School Vision Screenings

What grades do we need to test?  Distance and near visual acuity screening must be performed on grades K or 1, 3, 5 and 8.  This differs from the previous act, as the 5th grade screening has been added, and near vision testing has been included.  Additionally, a "Modified Clinical Technique” battery of tests by an optometrist or ophthalmologist must be performed in either grade K or 1.

We use a vision tester instrument for acuity screenings.  Is this ok in the new revised law?  Vision screening instruments do not meet the requirements for visual acuity testing for students in grades kindergarten through twelve in Indiana. 

 Is near and far vision required when doing visual acuity screening?  Yes, the testing of visual acuity is to be done at both near and far distances for all grades that are required to be screened (K or 1, 3, 5 and 8).  The law defines vision screening as the testing of visual acuity to determine an individual’s ability to see at various distances, of either ten (10) to twenty (20) feet for distance vision, and a distance of fourteen (14) inches for near vision.

What are the procedures for doing near vision screening?  Near vision can be screened using a 14 or 16 inch card.  A visual acuity of 20/30 on a 16 inch testing card will be roughly equivalent to the 20/32 acuity on a 14 inch card, so that is still a passing performance.

 Where can I get near cards?   While we are not advocating or promoting any manufacturers in particular, a search on the website reveals a number of inexpensive near cards are available.  They included the:

                                - McCoy-Ultimate Rosenbaum/Snellen Pocket Eye Chart

                                -  Prestige Medical Pocket Eye Chart

                                -  Grafco Pocket Size Plastic Eye Chart

Does the child pass if they are able to read a line at 20/30? An acuity of 20/30 or 20/32, depending on the test instrument, is considered a passing acuity.  If they cannot read 20/30, so they are worse then 20/30, the student needs to be recommended for referral.

How many symbols on the 20/30 or 20/32 line must the child read correctly in order to pass the screening?  A student must correctly identify more than half of the letters or symbols on a given acuity line to be considered to have "passed" that level of acuity. 

What should I do if I cannot find an eye professional to do the MCT screening?  If an eye care professional cannot be found, the school must contact the Indiana Department of Education for a waiver.  If a waiver is provided, the law still requires kindergarten/1st grade students to undergo a vision screening.  That screening may be done in the same manner, and with the same resources, as the screenings conducted on 3rd, 5th and 8th grade students.

How do schools apply for a waiver?  If a school is unable to comply with completing the MCT vision screening requirement, the school may request a waiver from the IDOE by submitting a MCT Waiver Form.  The waiver form can be found at the following link:  Each individual school will need to submit a waiver request as waivers will not be granted at the corporation level.

Can schools require parents to complete the MCT screening at their own expense and by their own provider and send the results to the school?  The statute refers to schools obtaining the services of an eye professional and providing this screening to students.  Schools can ask or recommend that an MCT exam be provided by the parent, but a school cannot require this exam be completed in order for a student to enroll or attend school.  If a school does require the MCT screening and a parent is not able to afford this screening, the school must pay for this service for this child.

Which students are not to be screened  

  1. Any student that has written documentation by an optometrist, ophthalmologist, or physician stating a known vision loss in both eyes does not need to be screened. If a student has a permanent unilateral vision loss (loss only in one eye), the non-affected eye should be screened. Appropriate school personnel must be notified of this child with vision loss.
  1. No student should be required to submit to vision screening testing if written objection by the parent/guardian is submitted to the proper school authority. 
  1. Any student that is unable to be screened with traditional methods should be referred for follow-up testing.

If eye professionals come to the school to perform the MCT, what things do they need, how long might it take, etc.?  Generally, the eye professionals and possibly some of their staff will bring everything they need to conduct the testing.  Usually, visual acuity screenings can be done in advance by the school nurse or his/her designee, and a recording sheet or card prepared for each student with that visual acuity listed.  There will need to be at least a semi-dark room to be able to conduct the refractive testing (generally a test called retinoscopy), and it is often useful if there is a movie playing at the far end of the room to give the student something to look at and hold their attention during this test.  The screening of each student takes only a minute or two for the MCT test, if visual acuities have been tested in advance by the school nurse or his/her designee.

The recording sheet should have places to record the findings for visual acuities at distance and near, and then Pass/Fail listings to circle, or boxes to check for the refractive, eye health, and eye binocular coordination.  An open area as a "Comments” section is helpful, and then a Final Results area to indicate Pass, Fail, or Borderline for the test results as a whole.  A sample recording sheet can be found as Appendix A.

The borderline designation is sometimes helpful when the student just passes the criteria, but the eye professional thinks the student might have problems prior to 3rd grade, and be flagged for special testing in 2nd grade, or tested later in the 1st grade.  If the student is listed as borderline, the student does not need to be referred to an eye professional for further testing.  The parent should be notified of the borderline result and the school nurse should rescreen the student at the beginning of 2nd grade or sooner if requested by the parent or the teacher. This may also be the case if the student was not cooperative and testing may not have been complete or reliable.

If the eye exam is done outside the school venue, can a pediatrician do it?  With regard to kindergarten and first grade students, the law specifically requires that a MCT screening be done by an Optometrist or an Ophthalmologist.  This is because this type of screening is more comprehensive and requires the skills and expertise of professionals with specific training in that area.  

Can eye professionals charge the school for this service?  Nothing in the law prohibits an eye care professional from charging for a service.  However, the intent of the law is not to add an additional financial burden to the school.

How would billing be done if the student had Medicaid?  Medicaid will not cover school vision examinations conducted in schools.  However, Medicaid will cover comprehensive eye examinations of children enrolled in that program.  The service must be done by a provider who accepts Medicaid and the provider will bill Medicaid directly.

What type of school does this law apply to?  This law applies to all public schools, all charter schools, and all accredited private schools

Where can I find a copy of the law to view?  To view the complete law, please click on the following link or search the Indiana General Assembly website at for code #20-34-3-12.

Click here to read the Indiana Department of Education Vision Screening Guidelines as published in the Indiana School Nurse Manual

Click here to see a Sample MCT Recording Sheet

Click here to see more information for Doctors and School Nurses

The information contained on this website is not intended to serve as legal advice and should not be treated as such. The information provided is not exhaustive. If you have any specific questions about any legal matter you should consult your attorney or other professional legal services provider.