BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1840
AUTHOR: Campos
AMENDED: May 8, 2014
HEARING DATE: June 18, 2014
CONSULTANT: Diaz
SUBJECT : Pupil health: vision appraisal.
SUMMARY : 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.
Existing law:
1.Requires, 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, a child's vision to be appraised by the school
nurse or other authorized person, as specified. Requires
results of the appraisal to be entered in the health record of
the pupil. Requires the vision appraisal to include tests for
visual acuity and color vision. Requires color vision to be
appraised once and only on male children, beginning in the
first grade.
2.Permits the vision appraisal to be waived, at the parent's
request, by presenting a certificate from a physician, a
physician assistant, or an optometrist providing the results
of a determination of the child's vision, including visual
acuity and color vision. Provides an exemption to the
appraisal requirement to a child whose parents or guardian
file a written statement based on the faith or teachings of
any well-recognized religion.
This bill:
1.Adds a trained individual, who meets requirements established
by the California Department of Education (CDE), to those who
can perform gross external observation of a child's eyes,
visual performance, and perception.
2.Permits a child's vision to be appraised using an eye chart or
any other scientifically validated screening test.
Continued---
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3.Makes other technical, clarifying changes.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor absorbable costs to CDE to develop or update
guidelines. Workload could be absorbed by the School Health
Education Consultant at CDE.
PRIOR VOTES :
Assembly Health: 15- 4
Assembly Appropriations:13- 4
Assembly Floor: 56- 15
COMMENTS :
1.Author's statement. According to the author, childhood vision
disorders are a prevalent and significant public health
problem. Yet there is a significant lack of public awareness
about the importance of eye care in children and the inability
of children to recognize their own vision problems. These
problems are heightened in families from economically
disadvantaged backgrounds by financial hardship and lack of
access to appropriate medical care. Furthermore, it is well
recognized that vision screenings are most effective when
early identification and treatment of many conditions can
prevent irreversible vision damage or loss. Early
identification and correction of a vision disorder is an
essential part of a child's overall health and their ability
to learn. While vision screening is a valuable public health
procedure, it is not a substitute for professional eye care.
Screening is the first step. Currently, only eye charts are
used in preventive vision screenings. Allowing students to get
vision screenings that use digital technology, alongside eye
charts, will help detect potential problems. While eye charts
are a long-standing and proven method, technology has advanced
to the point that portable camera-like equipment has been
invented that can provide comprehensive and reliable analysis
in seconds. These types of technologies can be used by any
trained individual and can provide a quick, mobile, and
accurate screening.
2.Vision screening in California schools. A 2005 guide developed
by CDE, "A Guide for Vision Testing in California Public
Schools," states that only the following are currently
authorized to conduct vision tests:
a. Medical practitioners, including a nurse, physician,
ophthalmologist, or optometrist, who hold both a license
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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, as specified;
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.
1.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.
2.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Education Committee.
3.Related legislation. SB 430 (Wright) 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. This bill
failed in the Assembly Health Committee without being heard.
SB 1172 (Steinberg) would revise the functions to be performed
by the school nurse and the classroom teacher during pupil
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vision screenings in observing a pupil's eyes, appearance, and
other factors that may indicate vision difficulties. This
bill requires CDE to adopt guidelines to implement those
provisions, including training requirements and a method of
testing for near vision. This bill is currently pending in the
Assembly.
4.Prior legislation. 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. This bill 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. This bill 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.
This bill died on the Senate Floor's inactive file.
5.Support. Supporters argue that scan cameras are quick,
efficient, reliable, and do not require medical professionals
to complete the screenings. They further argue that this bill
will help children by ensuring that schools have the
capabilities to identify vision problems early by using the
most current technology available.
SUPPORT AND OPPOSITION :
Support: California Coverage & Health Initiatives
Healthier Kids Foundation, Santa Clara County
See Well to Learn
Oppose: American Academy of Pediatrics (previous version)
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