BILL ANALYSIS Ó
SENATE COMMITTEE ON EDUCATION
Senator Carol Liu, Chair
2015 - 2016 Regular
Bill No: SB 402
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|Author: |Mitchell |
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|Version: |February 25, 2015 Hearing Date: |
| | April 15, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|Olgalilia Ramirez |
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Subject: Pupil health: vision examinations
NOTE: This bill has been referred to the Committees on
Education and Health. A "do ???... pass" motion should include
referral to the Committee on Health.
SUMMARY
This bill deletes the requirement that students' vision be
appraised by a school nurse, and instead requires that students'
vision be examined by a physician, optometrist, or
ophthalmologist.
BACKGROUND
Current law:
1. Requires, during kindergarten or upon first enrollment
in an elementary school, and in grades 2, 5, and 8, the
vision of students to be appraised by the school nurse or
other authorized person. The appraisal must include tests
for visual acuity and color vision, however, color vision
is to be appraised once and only on male students.
Continual and regular observation of students' eyes,
appearance, behavior, visual performance and perception are
to be done by the school nurse and the classroom teacher.
The appraisal 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)
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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:
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)
1. Provides that:
A. An employee of a school district or of a
county superintendent of schools to be authorized to
give vision tests and be designated a "duly qualified
supervisor of health" if the employee is a physician
and surgeon or osteopath, a school nurse, or an
optometrist.
B. 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 deletes the requirement that students' vision be
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appraised by a school nurse or other authorized person, and
instead requires that students' vision be examined by a
physician, optometrist, or ophthalmologist. Specifically, this
bill:
1. Adds binocular function, refraction, and eye health
evaluation to the list of required vision examinations.
2. Requires the parent or guardian to provide test results to
the school and eliminates vision appraisal waivers.
3. Requires examinations to be aligned with the most current
standards, policy or guidelines adopted by the American
Academy of Pediatrics, the American Academy Ophthalmology
or the American Optometric Association.
4. Requires students' vision to be examined every two years
until the student completes grade 8.
5. Deletes the following provisions:
A. Clarifying if first enrollment occurs
in grade 4 or 7 the student's vision need not be
appraised in the year immediately following.
B. Requiring color vision to be only for
male students after the student has reached first
grade instead specifies that student's color vision be
examined once at enrollment.
C. Specifying that a student's vision may
be appraised using an eye chart or other
scientifically validated photoscreening test.
6. Requires the department to adopt regulations to implement
this section as well as provide participation data in lieu
of adopting guidelines, as specified.
STAFF COMMENTS
1. Need for the bill. According to the author, vision testing
in California schools is limited to screening for visual
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acuity and while current practices are important for
identifying children who may need glasses, it does not
address how well the two eyes work together while reading
which may impact academic performance. The author asserts
that although there are optional procedures for assessing
vision in public schools that could uncover eye
coordination problems, these are rarely used. This bill
requires students entering elementary school to receive a
comprehensive eye exam by a physician, optometrist, or
ophthalmologist for the purposes of identifying visual
defects like eye coordination problems that may be missed
by existing testing methods.
2. Comprehensive eye exam. According to the California
Optometric Association comprehensive eye exams evaluate
three primary areas: vision, binocularity and eye health.
"A subjective and/or an objective refraction are performed
to detect myopia (nearsightedness), astigmatism
(irregularity of the cornea) or hyperopia
(farsightedness)." Additionally, focusing ability is
evaluated and near visual acuity as well as color vision is
tested. There is a binocular assessment, which checks depth
perception, eye alignment, teaming tracking, and
convergence important skills for reading and learning.
Overall, a thorough evaluation is performed to ensure good
eye health. This bill adds binocular function, refraction,
and eye health evaluation to the list of required vision
examinations and requires the parent or guardian to provide
test results to the school.
3. Frequency of appraisal. Current law 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, including tests
for visual acuity and color vision. The evaluation of
color vision is to be appraised once and only on male
students, and need not begin until the male student has
reached grade 1. This bill instead, provides that
examinations including binocular function as well as
refraction and eye health examinations are given to
students every two years until the student completes grade
8.
4. Vision screening in California's schools. The Guide for
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Vision Testing in California Public Schools developed by
California Department of Education (CDE) provides districts
and school health personnel with guidelines for a vision
testing program. The guidelines facilitate the planning and
implementation of programs for assessment of vision for all
students in California public schools. Among its
recommendations, the publication provides that those
authorized to conduct vision appraisals include the
following:
A. Medical practitioners, including a nurse,
physician, ophthalmologist, or optometrist who holds
both a license 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;
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.
Current law requires CDE to adopt guidelines to implement
this section and provides CDE with flexibility to consult
with the appropriate entities. Rather than require the
implementation of standards from non-governmental entities
staff recommends striking on page 2 line 9 "This
examination shall be consistent with the most current
standard, policy or guideline adopted by the American
Academy of Pediatrics, the American Academy Ophthalmology
or the American Optometric Association."
Current law provides students' vision to be appraised by a
school nurse. This bill deletes this option and provides no
alternative for parents. Staff recommends the bill be
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amended to reinstate the following provisions:
A. A school shall not deny admission to a pupil or
take another adverse
action against a pupil if his or her parent or
guardian fails to provide the
results of the examination to the school.
B. If the results of the eye examination are not
provided to the school,
then during the kindergarten year or upon first
enrollment or entry, and in
grades 2, 5, and 8, the pupil's vision shall be
appraised by the school
nurse or other person authorized under Section 49452.
C. A pupil whose first enrollment or entry occurs
in grade 4 or 7 shall not
be required to be appraised in the year immediately
following the pupil's
first enrollment or entry.
D. The appraisal shall include tests for visual
acuity, including near vision
and color vision. However, color vision shall be
appraised once and only
on male pupils, and the results of the appraisal shall
be entered in the
health record of the pupil. Color vision appraisal
need not begin until the
male pupil has reached the first grade.
E. A pupil's vision may be appraised by using an eye
chart or any other
scientifically validated photoscreening test.
Photoscreening tests shall be
performed under an agreement with, or the supervision
of an optometrist
or ophthalmologist, by the school nurse, or a trained
individual who meets
requirements established by the department.
5. Prior legislation.
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AB 1840 (Campos, CH. 803, 2014) authorized a child's vision
to be appraised by using an eye chart or any scientifically
validated photoscreening test and requires photoscreening
tests to be performed, under an agreement with, or the
supervision of an optometrist or ophthalmologist, by the
school nurse or by a trained individual who meets specified
requirements as determined by the California Department of
Education (CDE). AB 402 would substantially delete the
provisions most recently enacted by AB 1840 (Campus 2014)
and SB 1172 (Steinberg 2014) regarding vision appraisals.
The amendments outlined in staff comment #4 reinstate the
deleted provisions only in the event that results of an
exam cannot be provided by a parent.
SB 1172 (Steinberg, CH. 925, 2014) 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 430 (Wright, 2013) would have required a pupil to
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.
SB 430 died in the Assembly Health Committee.
AB 1095 (Wright, 2001) would have required every student,
within 90 days of entering grade 1, to undergo a
comprehensive eye exam that included, 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.
SUPPORT
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California Black Health Network
California Federation of Teachers
California Federation of Teachers
California Optometric Association
California Pan-Ethnic Health Network
California State Board of Optometry
Numerous individuals
OPPOSITION
American Academy of Pediatrics
California Academy of Eye Physicians and Surgeons
California Academy of Family Physicians
California School Nurse Organizations
Kaiser Permanente
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