As much as 80% of earl y l earni ng i s obtai ned

vi sual l y, and a chi l d who cannot see wel l i s at

an obvi ous di sadvantage i n the cl assroom.
One of every ten or so school -age chi l dren has
a vi si on probl em, but parents usual l y don' t
suspect i t. That i s why a speci al vi si on screen-
i ng i s bei ng done at school .
The test uses an advanced screeni ng system,
devel oped and patented by NASA. The system
is based on a process called "photorefraction."
It takes a speci al col or i mage of the chi l d' s
eyes that can then be anal yzed for a wi de
range of probl ems.
From your chi l d' s poi nt of vi ew, the screeni ng
i s as si mpl e and as fast as havi ng a photo
taken. l t requi res no responses, and no eye
drops are used.
Many eye probl ems can be found thi s way,
such as nearsi ghtedness, farsi ghtedness,
probl ems l eadi ng I o l azy eye, eye al i gnment
probl ems and cataracts. l f your chi l d has
gl asses, the screeni ng can hel p confi rm that
the prescri pti on i s current.
A report detai l i ng the resul ts wi l l be sent to the
school a few weeks after the screeni ng, al ong
wi th a recommendati on for exami nati on by an
eye care professi onal i f possi bl e probl ems are
f ound.
.
Identify the children who need to be
seen by an eye care professional.
.
Minimize academic and other problems
resulting from poor vision.
What if a possible problem is detected?
The child should be seen by an eye doctor of your
choice for examination. The eye doctor will make a
diagnosis and treatment recommendation. You
may choose your own eye doctor, or your primary
physician can make a referral.
There i s no charge for thi s screeni ng.
Please fill out the attached
Student Form completely and
return i t to your chi l d' s teacher.
The eye screening program is provided through the
state Department of Education and is conducted by
Vision Research Corporation. Questions regarding
the screening
process or results should be directed
to Vision Research at the phone number or website
below.
Note: This program is based on a process that is
screening in nature, not diagnostic. Screening is
intended to identify, with a reasonably high
probability, children with a wide range of eye
problems who should seek the services of an eye
care professional for examination and
diagnosis. As with any screening process, there is
no assurance that all problems will be detected.
Also, there are eye problems that are not normally
detected by this screening process, including
diseases affecting the retina and optic nerve,
glaucoma, some astigmatisms and color blindness.
No screeni ng
process, i ncl udi ng t hat of Vi si on
Research, i s a subst i t ut e f or a f ul l exami nat i on
by a qualified eye care professional.
Vision Research Corporation
(800) e42-0025
For more information.,.
wrrvw.vis i on
-resea
rc h. co m
O Vision Research Corporation, 2008
Student Eye Screening Form
PLEASE PRINT CLEARLY
Use the common first name the child goes by in the classroom.
Gender
Age M/F
[ - ] [ _- ]
t l L
I I t l
Grade
n
I l
@
crri to' s...
Fi rst Name
Last Name
Teacher
lf for some reason you do not want your child screened, see fhe note in the box to the ight.
Othennise,
please continue with the items below.
@
ffas child ever been examined by an gE doctor? E Yes E Xo
l f Yes. . . About how l ong ago? What was result?
IYes Eruo Does chi l d have gl asses or contacts? Do they normal l y wear them?
Do you know or suspect any eye problems not mentioned above (describe)?
@
et"u." provide the contact information below to allow Sight Savers America, the state-designated assistance
agency, to contact you directly if your child has a possible problem.
Parent/Guardian' s
Name
Address
City, State Zip
Apt #
Phone: Day ( Eveni ng ( Cel l (
For Office Use
l f you do NOT want your chi l d
screened for eye problems,
pl ease wri te "NO" and si gn
your name in the box above.
Results are returned on this form.
Please do not fold, staple or tear.
IMPORTANT NOTE: Thi s eye screeni ng i s based on a process that i s screeni ng i n nature, and not di agnosti c. Screeni ng i s
intended to identify, with a reasonably high probability, subjects with a wide range of eye problems who should seek the services of
an eye care professi onal for exami nati on, di agnosi s, and correcti ve recommendati on. As wi th any screeni ng process, there i s no
assurance that all problems it is intended to detect will be detected. AIso, there are eye problems that are not normally detected by
thi s screeni ng
process, i ncl udi ng di seases affecti ng the reti na and opti c nerve, gl aucoma, some asti gmati sms, and col or bl i ndness.
No screen ing process r.s a substitute for full examination by a qualified eye care professional.
@ Vision Research Corporation, 2006,2014 All Rights Reserved.