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 features several components that support early identification of children with concerns for low vision who would benefit from further evaluation. These components include the Parent Questionnaire©, Objective Vision Testing, Scoring Guidance©, and a structured conversation with caregivers about potential concerns and recommended next steps.

Non-medical professionals using this protocol are trained to recognize signs that may indicate ocular or neurological vision issues.

It is important to note that the protocol is not a diagnostic tool nor does it offer a comprehensive assessment; instead, it serves as a preliminary screening to identify children who warrant further examination by a pediatric eye doctor.

2025 Updates to the Vision Screening Protocol©

Our 2025 update incorporates feedback from Colorado experts, including top pediatric ophthalmologists and optometrists, enhancing the precision and effectiveness of our instruments with more specific recommendations for our caregivers. Additionally, we integrated a HIPAA-compliant cloud-based platform to greatly streamline the administration of the protocol and significantly improve the caregiver experience.

A Shared Vision greatly values the time and expertise contributed by the following individuals in shaping this updated version of the Vision Screening Protocol©:

• Tanni Anthony, Ph.D., Colorado Department of Education, Director, State Consultant on Blindness, Denver.
• Patrick Arnold, MD, Eye Center of Northern Colorado, Fort Collins.
• Kiley Berry, OD, Southwest Eye Consultants, Durango.
• Rebecca S. Braverman, MD, CU School of Medicine and Children’s Hospital Colorado, Aurora.
• Kara Hanson, OD, Sue Anschutz-Rodgers Eye Center, Aurora.
• Erin Major, OD, Children’s Hospital, Anschutz Medical Campus, Aurora.
• Emily McCourt, MD, Ponzio Family Chair for Pediatric Ophthalmology, Chief of Pediatric Ophthalmology at Children’s Hospital Colorado, Aurora.
• Anna Steele, MD, Children’s Eye Physicians, Denver.

Vision Screening Process

The vision screening process begins with caregivers receiving a link to the Parent Questionnaire©. This tool gathers information about the child’s family vision history, medical history, eye and eyelid appearance, visual behaviors, and any concerns from caregivers. The screening continues with objective tests on fixation, tracking, pupillary reflex, and corneal light reflection.

Results of the screening are analyzed and summarized using a detailed rubric, leading to documented next steps on the Vision Screening Results & Recommended Next Steps for Caregivers© form.

This is complemented by discussions with caregivers, focusing on their observations and responses to the questionnaire. If follow-up is recommended, caregivers are provided with contact information for pediatric ophthalmologists in Colorado and directed to the Colorado Optometric Association’s website for further assistance.

Additionally, for children receiving early intervention services, adding an Early Intervention Teacher of the Visually Impaired (EI-TVI) to the care team is encouraged to assist with coordinating and attending eye appointments, and providing ongoing support and strategies that benefit the child and their family.

Current Uses

The protocol is designed for use by a diverse range of professionals and organizations intent on determining if a child's vision concerns warrant a follow-up with a pediatric eye doctor. This includes Early Intervention and Child Find teams, Head Start evaluation teams, nonprofits, state entities, in-patient hospital teams, well-child vision screening professionals, caregivers of newborns with risk factors, and daycare centers and pre-kindergarten schools.

Since its inception in 2020, over 1,300 professionals across Colorado and 13 other states have been trained to use this invaluable protocol for vision screening of children from birth to age three.

Vision Screening Resources

To support the effective implementation of the Vision Screening Protocol©, we provide comprehensive resources tailored to enhance the capabilities of non-medical professionals. These resources include:

• Training. We provide two targeted training sessions tailored to the specific needs of professionals. (1) A refresher course for those who have completed the Parent Questionnaire© training from 2022 to 2024. (2) A foundational training program for new professionals or those who have not previously completed training but are interested in performing or facilitating vision screenings for this demographic.
• Parent Questionnaire©. Available on the CognitoForms platform in both English and Spanish, this HIPAA-compliant tool enables caregivers to conveniently complete the questionnaire from any device, such as smartphones, tablets, or computers. We also provide ready-to-use email and text templates to facilitate easy distribution of the questionnaire to caregivers.
• Objective Vision Testing. Detailed documentation guides professionals through essential tests on fixation, tracking, pupillary reflex, and corneal light reflection. In collaboration with the Colorado Department of Education Deaf-Blind Project, we also offer specialized training that includes the provision of penlights and other necessary resources.
• Scoring Guidance©. This comprehensive guide, including a Scoring Rubric©, is designed to accurately interpret caregiver responses and professional observations, ensuring precise assessment outcomes.
• Results & Recommended Next Steps for Caregivers©. Utilizing this form, professionals can document screening outcomes and outline subsequent recommendations for caregivers. It is readily accessible via CognitoForms, in both English and Spanish.
  
• Help Desk. A Shared Vision provides ongoing Help Desk support to assist professionals in navigating and utilizing the protocol, including the CognitoForms platform.

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 on 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.

References

A Shared Vision gratefully acknowledges the contributions of the following sources:

• Colorado Department of Education (2005). Visual Screening Guidelines: Children Birth through Five Years.
• Kansas Department of Health and Environment, Kansas State Department of Education (2018). Kansas Vision Screening Requirements & Guidelines.
• Teach CVI (2020). Screening List for Children with a Suspicions of a Cerebral Visual Impairment (CVI) / Screen List CVI 1.
• 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, University of North Carolina at Chapel Hill.

History of Colorado Vision Screening and Approach During Pandemic

This 85-minute briefing provides a concise history of 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