May 2008
Volume 49, Issue 13
ARVO Annual Meeting Abstract  |   May 2008
Comparison of State Guidelines and Policies for Vision Screening and Eye Exams; Preschool Through Early Childhood
Author Affiliations & Notes
  • N. T. Naser
    University of Alabama at Birmingham, Birmingham, Alabama
    Vision Sciences,
  • E. E. Hartmann
    University of Alabama at Birmingham, Birmingham, Alabama
  • Footnotes
    Commercial Relationships  N.T. Naser, None; E.E. Hartmann, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 3131. doi:
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      N. T. Naser, E. E. Hartmann; Comparison of State Guidelines and Policies for Vision Screening and Eye Exams; Preschool Through Early Childhood. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3131. doi:

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To systematically compare policies, guidelines, type of test, ages, and legislations on vision screening (VS) and eye exams in young children in the United States (US). A previous survey of vision screening policy of preschool children in the US addressed the diversity of states’ vision screening guidelines, procedures, and policies (Ciner, 1999). Since then, different states have taken various approaches.

Methods: : Data for this project were acquired by scanning multiple Health and/or Education Departments’ websites for each state. In some cases, this information was verified or supplemented through phone calls or emails with knowledgeable individuals. Occasionally, news articles and scientific literature were also accessed. The following categories are summarized in table format: 1) Individual State’s requirements for vision care in children; 2) Ages tested; 3) Tests used; 4) Referral criteria; 5) Dates amended; 6) Links and resources. State data confirmation was approached by careful analysis of terminology used in laws and legislations. Criteria for specifying whether a VS or an eye exam shall or must be conducted, or is required or mandated, was determined. Legislators in some states have lobbied for mandatory vision screening tests or eye exams; many states have passed laws pertaining to type of tests, while some states have no policies with regard to vision care in children.

Results: : Currently, 30 states require or mandate VS in children; 2 states (IL and KY) mandate comprehensive eye exams; 2 states (NC and MO) mandate eye exams or VS based on age or grade level; 7 states insist on a follow-up if a child fails screening;15 states plus DC have no requirements; no two states follow the same protocols; age of children screened varies (3-9) but some similarities exist. Different states use different terminology for various test methods. While school nurses do most of the vision screening, many reports have shown that parents, teachers and certified personnel also conduct VS. Even though guidelines exist and many states require screening or eye exams, the vague terminology used when describing laws, legislations, and requirements, does not readily address questions about the implementation of such guidelines for all children.

Conclusions: : More states are mandating eye exams and vision screening, but we are still far from a universal screening system. Although Medicaid, voluntary contributions, non-profit organizations, some state funding and local community resources do compensate for costs of tests, issues of funding for these mandates or requirements are far from resolved.

Keywords: screening for ambylopia and strabismus • amblyopia • visual development: infancy and childhood 

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