BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 402
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|AUTHOR: |Mitchell |
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|VERSION: |April 22, 2015 |
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|HEARING DATE: |April 29, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Pupil health: vision examinations.
SUMMARY :
1. Requires a pupil's vision to be examined by a physician,
optometrist, or ophthalmologist, as specified, and requires
the pupil's parent or guardian to provide the results of the
examination to the pupil's school. Prohibits a school from
denying admission to a pupil or take any other adverse action
against a pupil if his or her parent or guardian fails to
provide the results of the examination. If the results of the
examination are not provided to the school, requires a pupil's
vision, instead, to be appraised pursuant to existing law, as
specified.
Existing law:
1.Requires a pupil's vision to be appraised, during the
kindergarten year or upon first enrollment or entry in a
school district of a pupil at an elementary school, and in
grades two, five, and eight, by the school nurse or other
authorized person, including duly qualified supervisors of
health employed by the district; certificated employees of the
district or of the county superintendent of schools who
possess the qualifications prescribed by the Commission for
Teacher Preparation and Licensing; by contract with an agency
duly authorized to perform those services by the county
superintendent of schools of the county in which the district
is located, under guidelines established by the State Board of
Education; or accredited schools or colleges of optometry,
osteopathic medicine, or medicine.
2.Prohibits a pupil's vision from being required to be appraised
in the year immediately following the pupil's first enrollment
or entry if it occurs in grades four or seven.
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3.Requires the vision appraisal to include tests for visual
acuity, including near vision, and color vision. Requires
color vision appraisal to be performed once on male pupils
only with the results to be entered in the pupil's health
record, and specifies that appraisal need not begin until the
male pupil has reached the first grade.
4.Allows the vision appraisal to be waived by the pupil's
parents if they present a certificate from a physician and
surgeon, a physician assistant, or an optometrist setting out
the results of a determination of a pupil's vision, including
visual acuity and color vision.
5.Allows a pupil's vision to be appraised using an eye chart or
any other scientifically validated photo screening test.
Requires photo screening tests to 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 California
Department of Education (CDE).
6.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
nurse and the classroom teacher.
7.Provides for an exemption of vision appraisal to a pupil whose
parent or guardian files with the principal of the school, in
which the pupil is enrolling, a statement in writing that they
adhere to the faith or teachings of any well-recognized
religious sect, denomination, or organization and in
accordance with its creed, tenets, or principals depend for
healing upon prayer in the practice of their religion.
8.Requires CDE to adopt guidelines to implement the vision
appraisal requirements, including training requirements and a
method of testing for near vision.
This bill:
1.Expands current law by requiring a pupil's vision to be
examined during the kindergarten year or upon first enrollment
or entry in a school district of a pupil at an elementary
school, and at least every second year thereafter until the
pupil has completed grade 8, by a physician, optometrist or
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ophthalmologist.
2.Expands current law by requiring the examination to include
tests for visual acuity, binocular function, and refraction
and eye health evaluations, in addition to current screening
tests. Requires the pupil's parent or guardian to provide
results of the examination to the school.
3.Prohibits a school from denying admission to a pupil or taking
any other adverse action against a pupil if his or her parent
or guardian fails to provide the results of the vision
examination to the school.
4.If results of the vision examination required in this bill are
not provided to the school by a parent or guardian, requires a
pupil's vision to be appraised pursuant to existing law, using
existing vision screening methods at required grade levels, by
the school nurse or other qualified person pursuant to
existing law.
5.Requires CDE to adopt regulations, instead of guidelines, to
implement the provisions of this bill, including training
requirements. Requires CDE to provide participation data.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, this bill
clarifies that comprehensive vision exams should include
critical evaluations that can catch serious eye problems in
pupils.
Studies show that impaired vision in children can affect
cognitive, emotional, neurological, and physical development.
Students with impaired vision experience developmental delays,
lower educational attainment, and a greater need for special
education, as well as vocational and social services.
In 2011, almost 40 percent of students tested at Los Angeles
Unified School District experienced significant discomfort
while reading or trying to study. In the author's district, 56
percent of students at Bradley Elementary School in Leimert
Park experienced binocular eye health problems. These eye
problems in children directly correlate with low reading
fluency. Under existing law, in-school vision screenings only
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test school children for near- and farsightedness, color
blindness, and any noticeable abnormalities. This bill will
ensure that children are tested for 11 more conditions that
can limit a student's ability to learn in the classroom, such
as astigmatism, convergence problems, binocular vision,
accommodation issues, and other serious eye diseases.
