BILL ANALYSIS                                                                                                                                                                                                    Ó






                          SENATE COMMITTEE ON EDUCATION
                                 Carol Liu, Chair
                            2013-2014 Regular Session
                                         

          BILL NO:       AB 1840
          AUTHOR:        Campos
          AMENDED:       May 8, 2014
          FISCAL COMM:   Yes            HEARING DATE:  June 25, 2014
          URGENCY:       No             CONSULTANT:Lynn Lorber

           SUBJECT  :  Vision appraisal.
          
           SUMMARY
           
          This bill adds a trained individual, who meets specified  
          requirements, to those who perform gross external observation  
          of a student's eyes, visual performance, and perception. 

           BACKGROUND
           
          Current law:

          1)   Requires, upon first enrollment in an elementary school,  
               and at least every third year thereafter until the child  
               has completed grade 8, the vision of students to be  
               appraised by the school nurse or other authorized  
               person.  The evaluation must include tests for visual  
               acuity and color vision, however, color vision is to be  
               appraised once and only on male students.  Gross  
               external observation of the child's eyes, visual  
               performance, and perception are to be done by the school  
               nurse and the classroom teacher.  The evaluation may be  
               waived if the parents present a certificate from a  
               physician and surgeon, a physician assistant or an  
               optometrist, and parents may opt-out based on religious  
               beliefs.  (Education Code § 49455)

          2)   Requires a report to be made to the parent when a visual  
               or other defect has been noted by the supervisor of  
               health or his/her assistant.  
               (EC § 49456)

          3)   Requires school districts to provide for the testing of  
               the sight and hearing of each student enrolled in the  
               district.  The test is to be given only by: 







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               a)        Duly qualified supervisors of health employed  
                    by the district.

               b)        Certificated employees of the district or  
                    county office of education who possess the  
                    qualifications prescribed by the Commission on  
                    Teacher Credentialing.


               c)        Contract with an agency duly authorized to  
                    perform those services by the county superintendent  
                    of schools, under guidelines established by the  
                    State Board of Education.

               d)        Accredited schools or colleges or optometry,  
                    osteopathic medicine, or medicine.  (Education Code  
                    § 49452)

          4)   Provides that non-medical certificated employees of a  
               school district or county office of education may be  
               authorized to give vision tests if the employee has  
               specified documentation.  (California Code of  
               Regulations, Title 5, § 591)

           ANALYSIS
           
           This bill  adds a trained individual, who meets specified  
          requirements, to those who perform gross external observation  
          of a student's eyes, visual performance, and perception.   
          Specifically, this bill:

          1)   Adds a trained individual who meets the requirements  
               established by the California Department of Education  
               (CDE) to the requirement that the school nurse and the  
               classroom teacher conduct gross external observation of  
               the student's eyes, visual performance, and perception.

          2)   Authorizes an eye chart or any other scientifically  
               validated screening test to be used to appraise a  
               student's eyes.

           STAFF COMMENTS
           








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           1)   Senate Health Committee amendments  .  This bill was heard  
               in the Senate Health Committee on June 18.  The Senate  
               Health Committee recommended, and the author accepted,  
               the following amendments that are to be adopted by this  
               Committee:
           
                a)        Strike addition of trained individual to those  
                    who perform gross external observation of a  
                    student's eyes, visual performance, and perception,  
                    thereby returning this provision to current law.
                
                b)        Delete the authority to use any other  
                    scientifically valid technology to appraise vision  
                    and instead authorize the use of any other  
                    scientifically validated photo screening test.
                
                c)        Requires photo screenings to be performed,  
                    under agreement with or the supervision of an  
                    optometrist or ophthalmologist, by the school nurse  
                    or other trained individuals who meet requirements  
                    established by the California Department of  
                    Education (CDE).
                


                As amended, this bill would authorize a student's vision  
               to be appraised using an eye chart or any other  
               scientifically validated photo screening, performed by  
               the school nurse or other trained individuals who meet  
               the requirements established by the CDE. 

