals using the protocol are looking for identifiers of both ocular and neurological indications of vision concerns. The protocol is not intended to diagnose medical conditions, provide a comprehensive assessment, or serve as a guide for educational programming.

History

In early 2020, Dr. Tanni Anthony from the Colorado Department of Education and A Shared Vision developed a protocol for conducting vision screenings of very young children via telehealth during the COVID-19 pandemic. The protocol leveraged research and materials from other experts in the field. (See Note 1 below.)

The 2020 protocol asked caregivers a series of questions that could indicate possible ocular and/or brain-based concerns and as a result warrant follow up with a pediatric eye doctor. Feedback from over 300 professionals who used the protocol during the pandemic was very positive. They found it simple to understand, easy to administer, and effective in achieving the intended goal.

In 2022, we updated the protocol with financial support from EI Colorado and with input from our user community as we returned to in-person vision screenings. Enhancements included clarifying and quantifying questions, adding age groupings, and removing redundant questions in the Parent Questionnaire©. Additionally, we added objective testing of a child's eyes, including fixation, tracking, pupillary reflex, and corneal light reflection leveraging the Kansas Vision Screening Requirements & Guidelines. (See Note 2 below.) Feedback has remained very positive, as professionals use the protocol for both in-person and telehealth vision screenings.

Also in 2022, Early Intervention Colorado, a department of the Colorado Department of Early Childhood, contracted A Shared Vision to provide training for their evaluation professionals as they assumed responsibility for Child Find of children birth to age three.

Building on expert insights from pediatric eye doctors and further input from our user community, we plan to enhance the protocol again in 2024. This improvement is crucial as we strive to address the under-identification of children with visual impairments in Colorado compared to our sister states.

Current Uses

Over 1,100 professionals in Colorado, along with colleagues from 13 other states, have been trained to use A Shared Vision’s protocol for vision screening of children birth to age three.

In Colorado, the protocol is primarily used to support Child Find and early intervention IFSP (Individualized Family Services Plans) reviews. Child Find is the state’s process for identifying children with developmental delays and/or disabilities who qualify for special education and related services so they may make progress towards preschool.

During early intervention IFSP reviews, the vision screening protocol is used to help identify children who are receiving other services (e.g., occupational therapy, physical therapy, speech-language pathology support, etc.) who may also have an unidentified visual impairment.

Looking ahead, we may be able to leverage the protocol to support vision screening during well-child visits with primary care professionals.

History of Colorado Vision Screening and Approach During Pandemic

This 85-minute briefing provides a concise history vision screening in Colorado and the state's response to vision screening for children birth to age five during the COVID-19 pandemic. The session features Dr. Tanni Anthony (Colorado Department of Education), Paula Landry (EI-TVI and co-founder of A Shared Vision) and Steven Lindauer (Executive Director and co-founder of A Shared Vision). Click HERE to view.

Notes

Note 1:

• Colorado Department of Education (2005). Visual Screening Guidelines: Children Birth through Five Years.
• Teach CVI (2020). Screening List for Children with a Suspicions of a Cerebral Visual Impairment (CVI) / Screen List CVI 1. Click HERE for the document.
• Topor, I. (2004). Approximate functional visual acuity for different sizes of objects and distances. Chapel Hill, NC: Early Intervention Training Center for Infants and Toddlers with Visual Impairments, FPG Child Development Institute, UNC-CH

Note 2:

• Kansas Department of Health and Environment, Kansas State Department of Education, Kansas School Nurses Organization, Inc., Kansas Vision Coalition, Kansas Optometric Association, and Envision, Inc. (2019). Kansas Vision Screening Requirements & Guidelines, sixth edition.

Photo credit: Atlantic Eye Institute