Detecting vision problems early through more comprehensive
exams will ensure that every child has the same opportunity
and potential to learn.
2.Current vision screening in schools vs. requirements in this
bill. Current law requires vision appraisals for pupils by
school nurses and other authorized persons. Current vision
appraisals test for visual acuity, including near vision and
color vision (for male pupils only, and only once). Appraisals
can be performed using an eye chart or any scientifically
validated photo screening test (under agreement with or
supervision of an optometrist or ophthalmologist). Also,
continual and regular observation of the pupil's eyes,
appearance, behavior, visual performance, and perception that
may indicate vision difficulties are required to be done by
the school nurse and the classroom teacher.
This bill would instead require a pupil to receive an eye
examination by a physician, optometrist, or ophthalmologist.
The eye examination would include current required tests
(visual acuity and color vision) and tests for binocular
function, as well as refraction and eye health evaluations. A
pupil's parent or guardian is required to submit results of
this examination to the school. However, if a parent or
guardian does not submit the results of the examination, a
pupil's vision would be appraised according to current law.
This bill prohibits a school from denying a pupil entry if the
results of examination required in this bill are not
submitted.
3.National Commission on Vision and Health (NCVH). A report by
the NCVH, Vision Exams for Children Prior to Entering School,
stated that one in four school-age children suffers from
vision problems that could have been treated if the child had
been properly screened upon entering school. Studies show that
there is an increasing need for eye care among children: 25
percent of children aged five to 17 have a vision problem; 79
percent have not visited an eye care provider in the past
year; 35 percent have never seen an eye care professional; and
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40 percent who fail initial vision screenings do not receive
the appropriate follow-up care. Younger children entering
school are even less likely than teenagers to receive vision
services. Only one out of 13 children under the age of six
visited an eye care provider, compared with about one third of
adolescents aged 12-17. Only 22 percent of preschool children
received some vision screening, and only 15 percent received
an eye exam.
NCVH states there are three primary methods for vision
assessment: school-based vision screening programs;
community-based or office-based screening programs; and
comprehensive eye exams conducted by an eye care professional.
In addition, studies have found that physicians do not
consistently conduct vision screenings on children. According
to the NCVH, the public, and most importantly parents and
teachers, believe that vision screenings can accurately
identify those children who need a comprehensive eye exam. A
vast majority of children's vision screenings have high rates
of false negatives, failing to adequately detect signs of
significant vision problems in children chronically burdened
by these difficulties, according to NCVH. The NCVH recommended
that children have timely access to comprehensive eye exams
and stated that if comprehensive exams by an optometrist or
ophthalmologist are not possible, science-based vision
screening with high sensitivity and specificity and controlled
follow-up for treatment is an acceptable, though not
preferred, method to providing vision care for children.
4.Vision problems in children. According to the National
Association of School Nurses (NASN), vision problems are the
fourth most prevalent class of disability in the United States
and one of the most prevalent conditions in childhood. NASN
maintains that this is an extremely important statistic
considering that 80 percent of what children learn comes
through their visual processing of information. According to
the Centers for Disease Control and Prevention (CDC), impaired
vision can affect a child's cognitive, emotional, neurologic
and physical development by potentially limiting the range of
experiences and kinds of information to which the child is
exposed. Despite the importance of appropriate vision testing,
the CDC reports that nearly two in three children enter school
without ever having had a vision screening.
5.Binocular vision. According to the Optometrists Network's Web
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site, binocular vision is wherein both eyes aim simultaneously
at the same visual target and both eyes work together
(simultaneously, equally, and accurately) as a coordinated
team. Healthy binocular vision produces important visual
perceptual skills, which are part of normal human vision:
binocular depth perception and stereopsis. Binocular vision
impairment is any visual condition wherein binocular visual
skills are inadequately developed, and often result in partial
or total loss of stereoscopic vision and binocular depth
perception. Conditions where the eye is obviously turned or
crossed are commonly referred to with terms like "cross-eyed,"
"wall-eyes," or "wandering eyes." These binocular vision
impairments are easily detected by others as all the observer
needs to do is notice that both eyes do not aim in the same
direction at all times. Binocular vision impairments are more
common than thought. Just one type of binocular impairment,
amblyopia (lazy eye), affects approximately three percent of
the population. At least 12 percent of the population has some
type of problem with binocular vision.