          2)   Other trained individuals  .  As amended by the Senate  
               Health Committee, this bill provides that photo  
               screening is to be performed by the school nurse or  
               "other trained individuals who meet requirements  
               established by the department."  The California  
               Department of Education (CDE) issued a Guide for Vision  
               Testing in California Public Schools that would be  
               required by this bill include:

               a)        Vision testing may be done in kindergarten or  
                    first grade and in grades two, five, and eight, as  
                    well as on enrollment and referral at any grade  
                    level.








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               b)        Have teachers make continual observations of  
                    students' appearance and behavior that may indicate  
                    vision difficulties.

               c)        Conduct vision testing of students whose  
                    school performance indicates a vision problem.  

               Current regulations provide that non-medical  
               certificated employees of a school district or county  
               office of education may be authorized to give vision  
               tests if the employee has one of the following  
               documents:

               d)        A statement from a qualified supervisor of  
                    health that the employee has satisfactorily  
                    completed an acceptable course of in-service in  
                    techniques and procedures in vision testing of at  
                    least six hours and that the employee is qualified  
                    to administer vision tests to students.

               e)        A transcript from an accredited college or  
                    university evidencing that the employee has  
                    successfully completed an acceptable course in  
                    vision testing of at least one semester unit. 
               (California Code of Regulations, Title 5, § 591)

               It is unclear what requirements the CDE has established,  
               as referenced in this bill.  The Guide for Vision  
               Testing in California Public Schools serves as guidance  
               and related to vision tests, not vision appraisals.   
               Further, the California Code of Regulations relate to  
               vision tests, not vision appraisals.  The author's  
               office provided no background or supporting materials  
               for this bill.  
                
           3)   Failure of vision appraisal or test  .  Current law  
               requires a report to be made to the parent when a visual  
               or other defect has been noted by the supervisor of  
               health or his/her assistant.  Current regulations  
               require a re-evaluation of a student who failed a vision  
               test, prior to a report being made to the student's  
               parents.  (Education Code § 49456 and California Code of  
               Regulations, Title 5, § 594) 








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           4)   Photo screening  .  According to the Assembly Health  
               Committee analysis, a policy statement issued by the  
               American Academy of Pediatrics (AAP) provides:

          "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."

          A November 2012 policy statement of the AAP states that  
               automated vision screening, including photoscreening and  
               autorefraction, is preferred for children aged 6 months  
               to 3 years because the procedure is quick and requires  
               little cooperation from the patient.  Visual acuity  
               charts continue to be the reliable method of screening  
               for children aged 4 to 5 years.   
                http://pediatrics.aappublications.org/content/130/5/983.f 
               ull  

           5)   Fiscal impact  .  According to the Assembly Appropriations  
               Committee, the current version of this bill would impose  
               minor absorbable costs to California Department of  








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               Education (CDE) to develop or update guidelines.   
               Workload could be absorbed by the School Health  
               Education Consultant at CDE.  

          6)   Related legislation  .  SB 1172 (Steinberg) requires  
               school vision appraisals to include tests for near  
               vision, and expands current requirements for school  
               nurses and teachers to observe student's eyes to also  
               include observation of the appearance and behavior of  
               student's eyes, and requires observation to be continual  
               and regular.  SB 1172 is scheduled to be heard in the  
               Assembly Health Committee on June 24.

          SB 430 (Wright) requires a pupil to receive a vision  
               examination from a physician, optometrist, or  
               ophthalmologist and requires that screening to include a  
               test for binocular function, refraction, and eye health.  
                SB 430 is in the Assembly Health Committee.


           7)   Prior legislation  .  AB 1095 (Wright, 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.  AB 1095 was held in the Senate  
               Appropriations Committee's suspense file.

          AB 1096 (Wright, 2001) would have established a pilot program  
               for schools scoring in the bottom 20% on state  
               achievement tests, to administer to poor readers a  
               comprehensive eye screening and remedial vision  
               training.  AB 1096 died on the Senate Floor's inactive  
               file.

          SB 606 (Vasconcellos, 2001) would have required the existing  
               student eye examination to include screening for  
               binocular function, ocular alignment, ocular motility,  
               and near visual acuity.  SB 606 was held on the Assembly  
               Appropriations Committee's suspense file.

           SUPPORT
           








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          None on file.

           OPPOSITION

           None on file.