BILL ANALYSIS Ó
SB 1172
Page 1
Date of Hearing: June 24, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 1172 (Steinberg) - As Amended: April 23, 2014
SENATE VOTE : 35-0
SUBJECT : Pupil health: vision appraisals.
SUMMARY : Requires a pupil's vision to be appraised by
authorized individuals, as specified, during kindergarten or
upon first enrollment or entry in a California elementary
school, and again in grades 2, 5, and 8. Requires the
California Department of Education (CDE) to adopt guidelines to
implement these provisions. Specifically, this bill :
1)Requires, during kindergarten or upon first enrollment or
entry in a California school and again in grades 2, 5, and 8,
a pupil's vision be appraised, by the school nurse or other
authorized person including:
a) 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 authorized to perform those
services by the county superintendent of schools, as
established by the California Board of Education; and,
d) Accredited schools or colleges or optometry, osteopathic
medicine, or medicine.
2)Specifies that a pupil whose first enrollment or entry occurs
in grade 4 or 7 is not required to be appraised in grade 5 or
8, respectively.
3)Requires visual acuity appraisals to include tests for near
vision.
4)Requires continual and regular observation of the pupil's
eyes, appearance, behavior, visual performance, and perception
that may indicate vision difficulties to be done by the school
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nurse and the classroom teacher.
EXISTING 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 including:
a) 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 authorized to perform those
services by the county superintendent of schools, as
established by the State Board of Education; and,
d) Accredited schools or colleges or optometry, osteopathic
medicine, or medicine.
2)Requires the vision evaluation to include tests for visual
acuity and color vision, however, requires that color vision
to be appraised once and only on male students.
3)Requires the results of the appraisal to be entered in the
health record of the pupil.
4)Permits external observation of the child's eyes, visual
performance, and perception by the school nurse and the
classroom teacher.
5)Permits the evaluation to be waived if the parents present a
certificate from a physician, a physician assistant or an
optometrist, and parents may opt-out based on religious
beliefs.
6)Requires CDE to adopt guidelines for implementation, including
training requirements and a method of testing for near vision.
FISCAL EFFECT : According to the Senate Appropriations
Committee, this bill has potential substantial reimbursable
mandate to increase the number of required vision tests, and the
scope of those tests. The requirement for "continual and regular
observation of the pupil's eyes" by teachers and school nurses
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could result in significant local costs, and could be an
additional reimbursable mandate to the extent that costs could
be proven.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, current law
allows school nurses to screen students for distance vision,
and statutory authority is necessary to allow them to be
trained to screen for near vision. This bill ensures that
there is uniformity of training and methodology by requiring
CDE to adopt guidelines to implement the near vision
screening.
The author believes that near vision deficiencies may be
interfering with a child's ability to read. Research has
shown that third grade reading scores are highly correlated
with later academic success. Some research indicates that
reading proficiency at the end of third grade marks the
transition for "learning to read" to "reading to learn".
While the primary factors that led to low-level of reading
skills among low-income children were socioeconomic factors
and the studies found that preschool programs reversed this
trend, the lack of health care was also identified as a
factor. Lack of health care could result in undiagnosed
vision problems.
2)BACKGROUND .
a) Current Regulations. Title 5, Section 594 of the
California Code of Regulations currently requires that the
test of visual acuity be administered by means of an
optotype (letters or symbols) test. Test failure for the
visual acuity test is defined as:
i) For children under six years of age: visual acuity
of 20/50 or worse. The designation 20/50 or worse
indicates the inability to identify inability to identify
accurately the majority of letters or symbols on the
20-foot line of the test chart at a distance of 10 feet;
ii) For children under six years of age: visual acuity
of 20/50 or worse. The designation 20/50 or worse
indicates the inability to identify accurately the
majority of letters or symbols on the 20-foot line of the
test chart at a distance of 10 feet; and,
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iii) For children six years of age or older: visual
acuity of 20/40 or worse. This means the inability to
identify the majority of letters or symbols on the
15-foot line of the test chart at a distance of 10 feet.
