Overcoming obstacles to better vision screening and referral fulfillment
In addition to the vision problems missed by traditional school vision screening, the Vision Council of America estimates that 40% to 70% of children do not receive care from an eye care professional even when vision problems are detected.

Schools using VERA for general population screening report an increase in identified vision difficulties and fulfilled referrals owing to the program's accuracy, personalized reports and letters and follow‐up capabilities. VERA facilitates sharing of a student's vision status with teachers and administration so they can encourage compliance with the referral and better accommodate students in class. As a result, schools can position vision as a more integral part of the learning experience. And since VERA requires no new clinical skills of school nurses, the program is easily accepted.

Additional referrals to eye doctors
When VERA's vision skills screening is also employed, the identification of affected students can be a powerful inducement for schools to modify their instruction, defer expensive special education services and inform parents of community options for professional help. Millions of students nationally suffer from undetected visual skills problems due to the lack of appropriate evaluation. The majority of these students can be identified by VERA and treated by vision specialists.

A practitioner located near schools using VERA reported that as of the first 90 VERA referrals to his practice, VERA was 90% accurate in identifying students who subsequently benefited from vision therapy. He went on to state that:

"The difference between these VERA referrals and typical school referrals is the inclusion of evidence of visual skills dysfunction. Parents had also received written materials from the school and had been referred to websites discussing vision and learning. This resulted in parents more often appreciating their child's potential vision problems and the connection to classroom performance. During the past year an additional school district and a private elementary school near the practice have also begun to use VERA. The director of special services in the first district to use VERA reported recently that their district currently has the lowest rate of student classification for special education in the county. This is not only due to VERA and subsequent vision therapy, but she says that screening and remediation of learning related vision problems have been a significant factor."

VTA recommends Expansion Consultants, Inc. as a resource for doctors who wish to incorporate vision therapy into their practice, increase their vision therapy case load, or better retain prospective therapy patients. Every aspect of vision therapy practice development and promotion is addressed, including staffing, case presentation and fee acceptance and increasing referrals from schools and other practitioners who do not provide these services.

VERA research
Experience from screening one million students has refined VERA's routine screening. The result has been consistent identification of refractive and basic binocular vision issues which would have been missed by eye charts and many traditional screening methods.

VERA research first revealed that with the exception of visual acuity screening, other vision screening tests requiring one subject response had little correlation to reading grade level and/or curriculum-based assessments. By contrast, VERA's computerized visual performance screening (requiring multiple responses to critically controlled demands over time) correlated well with academic standing and the results of functional vision examinations. This screening is very difficult to do manually; this is why school vision screening misses so many vision issues which affect learning. VTA was later awarded two patents for this automated method of identification.

Recently published research research further defined VERA's accuracy in identifying students with visual skills problems when compared to teams of vision and reading specialists assessing the same students. VERA identified students with visual skills problems with approximately 60% sensitivity and nearly 90% specificity when combined with its symptom survey.

VERA in a professional office:
VERA's routine screening can be used as a pre‐examination screening for visual acuity, hyperopia and binocular vision for patients of any age. The vision skills screening can be given if the patient passes the routine screening or later, once their vision correction is in place. If the doctor has already made a determination of need for vision therapy, VERA can be used to demonstrate this need to patients and/or parents.

Because VERA was designed as an institutional screening tool, the program may differ from usual in-office testing as follows:

• The visual acuity screening has test lines which correspond to 20/20, 20/25, 20/30, 20/40, 20/70, 20/200 and 20/400. Other lines have been omitted to render an institution's vision screening more efficient without changing the pass/fail accuracy. Nonetheless, the program gives an accurate indication of whether or not your patient's visual acuity requires correction.

• The routine binocular vision screening includes tests for suppression, stereopsis and phoria which are not scored individually. Passing the binocular screening requires passing any 2 of the three tests. As such, the program gives an indication of whether additional binocular testing is advised.
  

• The scoring for visual skills is calibrated for ages 7‐13, but older, non-presbyopic patients may still be screened with VERA. They will be compared to the oldest subjects the database and still give reasonably accurate results. Patients under age 7 may have a developmental lag and yield equivocal results.

The entire screening can be run by an assistant and areas of potential weakness can then be confirmed during your examination. Even if a practice does not provide vision therapy services, screening for a visual skills deficiency can enable an appropriate and appreciated referral with a minimum of time and effort.