1. (a) Once the individual's parent or guardian has given consent for screening, vision screening is required to find signs of potential vision disorders for individuals attending a facility. Vision screening as described in this subchapter must meet the following requirements.

   1. (1) Facilities and school districts may select subparagraph (A) or (B) of this paragraph for vision screening of all ages. Deciding factors may include student population, screener availability, and cost.

      1. (A) Facilities may screen for visual acuity using traditional wall charts or electronic eye charts that show approved optotypes at the correct distances. See the vision screening manual on the Department of State Health Services (DSHS) website for detailed instructions and a list of approved optotypes.
      2. (B) Facilities may screen using an automated screening device. Refer to the vision screening manual on the DSHS website for additional guidance.
      3. (C) Facilities must calibrate, operate, and maintain all screening devices or equipment according to the manufacturer's instructions. Any screening tool that is not in good working order must not be used. The screening tool must be repaired or replaced.

   2. (2) Facilities must refer children aged four years and younger for a professional examination in the following circumstances.

      1. (A) Either eye cannot correctly identify the majority of optotypes on the 20/40 acuity line or if there is a difference of two lines between passing acuities in either eye. For example, if a child has 20/40 vision in one eye and 20/20 in the other, the child must be referred. However, if a child has 20/40 vision in one eye and 20/30 in the other, the child passed the screening.
      2. (B) Either eye receives a failing result when screened with an automated screening device. DSHS recommends children who fail an automated screen receive a follow-up screen with a traditional or electronic eye chart and other optional screening methods described in the vision screening manual on the DSHS website.

   3. (3) Facilities must refer children aged five years and older for a professional examination in the following circumstances.

      1. (A) Either eye cannot correctly identify the majority of optotypes on the 20/30 line. The DSHS requirement differs from the AAPOS standard of 20/32.
      2. (B) Either eye receives a failing result when screened with an automated screening device. DSHS recommends children who fail an automated screen receive a follow-up screen with a traditional or electronic eye chart and other optional screening methods described in the vision screening manual on the DSHS website.
   4. (4) Facilities must refer to and comply with additional pass or fail criteria in the vision screening manual on the DSHS website.
   5. (5) Facilities must use instrument-based vision screening, when available, for children aged 42 months to five years, as recommended by AAPOS, and for individuals with disabilities who do not respond well to other screening methods. Refer a child for a professional examination if the child fails the photoscreening.
2. (b) A screener who is not a provider and conducts vision screening in facilities must be trained and certified as described in §37.27 of this subchapter (relating to Standards and Requirements for Screening Certification and Instructor Training).
3. (c) Facilities must give the child's parent, other legally responsible adult, or the individual in the scenarios described in Texas Family Code §32.003, a referral form if the child fails a second screening or if after failing the initial screening, the screener determines a second screening is unnecessary. The referral is for further evaluation by an appropriate provider. Facilities must not refer a child to a specific person.
4. (d) Facilities, school districts, and screeners must follow all instructions in the vision screening manual available on the DSHS website.

Source Note:The provisions of this §37.23 adopted to be effective August 17, 2014, 39 TexReg 6055; amended to be effective February 9, 2026, 51 TexReg 732.