BILL ANALYSIS                                                                                                                                                                                                    Ó



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          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  








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          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  








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            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 









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