BILL ANALYSIS Ó
SB 430
Page 1
Date of Hearing: June 26, 2013
ASSEMBLY COMMITTEE ON EDUCATION
Joan Buchanan, Chair
SB 430 (Wright) - As Amended: June 18, 2013
[Note: This bill is double referred to the Committee on Health
and will be heard by that committee as it relates to issues
under its jurisdiction.]
SENATE VOTE : 38-0
SUBJECT : Pupil health: vision appraisal: binocular function.
SUMMARY : Requires, as of September 1, 2014, all pupils to have
a vision exam by an optometrist or ophthalmologist before first
enrolling in a California school, and every three years
thereafter until the eighth grade. Specifically, this bill :
1)Requires, as of September 1, 2014, school districts to notify
parents that they have two weeks at the beginning of a school
year to supply evidence that the pupil has had a vision exam,
as specified.
2)Requires, as of September 1, 2014, all pupils to be examined
by an optometrist or ophthalmologist before first enrollment
in a California school, and at least every third year
thereafter until the pupil has completed the eighth grade.
3)Specifies that the vision exam shall include tests for visual
acuity, binocular function, color vision, refraction and eye
health evaluations.
4)Specifies that color vision shall be appraised once on male
pupils and before the male pupil has reached the first grade.
5)Specifies the binocular function exam need not begin until the
pupil has reached the third grade.
6)Requires the parent or guardian to provide the results of the
examination to the school district.
7)Specifies that if a pupil is ineligible for Medicaid,
Children's Health Insurance Program coverage, or exchange
subsidies under the federal Patient Protection and Affordable
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Care Act, or any other health care service, the county office
of education or the school district shall refer the pupil to
the county health department or other appropriate community
resources able to perform a vision exam.
8)Specifies that if a pupil is unable to obtain a vision exam
through the referral, the school may waive the vision
examination requirement.
9)Defines "binocular function exam" to mean at a minimum, the
evaluation of accommodative ability, sensory and motor fusion
and ocular motility.
EXISTING LAW requires:
1)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; specifies the evaluation
must include tests for visual acuity and color vision,
however, color vision is to be appraised once and only on male
students; specifies that gross external observation of the
child's eyes, visual performance, and perception are to be
done by the school nurse and the classroom teacher; and,
specifies the evaluation may be waived if the parents present
a certificate from a physician and surgeon, a physician
assistant or an optometrist. (Education Code 49455)
2)School districts to provide for the testing of the sight and
hearing of each student enrolled in the district; and,
specifies the test is to be given only by duly qualified
supervisors of health employed by the district; certificated
employees of the district or county office of education who
possess the qualifications prescribed by the Commission on
Teacher Credentialing; 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; or, accredited schools or colleges or optometry,
osteopathic medicine, or medicine. (Education Code 49452)
FISCAL EFFECT : According to the Senate Appropriations
Committee, this bill could result in a significant new mandate
on local educational agencies (LEAs), whereby the state may have
to reimburse LEAs for every screening exam performed in
compliance with this bill, and any related staffing or training
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costs.
COMMENTS : This bill requires, as of September 1, 2014, all
pupils to have a vision exam by an optometrist or
ophthalmologist before first enrolling in a California school,
and every three years thereafter until the 8th grade. As an
example, this means that upon enrollment in kindergarten, 3rd
grade and 6th grade, a pupil will be required to show evidence
of an eye exam. This is a total of three eye exams before the
8th grade. The bill also specifies that color vision shall be
tested in male pupils before the 1st grade and the binocular
function exam need not begin until the 3rd grade. Current law
specifies that color vision examination shall not begin until
the 1st grade, but this measure specifies it shall be tested
before the 1st grade. To correct this drafting error, committee
staff recommends the bill be amended to specify that color
vision examination shall not begin until 1st grade. Further
committee staff recommends the start date for this requirement
begin July 1, 2014 to better align with different school
calendars.
