State of Texas Interagency Eye Examination Report

  • Below is the State of Texas Interagency Eye Examination Report. This form was originally developed by the Texas Education Action Committee for the Education of Students with Visual Impairments and was last revised in November 2021. 

    In determining eligibility, in Texas, it is required to have:

    A report from a licensed ophthalmologist or optometrist that includes:

    • visual loss in exact measures of visual field and corrected visual acuity at a distance and at close range in each eye; or
    • if exact measures cannot be obtained, provides best estimates of the visual loss; and prognosis whenever possible;

    Eye report must state that the child has:

    • no vision or to have a visual loss after correction; or
    • a progressive medical condition that will result in no vision or a visual loss after correction.

    The State of Texas Interagency Eye Examination Report form is not required to be used in obtaining information required for eligibility, however, this form is highly recommended as it contains important information that guides the Functional Vision Evaluation, Learning Media Assessment, and Orientation and Mobility Evaluation. 

    Please contact your local Education Service Center if you have any additional questions.

If you are having trouble viewing the document, you may download the document.