Best Practices and Research
Children's Vision and Eye Health

12 Components of a Strong Vision Health System of Care

Successful vison screening requires 12 key steps before, during, and after a vision screening event. The National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness created a systematic approach to finding children with vision disorders. This comprehensive approach – the 12 Components of a Strong Vision Health System of Care – is designed for anyone responsible for screening vision, including Head Start and early care and development personnel.

1. Ensure that all parents/caregivers receive educational material, which respects cultural and literacy needs, about the importance of:

  • good vision for their child now and in the future;
  • scheduling and attending an eye exam when their child does not pass vision screening.

2. Ensure that parent/caregiver’s written approval for vision screening includes permission to:

  • share screening results with the child’s eye doctor and primary care provider;
  • receive eye exam results for your file;
  • talk with the child’s eye doctor for clarification of eye exam results and prescribed treatments;
  • share eye exam results with the child’s primary care provider.

3. Screen vision with age-appropriate and evidence-based tools and procedures, including optotypes (pictures) and/or instruments.

  • Follow national referral and rescreening guidelines.
  • Include vision screening training for your staff that leads to certification in evidence-based vision screening procedures.
  • Ensure that contracted screening organizations use evidence-based tools and procedures, utilize national referral and rescreening guidelines, and clearly state that a screening does not replace an eye exam nor provide a diagnosis.

4. Create policies for screening or direct referral for children with special needs.

5. Rescreen or refer difficult-to-screen (untestable) children.

  • Research suggests that untestable children are twice as likely to have a vision problem than children who pass a vision screening.
  • If you have reason to believe that the child may perform better on another day, consider rescreening the child within 6 months*. Otherwise, refer untestable children for an eye exam.

6. Provide parents/caregivers with vision screening results in easy-to-understand language, which respects cultural and literacy needs and provides steps to take for prompt follow-up with an eye care provider.

  • Provide written and verbal results.

7. Create a system for following-up with parents/caregivers to help ensure that the eye exam occurs.

  • Identify and remove barriers to follow up to eye care, such as transportation or a lack of knowledge of what will occur during the eye exam.
  • Consider ways to engage parents in peer-to-peer conversations to encourage follow up to eye care and adherence to prescribed treatments.

8. Link parents/caregivers for an eye examination with an eye doctor who specializes in the care and treatment of young children.

9. Receive eye exam results for your files.

10. Send a copy of eye exam results to the child’s primary care provider.

11. Ensure that the eye doctor’s treatment plan is followed.

  • Develop a plan

12. Evaluate the effectiveness of your vision health program annually.

  • Compare screening results to eye exam outcomes.
  • Identify variations in referral rates among your screeners.
  • Monitor screening procedures to ensure they follow current recommendations.
  • Monitor follow up to eye care for children who do not pass vision screening or who were untestable.
  • Look for common barriers in follow up to eye care and development and implement solutions.
  • Annual Vision Health Program Evaluation Checklist

* (American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel, 2012)