Vision Exam Requirement for Enrollment : While the bill requires
parents to provide evidence that the pupil has received a vision
exam within two weeks of enrollment in school, it is unclear
whether the district can prohibit enrollment if the
documentation is not received. Typically, pupils are prohibited
from enrollment in schools if they do not receive appropriate
immunizations (or sign a waiver), and this was put into place in
order to protect the general public health of pupils and to
avoid a public health infection outbreak. To clarify that
pupils will not be prohibited from enrollment for failing to
complete the eye exam, committee staff recommends the bill be
amended to specify that a school may not deny admission to a
child or take any other adverse action against a child because
of the child's parent or guardian did not obtain the exam
required. With the inclusion of this provision, it is no longer
necessary to authorize a school district to waive the vision
exam requirement for pupils who are unable to obtain a vision
exam through the referral to the county health department.
Committee staff recommends this waiver be deleted from the bill.
Committee staff recommends the bill be amended to separate this
new requirement for a vision exam by an optometrist or
ophthalmologist from the immunization requirements and instead
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create a new code section that specifies the new vision exam
requirements.
The bill specifies that the governing board of the school
district should notify parents of this requirement. It is
unclear whether charter schools are included in this
requirement. Staff recommends that the bill be amended to
clarify that school districts, county offices of education and
charter schools are included in the requirement for pupils to
receive a vision exam prior to enrollment.
According to the author, current vision testing in schools is
limited to using the eye chart for acuity one eye at a time,
from 20 feet away. While this is important in identifying
children who may need glasses, it does not address how well the
two eyes work together while reading. About 20% of children
have problems seeing at a reading distance. Existing law
provides for vision appraisal of a child by the school nurse or
other authorized person at entry into a California school
district, and at least every third year thereafter until the
child has completed the eighth grade. The evaluation includes
tests for visual acuity and color vision (for boys only, and
only once). The eye chart is used for vision screening to
determine whether a full eye examination is required, in a
pass/fail mode. This test cannot address the problem of how
well the eyes are able to converge on a page in a book that is
close to the face. While there are optional procedures in the
screening manual that could uncover eye coordination problems
such as convergence, these are rarely used. Emerging data and
practice in the field of vision shows that reading speed and
fluency are impacted by poor eye coordination. In a study with
normal children, when the eyes were temporarily made less
coordinated, reading speed declined significantly. In other
studies with school children, reading fluency improved when eye
coordination improved. SB 430 would bring California into the
modern era, where it is acknowledged that convergence
insufficiency (a technical term for one type of eye coordination
problem) can impact reading and learning.
What are other States doing ? According to the author, other
States are ahead of California. Three states - Arkansas,
Illinois and Kentucky, already require binocular vision
assessment either during school screenings or via a complete
eye examination.
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Committee Amendments :
1) Move the requirement for an eye exam to a separate code
section separate from the immunization requirements.
2) Specify that color vision examination shall not begin
until 1st grade.
3) Specify that a school may not deny admission to a child
or take any other adverse action against a child because of
the child's parent or guardian did not obtain the exam
required.
4) Delete the provisions authorizing a school district to
waive the requirement if a pupil is not able to obtain a
vision exam through the referral to the county health
department.
5) Specify that the provisions in the bill commence on July
1, 2014, to better align the implementation of this
requirement with the start of the school year.
6) Clarify that school districts, county offices of
education and charter schools are included in the
requirement for pupils to receive a vision exam prior to
enrollment.
Previous Legislation : AB 1095 (Wright) from 2001, which was held
in the Senate Appropriations Committee's suspense file, would
have required every child to undergo a comprehensive eye
examination by an optometrist or ophthalmologist within 90 days
of entering the first grade.
AB 1096 (Wright) from 2001, which died on the Senate Floor's
inactive file, would have established a three-year pilot program
to provide comprehensive eye examinations for poor readers.
SB 606 (Vasconcellos) from 2001, which was held in Assembly
Appropriations Committee's suspense file, would have required
the existing student eye examination, conducted upon enrollment
and every third year thereafter through 8th grade, to include
screening for binocular function, ocular alignment, ocular
motility, and near visual acuity.
REGISTERED SUPPORT / OPPOSITION :
Support
California State Board of Optometry
California Teachers Association
SB 430
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Opposition
American Academy of Pediatrics, California
California Immunization Coalition
Analysis Prepared by : Chelsea Kelley / ED. / (916) 319-2087