BILL ANALYSIS Ó AB 1840 Page 1 ASSEMBLY THIRD READING AB 1840 (Campos) As Amended May 8, 2014 Majority vote HEALTH 15-4 APPROPRIATIONS 13-4 ----------------------------------------------------------------- |Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bocanegra, | | |Ammiano, Gordon, Bonilla, | |Bradford, | | |Bonta, Chesbro, Gomez, | |Ian Calderon, Campos, | | |Gonzalez, Roger | |Eggman, Gomez, Holden, | | |Hernández, Lowenthal, | |Linder, Pan, Quirk, | | |Waldron, Nazarian, | |Ridley-Thomas, Weber | | |Ridley-Thomas, Wieckowski | | | | | | | | |-----+--------------------------+-----+--------------------------| |Nays:|Chávez, Nestande, |Nays:|Bigelow, Donnelly, Jones, | | |Patterson, Wagner | |Wagner | | | | | | ----------------------------------------------------------------- SUMMARY : Authorizes the use of an eye chart or any other scientifically validated test to be used for pupil vision screening performed in schools. EXISTING LAW requires, upon first enrollment in a California school district of a child at an elementary school, and at least every third year thereafter until the child has completed the eighth grade, the child's vision to be appraised by the school nurse or other authorized person, as specified, and requires results of the appraisal to be entered in the health record of the pupil. FISCAL EFFECT : According to the Assembly Appropriations Committee, minor absorbable costs to the California Department of Education (CDE) to develop or update guidelines. Workload could be absorbed by the School Health Education Consultant in CDE. COMMENTS : According to the author, childhood vision disorders are a prevalent and significant public health problem, yet there is a significant lack of public awareness about the importance of eye care in children and the inability of children to recognize their own vision problems. The author asserts these AB 1840 Page 2 problems are heightened in families from economically disadvantaged backgrounds by financial hardship and lack of access to appropriate medical care. The author states that this bill will help broaden the accessibility to vision screenings because any trained individual can utilize digital technology to screen students, the results are immediate and digital, and the results indicate whether or not a child would need a follow up eye exam. More students in low-income, urban, and rural areas would have access to this new digital technology to provide accurate and quick results. Photoscreening. According to the American Academy of Pediatrics (AAP) policy statement, Use of Photoscreening for Children's Vision Screening, photoscreening is a vision screening technique used to screen for amblyogenic factors such as strabismus (lazy eye) and significant refractive errors in one or both eyes in children. Using a camera or video system, images of the pupillary reflexes (reflections) are obtained. Other than having to fixate on the appropriate target long enough for the photoscreening, little cooperation is needed from the child. Data is then analyzed by the evaluator. Children who do not pass the test may be referred for a complete eye examination. Photoscreening does not represent a single technique or piece of equipment. Different optical systems can be used for photoscreening. Each photoscreening system may have its own advantages and disadvantages, and it appears that results published in the literature for one system are not necessarily valid for others. Studies performed by different investigators using the same photoscreening apparatus may yield a wide range of results. Likewise, it is not certain that data gathered about different groups of children or different settings can be extrapolated to other groups or settings. The AAP favors additional research of the efficacy and cost-effectiveness of photoscreening as a vision screening tool. Vision screening in California's schools. A guide developed by the CDE titled, "A Guide for Vision Testing in California Public Schools," states that the only people authorized to conduct vision tests include the following: 1)Medical practitioners, including a nurse, physician, ophthalmologist, or optometrist who holds both a license from the appropriate California board or agency, and a health and development credential, a standard designated service AB 1840 Page 3 credential with a specialization in health, a health services credential as a school nurse, or a school nurse services credential; 2)Certificated school district or county employees who hold a teaching credential and are qualified by training, including satisfactory completion of six hours of vision testing, or an accredited college or university course in vision testing of at least one semester unit; or, 3)Contracting agents who have met the training requirements specified above and who have been authorized by the county superintendent of schools in which the district is located to perform the tests. Healthier Kids Foundation of Santa Clara County (Foundation) supports this bill and writes that one of the most important visual skills for reading is the ability to coordinate the two eyes together and that an eye chart helps to test vision for distance but not how the eyes team together. The Foundation further argues that a few states, including Alabama, Florida, and parts of New York have replaced eye charts with photo optic scan cameras in school settings, which are quick, efficient, reliable, and don't require medical professionals to complete screenings. The California School Nurses Organization (CSNO) opposes this bill and writes that according to the American Academy of Ophthalmology Instrument-Based Pediatric Vision Screening Policy, evidence based practice does not support the use of instrument based screening in children older than five years of age. CSNO further argues that while children younger than four years can benefit from instrument-based screening, for children four to five years of age, photoscreening has not been shown to be superior or inferior to visual acuity testing with the use of vision charts. Finally, CSNO states that current law already permits the use of alternative tests with children who, because of age or special needs, are not able to be tested with an optotype test. Analysis Prepared by : Paula Villescaz / HEALTH / (916) 319-2097 AB 1840 Page 4 FN: 0003543