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: AB 1840 Page 2 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 AB 1840 Page 3 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. AB 1840 Page 4 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) AB 1840 Page 5 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 AB 1840 Page 6 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 AB 1840 Page 7 None on file. OPPOSITION None on file.