6.Refraction. According to the National Institutes of Health,
the refraction test is an eye exam that measures a person's
prescription for eyeglasses or contact lenses. This test is
performed by an ophthalmologist or optometrist. This test can
be done as part of a routine eye exam. The purpose is to
determine whether a person has a refractive error (a need for
glasses or contact lenses). If a person's final vision is less
than 20/20, even with lenses, there is probably another,
non-optical problem with the eye. The vision level one
achieves during the refraction test is called the
best-corrected visual acuity. Abnormal results may be due to:
astigmatism, farsightedness, nearsightedness, or presbyopia
(inability to focus on near objects that develops with age).
People with a refractive error should have an eye examination
every one to two years, or whenever their vision changes.
7.Double referral. This bill was heard in the Senate Education
Committee on April 15, 2015, and passed with a vote of 7-0.
8.Prior legislation. SB 1172 (Steinberg), Chapter 925, Statutes
of 2014, required a pupil's vision to be appraised by the
school nurse or other authorized person during kindergarten or
upon first enrollment or entry in a California school district
of a pupil at an elementary school, and in grades two, five,
and eight, except as provided; revised the functions to be
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performed by the school nurse and the classroom teacher in
observing a pupil's eyes, appearance, and other factors that
may indicate vision difficulties; required the Department of
Education to adopt guidelines to implement those provisions,
including training requirements and a method of testing for
near vision.
AB 1840 (Campos), Chapter 803, Statutes of 2014, authorized a
child's vision to be appraised by using an eye chart or any
scientifically validated photo screening test. Required photo
screening tests to 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 of Education.
SB 430 (Wright), of 2013, would have deleted the existing
requirement for appraisal upon first enrollment in an
elementary school by the school nurse or other authorized
person, and replaced it with a requirement that a pupil
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
failed in the Assembly Health Committee without being heard.
SB 606 (Vasconcellos), of 2001, would have required the
student eye examination to include screening for binocular
function, ocular alignment, ocular motility, and near visual
acuity. SB 606 was held on suspense in the Assembly
Appropriations Committee.
AB 1095 (Wright), of 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 on
suspense in the Senate Appropriations Committee.
AB 1096 (Wright), of 2001, would have established a pilot
program for schools scoring in the bottom 20 percent 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.
9.Support. The sponsor of this bill (State Board of Optometry)
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and supporters, which include consumer advocates, labor
groups, and optometrists, argue that current vision testing in
schools is limited to using the eye chart for acuity one eye
at a time, from 20 feet away, which does not address how well
the two eyes work together while reading. Supporters argue
that emerging data and practice in the field of vision show
that reading speed and fluency are impacted by poor eye
coordination, which can lead to problems like declined reading
speed, poor hand-eye coordination, headaches, eye strains, and
frustration, which has often been misdiagnosed as attention,
behavioral, or emotional disorders. The California Pan-Ethnic
Health Network and the California Black Health Network cite
health disparities that disproportionately affect Latino,
African-American, and American Indian/Alaska Native
populations, who have scored lower than white students as
proficient or advanced on the third-grade state language arts
exam. They state that reading exams can serve as a tool to
identify vision problems early in life to help reduce
educational disparities.
10.Opposition. Kaiser Permanente and the American Academy of
Pediatrics argue that the requirements in this bill mandate
procedures that are not necessary or recommended by eye health
professionals and bring very little clinical value at a
possible cost and inconvenience to parents. They state that
this bill could fragment care for children who can be screened
in the medical home by their pediatrician or other health care
provider, and also state that there is no data to support that
a visit with an optometrist or ophthalmologist is an effective
screening system or justifies the associated costs. They argue
that expanded screening requirements increase cost and the
complexity of accomplishing the screens without evidence that
it would produce better outcomes for children and that this
bill will result in school absenteeism for children and work
absenteeism for parents for having to take children to
unnecessary extra provider visits.
Other opponents shared similar concerns in a previous version
of this bill. They expressed concerns about the need for
expanding the current vision screenings and the costs
associated with the new requirements.
11.Technical amendment. The author has indicated that an
amendment to clarify what should be included in a
comprehensive exam will be proposed to be taken in this
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committee.
SUPPORT AND OPPOSITION :
Support: California State Board of Optometry (sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
California Black Health Network
California Chapter of the National Association of
Social Workers
California Federation of Teachers
California Optometric Association
California Pan-Ethnic Health Network
Disability Rights California
Hundreds of individuals
Oppose: American Academy of Pediatrics
California Academy of Family Physicians (previous
version)
California School Nurses Organization (previous
version)
Kaiser Permanente
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