How does the passage of House Bill 3157 impact my school? What do school administrators need to do related to vision screening?

House Bill 3157 allows the use of photoscreening devices but does not require the use or purchase of photoscreening devices. Schools should continue to follow current rules, which allow for the use of photoscreening technology according to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) recommendations. (Read additional details about the use of photoscreening below). 

My school is considering using photoscreening for all children. Is that an allowable vision screening technique?

Yes, photoscreening devices can be used to screen students at any age for risk factors that may lead to vision disorders. However, for children 6 years old and older who do not have a disability, photoscreening does not screen for visual acuity. Therefore, to meet current requirements, additional screening using an approved eye chart is needed to test visual acuity for children over the age of 5.

My school is considering using an outside entity to perform the vision screenings. Is this allowable?

Yes, entities not affiliated with the school may perform vision screening.

• Licensed professionals, like ophthalmologists or optometrists, may screen children using acceptable screening procedures as defined under their professional licensure.
• Individuals who are not licensed professionals but have completed appropriate training and are certified by the Texas Department of State Health Services (DSHS), may screen children according to current rules. 

As new technology becomes available, how will DSHS evaluate screening methods and determine what is acceptable for use?

All new technology or methods are vetted within the agency and with experts to ensure it complies with current guidance.  DSHS continually follows AAPOS guidelines and recommendations to determine acceptable visual acuity screening technology or methods. If new technology or methods are deemed to have met AAPOS guidelines, DSHS will update its program rules, as needed, and communicate the new guidance with stakeholders. 

Will computerized visual acuity screenings satisfy the DSHS requirements for screening children?

DSHS follows American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines (https://aapos.org/members/policy-statements) for the screening program. Our current interpretation of the AAPOS guidelines is that there is insufficient independent validation of computerized visual acuity screening to have a formal endorsement or recommendation of its use. The DSHS position at this time is that schools use the Sloan Letter Chart or HOTV charts as they are considered the gold standard for screening vision in otherwise healthy school-age children. 

DSHS does not promote or endorse vendors or products on the market.  DSHS also does not maintain an approved list of screening devices. Texas schools have the autonomy to choose products that best serve their students, and DSHS will continue to recommend methods that align with AAPOS guidelines.  

What is a photoscreening?

Photoscreening is a form of pediatric vision screening that uses a special-purpose camera to determine how well a child can see. Other related terms are autorefractor, objective screening, and instrument-based screening. By detecting special light reflexes from each eye, the devices produce images that can help identify refractive errors (like a prescription for glasses) and ocular misalignments (strabismus). Photoscreening is particularly useful with preverbal children (under age 3 years), young children (age 3 to 5 years), and older, non-cooperative, or non-verbal children. However, photoscreening cannot determine exactly how well a child’s visual acuity is developing. 

What is visual acuity?

Visual acuity is the sharpness of vision, measured by the ability to discern letters or numbers at a given distance according to a fixed standard. The use of an eye chart requires a cooperative child, so successful testing is greatest with children 3 years and older. It is the only screening method that directly measures visual acuity and is the preferred exam for older children.

Rule 37.23 states that photoscreening may be used on any student with a disability who does not respond well to chart screening and a referral for a professional examination is recommended if they fail photoscreening. However, recommendation #3 on the DSHS website says that these children should be referred regardless of photoscreening result. So, if they pass the photoscreening are we still supposed to refer the child? 

Photoscreening may be used on children with disabilities, and they should be referred for a professional evaluation if they fail. The expert panel recommendation to refer these children regardless of photoscreening result is not a program requirement, but rather a recommendation of best practices. In other words, schools should consider that a photoscreener does not accurately assess visual acuity in children ages 6 and older. Therefore, at the school's evaluation and discretion, disabled children who pass photoscreening may still need a referral for a more comprehensive eye exam. 

If a child with a disability passes photoscreening but the screener determines that the child may benefit from a more comprehensive eye exam, and refers the child, how should the school report the result?

The school will only report the passing result of the photoscreening.