Improving vision screening for children

The Vision 20/20 Project is a peer-to-peer vision screening programme. It’s a collaborative effort involving occupational therapists and product designers from Otago Polytechnic, optometrists from Otago University’s School of Medicine and staff and pupils at Tahuna Normal Intermediate School in Dunedin. The team hopes the Vision 20/20 Project will ultimately benefit children and their learning throughout Aotearoa. Their work is funded by the New Zealand Government’s Participatory Science Platform (PSP) – a world-first initiative that aims to engage communities in research projects that are locally relevant and have quality science and learning outcomes.

Vision testing in New Zealand

Sometimes students’ eyesight is not as good as it could be. At present, there are two national opportunities for vision screening for children. The first is at the age of 4 when children are screened for amblyopia (lazy eye), but other conditions that might affect their capacity to read, such as long-sightedness and short-sightedness, and eye co-ordination are not tested. At age 11, students are again tested but only for distance vision. After both tests, it is up to parents to take action if follow-up care is required.

The gaps in the screening programmes led Mary Butler, Professor of Occupational Therapy at Otago Polytechnic, to think about social innovation as a way of reducing the effects of visual impairment on learning. Mary and her students created a prototype called the child-to-child vision screening toolkit.

I want to create awareness of the need for vision screening in children. As we have unpacked this, we have realised the issue is huge. It gets harder and harder for children with untreated low vision as they go through the education system as more and more reading is required.

Mary Butler, Vision 20/20 Project lead

How the child-to-child vision screening toolkit works

The toolkit has four tests for students to complete – high-contrast vision tests for each eye and low-contrast vision tests for each eye. It uses a ‘tumbling E’ acuity test, which means the person being tested simply has to point to the direction the limbs of the E are facing – up, down, left or right. The tumbling E also shows how the eye is behaving when it is reading key information.

The students work in groups of three and take turns being the tester, the recorder and the testee. The tester stands 4 m from the testee, holds up a chart and reads out the instructions for each test. The recorder watches the responses of the person being tested and uses a tick sheet that corresponds to the testing chart. The pages of the chart and the record sheets are colour coded to ensure the tester and recorder are using the same charts.

Co-designing the child-to-child vision screening toolkit

Students from Tahuna Normal Intermediate School have been working with the research team to find out what works and what needs to be tweaked.

We believe that, by designing in a collaborative and iterative way, this takes the guesswork away. We’re developing a toolkit that is truly user friendly, educational, visually appealing and is scientifically valid.

Machicko Niimi, product designer

The students have provided considerable feedback. In early iterations of the test, they found people being tested could simply memorise the letter patterns, which were repeated from test to test, so the team switched to the tumbling E design. Students suggested other modifications to the testing chart, including colour coding and the amount of text the tester had to read. They noted working in groups of three was easier and more effective than working in pairs. The students appreciate how their suggestions have been incorporated.

More than just an eye test

The Vision 20/20 Project provides an authentic context for learning. Two of the components – looking at the eye and eye health and using simulations that demonstrate how certain eye conditions can affect vision – align with the health and physical education curriculum. Working through the eye test helps students develop their science capabilities in gathering and interpreting data and using evidence. Vision 20/20 also hopes to create a supportive environment that enables students to get the help they need and to reduce any stigma about wearing eyeglasses.

The project team have created classroom resources:

• The Vision Health Module (PDF, 2.4 MB) is a ready-made teaching package for year 7 teachers to implement in their classrooms, over six separate sessions.
• The Child to Child Vision Screening Manual (PDF, 660 KB) outlines the process of carrying out child-to-child vision screening. If you are interested in this project and would like a flip chart please email us.

The following resources are designed to be used alongside the Vision Health Module:

• How do our eyes work – Part 1 (PPT, 2.8 MB)
• How do our eyes work – Part 2 (PPT, 2.4 MB)
• Looking after our eyes (PPT, 3.7 MB)
• We all see differently (PPT, 4.4 MB)
• Technology and vision (PPT, 5.8 MB)
• Child-to-child vision screening (PPT, 960 KB)
• Vision Health Module – Student Workbook (PDF, 1 MB)
• Vision Health Module – Workbook Answers (PDF, 950 KB)
• Template for recording class vision screening results (XLS, 10 KB)
• The vision screening student recording sheet (PDF, 356 KB)

If you are interested in this project and would like a flip chart please email us.