1 © © 2021 The following slides are pulled from a longerfrom are a pulled followingslides The presentationprovidedforstate, local, regional, and international and meetings national, conferences. P.EdD Kay Chaplin, Nottingham [email protected] 304-906-2204 2 © © 2021 Introduction and Disclaimer and Introduction Trained individuals,>1,600 178 workshops(majoritylocation)on NationalAssociation of SchoolNurses NationalHead Start Association School-BasedHealthAlliance NationalCenter on EarlyChildhood Healthand Wellness OfficeHeadof Start’s National Center Health,onBehavioral Health, and Safety omrDrco/edTanr–Vso ntaiefrCide West Virginia University VisionInitiative Eye for ChildrenFormer Director/Lead – Trainer – Institute NationalCenter for PreventBlindnessCurrent – Education and Outreach Coordinator – Children’s Visionand EyeHealth NationalVisionScreening Trainerfor Prevent Blindness Visionand EyeConsultantHealth to SchoolHealth Corporation and Good-Lite Workedinthevision and eyehealth space since February 15, 2001 Lectured,trained, and consultedatmore 200 than international,national, state, district, and localvenues, including nationalwebinars, and annual conferencesforthe: • • • • • •

4 © © 2021 The next two slides describe the national and and national the describe slides next The two for standardizedguidelines international eye references. with along design, chart 5 (WHO) Advances Advances (NAS-NRC) © © 2021 :103–148. Committee on Vision. (1980). Recommended standard procedures for the clinical measurement measurement clinical the for procedures standard Recommended Social and (1980). Behavioral Vision. of on Assembly Committee 39. group working of Report acuity. visual of DC. Washington, specification and Sciences, of Academy National Council, Research National Sciences, 41 Ophthalmology, in www.icoph.org/dynamic/attachments/resources/icovisualacuity1984.pdf for standards of development on Consultation deafness. and (WHO/PBL/03.91). blindness of WHO;2003 Prevention Geneva: functioning. visual and loss vision of characterization visual clinical in used optotypes of design optical the for standard Performance systems measurement acuity Recommended Standard Procedures for the Clinical Measurement and and Measurement Clinical the for Procedures Standard Recommended Acuity Visual of Specification standard. measurement acuity Visual Vision of Characterization for Standards of Development on Consultation Functioning Visual and Loss 2010 27, May Approved (R2004) Z80.21-1992 ANSI • • • • • • • • 1980 - National Academy of Sciences-National Research Council Council Research Sciences-National of Academy National - 1980 (ICO) Ophthalmology of Council International - 1984 Deafness & Blindness of Prevention Organization Health World - 2003 Inc. Institute, Standards National American – 2010 National andInternational Distance Visual Acuity Eye ChartRecommendations • • • •

7 NO © © 2021 YES 3Tips for knowing whether the chart is appropriate: • Line outside optotypes 1. 20/32 vs. 20/30 2. 10feet vs. 20 feet 3.

