BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 1840 AUTHOR: Campos AMENDED: May 8, 2014 HEARING DATE: June 18, 2014 CONSULTANT: Diaz SUBJECT : Pupil health: vision appraisal. SUMMARY : Adds a trained individual, who meets specified requirements, to those who can perform gross external observation of a child's eyes, visual performance, and perception. Permits a child's vision to be appraised using an eye chart or any other scientifically validated screening test. Existing law: 1.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, a child's vision to be appraised by the school nurse or other authorized person, as specified. Requires results of the appraisal to be entered in the health record of the pupil. Requires the vision appraisal to include tests for visual acuity and color vision. Requires color vision to be appraised once and only on male children, beginning in the first grade. 2.Permits the vision appraisal to be waived, at the parent's request, by presenting a certificate from a physician, a physician assistant, or an optometrist providing the results of a determination of the child's vision, including visual acuity and color vision. Provides an exemption to the appraisal requirement to a child whose parents or guardian file a written statement based on the faith or teachings of any well-recognized religion. This bill: 1.Adds a trained individual, who meets requirements established by the California Department of Education (CDE), to those who can perform gross external observation of a child's eyes, visual performance, and perception. 2.Permits a child's vision to be appraised using an eye chart or any other scientifically validated screening test. Continued--- AB 1840 | Page 2 3.Makes other technical, clarifying changes. FISCAL EFFECT : According to the Assembly Appropriations Committee, minor absorbable costs to CDE to develop or update guidelines. Workload could be absorbed by the School Health Education Consultant at CDE. PRIOR VOTES : Assembly Health: 15- 4 Assembly Appropriations:13- 4 Assembly Floor: 56- 15 COMMENTS : 1.Author's statement. 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. These problems are heightened in families from economically disadvantaged backgrounds by financial hardship and lack of access to appropriate medical care. Furthermore, it is well recognized that vision screenings are most effective when early identification and treatment of many conditions can prevent irreversible vision damage or loss. Early identification and correction of a vision disorder is an essential part of a child's overall health and their ability to learn. While vision screening is a valuable public health procedure, it is not a substitute for professional eye care. Screening is the first step. Currently, only eye charts are used in preventive vision screenings. Allowing students to get vision screenings that use digital technology, alongside eye charts, will help detect potential problems. While eye charts are a long-standing and proven method, technology has advanced to the point that portable camera-like equipment has been invented that can provide comprehensive and reliable analysis in seconds. These types of technologies can be used by any trained individual and can provide a quick, mobile, and accurate screening. 2.Vision screening in California schools. A 2005 guide developed by CDE, "A Guide for Vision Testing in California Public Schools," states that only the following are currently authorized to conduct vision tests: a. Medical practitioners, including a nurse, physician, ophthalmologist, or optometrist, who hold both a license AB 1840 | Page 3 from the appropriate California board or agency, and a health and development credential, a standard designated service credential with a specialization in health, a health services credential as a school nurse, or a school nurse services credential, as specified; b. 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, c. 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. 1.Vision problems in children. According to the National Association of School Nurses (NASN), vision problems are the fourth most prevalent class of disability in the United States and one of the most prevalent conditions in childhood. NASN maintains that this is an extremely important statistic considering that 80 percent of what children learn comes through their visual processing of information. According to the Centers for Disease Control and Prevention (CDC) impaired vision can affect a child's cognitive, emotional, neurologic and physical development by potentially limiting the range of experiences and kinds of information to which the child is exposed. Despite the importance of appropriate vision testing, the CDC reports that nearly two in three children enter school without ever having had a vision screening. 2.Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Education Committee. 3.Related legislation. SB 430 (Wright) would have deleted the existing requirement for appraisal upon first enrollment in an elementary school by the school nurse or other authorized person, and replaced it with a requirement that a pupil receive a vision examination from a physician, optometrist, or ophthalmologist and required that screening to include a test for binocular function, refraction, and eye health. This bill failed in the Assembly Health Committee without being heard. SB 1172 (Steinberg) would revise the functions to be performed by the school nurse and the classroom teacher during pupil AB 1840 | Page 4 vision screenings in observing a pupil's eyes, appearance, and other factors that may indicate vision difficulties. This bill requires CDE to adopt guidelines to implement those provisions, including training requirements and a method of testing for near vision. This bill is currently pending in the Assembly. 4.Prior legislation. SB 606 (Vasconcellos), of 2001, would have required the student eye examination to include screening for binocular function, ocular alignment, ocular motility, and near visual acuity. This bill was held on suspense in the Assembly Appropriations Committee. AB 1095 (Wright), of 2001, would have required every student, within 90 days of entering grade 1, to undergo a comprehensive eye exam that includes, in addition to ocular health and distance and near visual acuity, additional evaluations of visual skills such as eye teaming, focusing and tracking that may impact a child's ability to read. This bill was held on suspense in the Senate Appropriations Committee. AB 1096 (Wright), of 2001, would have established a pilot program for schools scoring in the bottom 20 percent on state achievement tests to administer to poor readers a comprehensive eye screening and remedial vision training. This bill died on the Senate Floor's inactive file. 5.Support. Supporters argue that scan cameras are quick, efficient, reliable, and do not require medical professionals to complete the screenings. They further argue that this bill will help children by ensuring that schools have the capabilities to identify vision problems early by using the most current technology available. SUPPORT AND OPPOSITION : Support: California Coverage & Health Initiatives Healthier Kids Foundation, Santa Clara County See Well to Learn Oppose: American Academy of Pediatrics (previous version) -- END -- AB 1840 | Page 5