Comparative Analysis of Vision Screening Guidelines in the United States

Aims: To assess current school vision screening guidelines of states spread across different regions of the United States to inform quality guideline parameters and help combat preventable pediatric vision loss.

Study Design: Cross-sectional comparative analysis.

Methodology: States were first ordered alphabetically and then selected using an online random number generator (Alphabet Inc., Mountain View, California). States were selected until 13 available screening guidelines were identified. Each guideline was assessed using a 10-point multi-factorial scoring criteria detailed in Table 1. Descriptive statistics (mean and standard deviation) were calculated for each scoring criteria using Microsoft® Excel (version 16.63.1, Redmond, WA).

Results: Most state guidelines included what ages to screen (84.62%, 11/13), how to screen (84.62%, 11/13), and how to follow-up with students to arrange (92.31%, 12/13) and confirm eye care delivery (76.92%, 10/13). Sadly, only the minority of state guidelines described at least two main causes of amblyopia (46.15%, 6/13), and a less than one-third of school nurse vision screening guidelines discussed the window of time to save vision in amblyopia (30.77%, 4/12). Worse yet, very few nurse vision screening guidelines explained that subjectively a child can’t tell you if they are at risk of developing amblyopia (15.38%, 2/13), or included two treatments for amblyopia (7.69%, 1/13) in the vision screening educational program.

Conclusion: This study found that most of the assessed vision screening guidelines outlined the process of screening and follow-up but failed to emphasize why screening is important, causes, and treatment options for amblyopia. Gaps in these training guidelines may contribute to delayed recognition and treatment for amblyopia¾the leading cause of irreversible pediatric vision loss. Further improvements to vision screening guidelines are needed for school nurses and paraprofessional staff in the majority of the states evaluated.