9 TumblingE © © 2021 Lighthouse or or Lighthouse “House, Apple, Umbrella” KindergartenTest Chart Challenges With 5 Commonly UsedEye Commonly 5Charts With Challenges Snellen LettersSnellen Allen Pictures 10 TransactionsoftheAmerican © © 2021 , , 311-324. 3 3 Challenges With “Snellen Chart” Does notDoes meet national/international eye chart design guidelines not Isstandardized Some letters easier than others toidentify • • • Kaiser,P. (2009). K. Prospectiveevaluation visualof acuity assessment: A comparisonSnellenof versusETDRS charts inclinical practice (AnAOS thesis). OphthalmologicalSociety, 107 11 © © 2021 20/30 line 20/30 “Sailboat” Chart LacksScientific Evidence “Sailboat” Does notDoes meet national/international eyechart design guidelines Some optotypes in “blobs” black Optotypes of different sizes on same line • • • (8), (8), 12 Transactions the American of American Journal of Public Health, American Public 61 Health, Journal of © © 2021 , , 42, 49-99. “Sailboat” Chart Lacks“Sailboat” Scientific Evidence Only Only 1 looked at visual acuity, but with colored optotypes not same chart. = 4-yr-olds. and “too Deemed complicated” for 3- Only 1 study to pertained current chart goaland the wasto determine whether children liked the chart. – – – Found3studies • Fink, W.Fink, (1944). AnH. evaluation visual of symbols.acuity Ophthalmological Society Lippmann, O.Vision screening young of children. (1971). 1586-1601. I. (1964). Visionscreeningpreschool theof child:report a of Savitz, Reed A., B., R. Valadian R. & study. US Health, Education,Department of andWelfare. Welfare Administration. Children’s Bureau. Washington, US GovernmentDC: Printing Office. 13 (1), Pediatrics, 137 Pediatrics, Chart’s history and developer unknown Earliestphotograph: 1935 American August catalogCompanyOptical Donahue, S. S. P.,Donahue, Baker, on Committee C. AAP N.,& Section AAP Medicine, AmbulatoryandPractice of Association Ophthalmology,on American for Association American Orthoptists,Certified Strabismus,and OphthalmologyPediatric (2016). of AcademyOphthalmology American visual theof forProceduresevaluation the systempediatricians.by e20153597. http://pediatrics.aappublications.org/content/pe diatrics/early/2015/12/07/peds.2015- 3597.full.pdf • • Scientific Scientific Evidence © © 2021 American American Academy of Pediatrics American Association of Certified Orthoptists American Association for Pediatric Ophthalmology and Strabismus American Academy of Ophthalmology – – – – Not on recommendedon Not 2016 eyelist charts of from: guidelines joint Overarching Chart: LacksChallenge “Sailboat” With • 14 Acta OphthalmologicaActa , , 507-11. 58(4), ability to to ability guess at optotype by threshold at looking 3 or line solid lines open Hyvärinen, L., Näsänen, R., & Laurinen, R., Näsänen,L., Hyvärinen, P.testNewvisualacuity for(1980). pre- children.school (Copenhagen) 2. Potential Potential 2. The The , 269-276. , © © 2021 Emerging cognitive skill cognitive Emerging left/right before ages by place in Usually years 10 or 8 or 8 ages to prior skills years 10 direction challenges with with challenges direction optotypes directional a. emerges Up/down b. c. cognitive Measuring d. 2 Challenges With Tumbling E Tumbling With Challenges 2 1. Children’s orientation and and orientation Children’s 1. Elkind, D.Elkind,Children’s (1961). conceptions of Piagetleft:rightandreplication study IV. Genetic Psychology, Journal of 99

16 © © 2021 3 3 Challenges With Allen Pictures create “whole” picturea from “parts” SnellenE, 30-ft not Landolt(internationalC standard) 1. Asking Asking youngchildren to 1. Cultural bias 2. Calibrated against 3. 17 American American Academy of Pediatrics American Association of Orthoptists Certified American Association for Pediatric Ophthalmology Strabismus and American Academy of Ophthalmology – – – – Not on Not 2016list on of recommended charts by: (7), 4307-4313. (7), 52 © © 2021 , • Investigative Ophthalmology & Visual Science Visual & Ophthalmology Investigative (1), e20153597. Retrieved fromRetrieved e20153597. (1), Lighthouse Chart Optotypeseasy to guess. Poor visual acuity results when comparedwith international Landoltstandard.C Candy,T. S. Nosofsky, forR., performanceV. Mishoulam, pediatric Dobson, R. M., & discrimination R., Adult (2011). optotypes.test acuity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175947/pdf/z7g4307.pdf S. P.,Donahue,Ophthalmology, on Section AAP Baker, Medicine, Ambulatory andPractice on Committee C. AAP N.,& Strabismus,and for OphthalmologyPediatric Association American Orthoptists, of Certified Association American systembypediatricians.visual of the evaluationfortheProcedures (2016). Ophthalmologyof Academy American 137 Pediatrics, http://pediatrics.aappublications.org/content/pediatrics/early/2015/12/07/peds.2015-3597.full.pdf • • 18 100% spacing betweenspacing 100% optotypes(1 optotype- width) Unequalspacing not BETWEEN lines – Arbitrary andnon- standardizedbetween- line spacing geometric progression log of (logMAR) 0.1 • • • © © 2021 “Linear-Spaced” Eye “Linear-Spaced” Charts 19 Between-optotype >100%spacing Unequalspacing not BETWEEN lines – Between-line spacingis arbitrary Basically contains lines of optotypessingle geometric progression log of (logMAR) 0.1 • • • • © © 2021 Wd-pcd Eye Charts “Wide-Spaced”