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---



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          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  




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                 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  




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            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)


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