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The future of vision screening is presently receiving heated debate. Recent federal legislative activity in the area of comprehensive health planning has caused renewed interest in vision screening. Optometric recommendations supported at various governmental levels call for the development of standards for comprehensive vision screening of school children on a national scale. This paper attempts to review the philosophy and justification for school vision screening and to bring the readers up to date on related governmental activity. The question of adequate manpower to implement a nationwide vision screening program is discussed, and an argument is developed for preparing school nurse practitioners to assume an expanded role in comprehensive vision screening.

It has been observed that black preschool children low income families have a higher than average rate of referral from a school vision screening program. One potential contributing factor results from the fact that examiners often modified the referral criteria based on their clinical judgment. This study was designed to investigate the influence of the application of clinical judgment on the proportion of referrals as a function of ethnicity and socioeconomic income level. The results suggest that modifying the referral criteria based on clinical judgment does not significantly influence the proportion of referrals based on ethnicity or socioeconomic income level.