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Vision Screen Logistics

District 2E2 Lions can provide important vision screening support and patient education for our community. This means that all Lions that interact with children and adults need to have a solid understanding of eye health, optics and an understanding of where full professional care is available.


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Only licensed eye care professionals can diagnose and treat eyes. Our role is to assist those licensed individuals. Because of this responsibility, we ask that all Lions that conduct the vision screening be certified by a licensed individual either through the State of Texas, Prevent Blindness or Lions.


All Lions that conduct vision screenings will eventually have to complete a Texas Chart Certification program in order to meet the standards of the state and to protect the patient.




The following forms should be available in sufficient quantity for the screening event:


1. Registration/ Release Form. This form along with a copy of the screening results is kept for our records. Parents/ Guardians must sign the form as a release for the vision screening to take

place. If a child is referred to an eye care provider, place a large letter “R” in the upper right corner of this form.


 Registration Form (English)   pdf icon

 Registration Form (Spanish)  pdf icon


2. Screening Result Form. This form is provided to the parent and guardian after a verbal briefing is conducted that explains the results. We cannot make a medical diagnosis; however, we can explain that results that fall within or outside of the accepted results. If the results indicate that the child be seen by an eye care provider, we provide this form and the Examiner’s Report. Use the Screening Followup form to recontact those you referred to make sure they made and kept their appointment with an eye care professional.

 Screening Result (English)   pdf icon
 Screening Result (Spanish)  pdf icon


 Screening Follow-up  pdf icon


3. Have copies of the Prevent Blindness Referral forms for children that may qualify for a free

exam and glasses or provide them access to the Community Eye Clinic.

Forms can be provided to each club electronically so that they may reproduce them and fill in the forms for specific events.


Room Set-up tips


It is important to have a room that is both relatively quiet and has low light to get the best results for the screening. Have a registration table set-up outside of the screening room with chairs so that the forms can be completed. It is highly recommended that all forms be printed carefully by the parent or the Lion Club members.


Have a poster or banner to identify the event and the Lions. The Lions working on the Registration Table do not need to be certified, however, they should explain what service will be provided.


It is recommended that chairs are stacked for short children. The Lion can sit across from them on another chair or squat down without a chair. Do not use a table between the child and the screener. Have a table set-up with additional forms and for brochures for parents on children vision health. These are available through PBT or the LOEB.

Organize your screening team into four (4) groups:


1. Registration. Fill in the forms and explain the process. At large events, some members will go

out to encourage parents to come in for a screening.


2. Children Assistance. These Lions walk the children and parents over to the screening area and explain the process.


3. Screeners. These are Lions that are certified to use the equipment.


4. Parent discussion. They speak with the parents about the screening results. This is an important step to encourage parents to seek medical assistance if the screening indicates a vision issue.




The following supplies are important for each screening:

  • Stapler and staples

  • Pens

  • Clip Boards, typically 5-10

  • Extension cord and power strip. During an event, the Plusoptix run off their battery. It is not always possible to charge them during the event.

  • Spare, charged batteries for the Plusoptix. Each Instrument has a spare battery. Make sure that each battery is charged the night before. Charging is done though a separate charging machine. These should be set up at the recharging of the batteries.

  • Children Education materials about their vision needs. Each parent should get at least one brochure about their children’s vision needs.

  • It’s a great idea to have a Vision Screening Travel Box that has all of the forms, clipboards and materials in one location. Always bring an Instruction Manual in case you have questions.


Scheduling and Communicating a Vision Screening


Elementary Schools conduct a vision screening once every two years for each child. This leaves a gap for some children that experience vision problems or are new to the school district. Contact the District Offices, Health Services Department, and speak with the local director on ways to conduct a screening for a school during their class hours. Contact your schools several months in advance to verify if a background check needs to be made for the vision screeners.

Health Clinics. Many local hospitals and city offices will conduct a Health Fair during the year. Contact

the local Community Services Department to see if one is planned in your area.


Conduct a Lions Club Sponsored Vision Screening Event. The best results are when we partner our activities with other health care programs. This can be a stand-alone event or part of a local Club annual fund raising or community service activity. Posters, local advertising, coordination with the schools and churches helps get the word out. Take time to plan the event.

Local Community Assistance Groups. Often, local community assistance groups will conduct health programs in their community. Contact the local community assistance programs. This service may also apply to local churches.


Keep District Records


There are a number of records that each club should keep regarding this service and their efforts in the community. These include:

    • Annual Service Hours. Each club should track how many “Lions Service Hours” are used to conduct local community service events and support. This can be very important when your club approaches local organizations for funding and grants. It is also a measurable part of the service that we can provide. Our greatest resource is the number of people that we can bring to an event.

    • Track the number of vision screenings competed annually. Communicate the results of your screenings with the LOEB.

    • Report the number of students screened.

    • Track the names of the Lions that have been certified to conduct children (and adult) vision screening. This is important too when you approach organizations to explain the support you can provide. Only certified screeners are authorized to use the Plusoptix ® or other auto

      refractors provided by the 2E2 District, LOEB or Prevent Blindness.

    • Provide an update to the LOEB so that we can track the service we do across the 2E2 District.


Additional Support Resources


You have support through the 2E2 District, the Lions Organ and Eye Bank as well as through Prevent Blindness Texas. Plan to have a member from one of these organizations on hand for your first Children Vision Screening to help with the logistics and conducting the event.


Plan your activity at least two months in advance so that you can confirm that the Plusoptix Vision Screeners are available for your Club’s use. Contact the LOEB for reserving the equipment. Local vision screening should be managed and performed by local Lions. The LOEB would help with the initial screening and training.


Vision screening instruments will be available on a first come-first served basis. The “Back to School” time is especially busy so plan these events in advance. Only Certified Screeners are authorized to use these instruments. The requesting Lions Club is responsible for all reserved instruments and will be liable for any damage or loss of the equipment.





Lions Organ and Eye Bank

PO Box 830

Fort Worth, Texas 76101

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