This bill requires tests for visual acuity to include near
vision, which is recommended but not required as an
additional procedure in CDE's Guide for Vision Testing in
California Public Schools. CDE's guidance specifically
recommends and describes a Hyperopia test, which is used
for assessing near-distance vision at least once,
preferably in kindergarten or first grade. This bill
requires the CDE to adopt guidelines to implement this
bill, including a method of testing for near vision.
b) Optotype Test. The Optotype Test is administered by
having an individual accurately identify, to the best of
their ability, the majority of letters or symbols on a test
chart from various distances. Charts usually display
several rows of optotypes (test symbols), each row in a
different size. An optotype is a standardized symbol for
testing vision. Optotypes can be specially shaped letters,
numbers, or geometric symbols. The person is asked to
identify the optotype on the chart, usually starting with
large rows and continuing to smaller rows until the
optotypes cannot be reliably identified anymore.
Vision screenings with an eye chart are generally ineffective
at detecting farsightedness, according to the American
Optometric Association, since farsighted individuals can
normally identify the letters on an eye chart without much
difficulty. Because no verbal response from the child is
necessary, these types of pediatric vision screenings or
vision tests can be performed even when the child is very
young or preverbal.
c) Hyperopia Test. Hyperopia is a defect of vision caused
by an imperfection in the eye, often when the eyeball is
too short or the lens cannot become round enough, causing
difficulty focusing on near objects. As an object moves
toward the eye, the eye must increase its optical power to
keep the image in focus on the retina. If the power of the
cornea and lens is insufficient, as in hyperopia, the image
will appear blurred. Refraction testing is the process of
measuring how the eye focuses light. It's done with the
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aid of a phoropter, a specialized instrument that resembles
a pair of oversized goggles hanging from a boom. The
goggles conceal a series of lenses your eye care provider
adjusts as you read the letters on a projection screen,
choosing stronger and stronger lenses until the letters
look crisp.
d) Timeframe. This bill moves up the timeframe for vision
screening in schools so students are tested in either
kindergarten or first grade (whichever year they first
enroll) and again in second grade. This means the third
grade screening is moved to second grade. Several other
states require screening in kindergarten, first grade and
second grade, which is an even more comprehensive approach.
Those states include Alabama, Arizona, Arkansas, Colorado,
Connecticut, Washington DC, Massachusetts, Oklahoma,
Pennsylvania, and Washington.
e) Medical Background: According to the American Academy of
Pediatrics, the American Association of Certified
Orthoptists, the American Association for Pediatric
Ophthalmology and Strabismus, and the American Academy of
Ophthalmology policy statement on Eye Examination in
Infants, Children, and Young Adults by Pediatricians,
"Early detection and prompt treatment of ocular disorders
in children is important to avoid life-long visual
impairment." It further states that children should have
an assessment for eye problems in the newborn period and
then at all subsequent routine health supervision visits.
The policy statement recommends that, "all children who are
found to have an ocular abnormality or who fail vision
screening should be referred to a pediatric ophthalmologist
or an eye care specialist appropriately trained to treat
pediatric patients."
3)SUPPORT . According to the American Civil Liberties Union
(ACLU) of California, this bill makes several common-sense
improvements to existing requirements for visual acuity
appraisals that will help school districts detect vision
problems that may contribute to early academic deficits for
California's school children. By adding near vision to the
testing protocol, this bill ensures that students do not
needlessly fall behind in these critical skills as a result of
unidentified near vision problems. Additionally, this bill
clarifies existing law to conform to CDE's guidelines for when
vision appraisals should be conducted and will improve school-
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and district-level planning by regularizing the vision testing
schedule.
4)SUPPORT IF AMENDED . The California Academy of Eye Physicians
and Surgeons and the California Optometric Association express
concerns regarding an increase in "false positives" in visual
acuity tests, and the insufficient nature of a screening
versus a comprehensive eye exam, respectively.
5)RELATED LEGISLATION .
a) SB 430 (Wright) from 2013, currently pending in the
Assembly Health Committee, deletes an existing requirement
that 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, the child's vision to be appraised by the
school nurse or other authorized person, and replaces it
with a requirement that, upon first enrollment in a private
or public elementary school, a pupil 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.
b) AB 1840 (Campos), from 2014, currently pending in the
Senate Health Committee, 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.
6)PREVIOUS LEGISLATION .
a) AB 1095 (Wright) from 2001, which was held on 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.
b) 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.
c) SB 606 (Vasconcellos) from 2001, which was held on
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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.
7)DOUBLE REFERRAL . This bill is double referred, it was heard
in the Assembly Committee on Education and passed on June 11,
2014 with a vote of 6-0.
REGISTERED SUPPORT / OPPOSITION :
Support
American Civil Liberties Union
State Public Affairs Committee of the Junior Leagues of
California
Opposition
None on file.
Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097