California State
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Summary of the California State Guidelines
1. Required Screenings
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Grades:
- Transitional Kindergarten (TK)/Kindergarten
- Grade 2, Grade 5, Grade 8
- Special Education students
- Types of Screenings:
- Distance Vision: Required for all specified grades.
- Near Vision: Required at specific grades.
- Color Vision Deficiency: Mandatory for boys starting in Grade 1; not required for TK/K students.
2. Screening Referral Criteria (Criteria for Passing Vision Test)
- Pass/Fail Criteria:
- Preschool (Age 3): Refer if 20/60 or worse in either eye.
- Preschool (Age 4): Refer if 20/50 or worse in either eye.
- TK/Kindergarten (Age 5): Refer if 20/40 or worse in either eye.
- Grades 1 and up: Refer if 20/40 or worse in either eye or greater than or equal to a two-line difference between eyes (e.g., 20/20, 20/32).
- Automatic Fail:
- Students unable to complete screening for any reason (e.g., non-cooperation, occluder refusal) must be referred for a comprehensive eye exam.
3. Children Who Should Bypass Screening
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Preschoolers:
- Children with noticeable eye abnormalities such as strabismus or ptosis.
- Children with noticeable eye abnormalities such as strabismus or ptosis.
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At-Risk Children:
- Children with neurodevelopmental disorders (e.g., cerebral palsy, Down syndrome, autism spectrum disorder, cognitive impairment, hearing impairment, speech delays) should be directly referred to an ophthalmologist or optometrist.
- Children with neurodevelopmental disorders (e.g., cerebral palsy, Down syndrome, autism spectrum disorder, cognitive impairment, hearing impairment, speech delays) should be directly referred to an ophthalmologist or optometrist.
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Parental Concerns:
- Any child whose parent or guardian believes they may have a vision issue should bypass screening and see an eye care professional.
4. Required Tools OR Important Changes to Tools Used/Discontinued
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Screening Tools:
- Digital/Computer-Based Optotypes: Recommended as they minimize memorization and screener bias while offering developmentally appropriate charts for different ages.
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LEA SYMBOLS® or HOTV Charts: Recommended for pre-literate or young children.
- Digital/Computer-Based Optotypes: Recommended as they minimize memorization and screener bias while offering developmentally appropriate charts for different ages.
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Occluders:
- Avoid hands, tissues, or cups due to risk of peeking and pathogen exposure.
- Use adhesive patches, surgical tape, or occluder glasses for eye coverage.
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Instrument-Based Screening:
- Photoscreening is recommended for students who cannot complete traditional visual acuity tests (e.g., preschoolers, non-verbal, or developmentally delayed children).
