BILL ANALYSIS �
SENATE COMMITTEE ON EDUCATION
Carol Liu, Chair
2013-2014 Regular Session
BILL NO: AB 1840
AUTHOR: Campos
AMENDED: May 8, 2014
FISCAL COMM: Yes HEARING DATE: June 25, 2014
URGENCY: No CONSULTANT:Lynn Lorber
SUBJECT : Vision appraisal.
SUMMARY
This bill adds a trained individual, who meets specified
requirements, to those who perform gross external observation
of a student's eyes, visual performance, and perception.
BACKGROUND
Current 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. The evaluation must include tests for visual
acuity and color vision, however, color vision is to be
appraised once and only on male students. Gross
external observation of the child's eyes, visual
performance, and perception are to be done by the school
nurse and the classroom teacher. The evaluation 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)
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:
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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)
4) Provides that 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 adds a trained individual, who meets specified
requirements, to those who perform gross external observation
of a student's eyes, visual performance, and perception.
Specifically, this bill:
1) Adds a trained individual who meets the requirements
established by the California Department of Education
(CDE) to the requirement that the school nurse and the
classroom teacher conduct gross external observation of
the student's eyes, visual performance, and perception.
2) Authorizes an eye chart or any other scientifically
validated screening test to be used to appraise a
student's eyes.
STAFF COMMENTS
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1) Senate Health Committee amendments . This bill was heard
in the Senate Health Committee on June 18. The Senate
Health Committee recommended, and the author accepted,
the following amendments that are to be adopted by this
Committee:
a) Strike addition of trained individual to those
who perform gross external observation of a
student's eyes, visual performance, and perception,
thereby returning this provision to current law.
b) Delete the authority to use any other
scientifically valid technology to appraise vision
and instead authorize the use of any other
scientifically validated photo screening test.
c) Requires photo screenings to be performed,
under agreement with or the supervision of an
optometrist or ophthalmologist, by the school nurse
or other trained individuals who meet requirements
established by the California Department of
Education (CDE).
As amended, this bill would authorize a student's vision
to be appraised using an eye chart or any other
scientifically validated photo screening, performed by
the school nurse or other trained individuals who meet
the requirements established by the CDE.
2) Other trained individuals . As amended by the Senate
Health Committee, this bill provides that photo
screening is to be performed by the school nurse or
"other trained individuals who meet requirements
established by the department." The California
Department of Education (CDE) issued a Guide for Vision
Testing in California Public Schools that would be
required by this bill include:
a) Vision testing may be done in kindergarten or
first grade and in grades two, five, and eight, as
well as on enrollment and referral at any grade
level.
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b) Have teachers make continual observations of
students' appearance and behavior that may indicate
vision difficulties.
c) Conduct vision testing of students whose
school performance indicates a vision problem.
Current regulations provide that non-medical
certificated employees of a school district or county
office of education may be authorized to give vision
tests if the employee has one of the following
documents:
d) A statement from a qualified supervisor of
health that the employee has satisfactorily
completed an acceptable course of in-service in
techniques and procedures in vision testing of at
least six hours and that the employee is qualified
to administer vision tests to students.
e) A transcript from an accredited college or
university evidencing that the employee has
successfully completed an acceptable course in
vision testing of at least one semester unit.
(California Code of Regulations, Title 5, � 591)
It is unclear what requirements the CDE has established,
as referenced in this bill. The Guide for Vision
Testing in California Public Schools serves as guidance
and related to vision tests, not vision appraisals.
Further, the California Code of Regulations relate to
vision tests, not vision appraisals. The author's
office provided no background or supporting materials
for this bill.
3) Failure of vision appraisal or test . Current law
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. Current regulations
require a re-evaluation of a student who failed a vision
test, prior to a report being made to the student's
parents. (Education Code � 49456 and California Code of
Regulations, Title 5, � 594)
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4) Photo screening . According to the Assembly Health
Committee analysis, a policy statement issued by the
American Academy of Pediatrics (AAP) provides:
"Use of Photoscreening for Children's Vision Screening,
photoscreening is a vision screening technique used to
screen for amblyogenic factors such as strabismus (lazy
eye) and significant refractive errors in one or both
eyes in children. Using a camera or video system,
images of the pupillary reflexes (reflections) are
obtained. Other than having to fixate on the
appropriate target long enough for the photoscreening,
little cooperation is needed from the child. Data is
then analyzed by the evaluator. Children who do not
pass the test may be referred for a complete eye
examination. Photoscreening does not represent a single
technique or piece of equipment. Different optical
systems can be used for photoscreening. Each
photoscreening system may have its own advantages and
disadvantages, and it appears that results published in
the literature for one system are not necessarily valid
for others. Studies performed by different
investigators using the same photoscreening apparatus
may yield a wide range of results. Likewise, it is not
certain that data gathered about different groups of
children or different settings can be extrapolated to
other groups or settings. The AAP favors additional
research of the efficacy and cost-effectiveness of
photoscreening as a vision screening tool."
A November 2012 policy statement of the AAP states that
automated vision screening, including photoscreening and
autorefraction, is preferred for children aged 6 months
to 3 years because the procedure is quick and requires
little cooperation from the patient. Visual acuity
charts continue to be the reliable method of screening
for children aged 4 to 5 years.
http://pediatrics.aappublications.org/content/130/5/983.f
ull
5) Fiscal impact . According to the Assembly Appropriations
Committee, the current version of this bill would impose
minor absorbable costs to California Department of
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Education (CDE) to develop or update guidelines.
Workload could be absorbed by the School Health
Education Consultant at CDE.
6) Related legislation . SB 1172 (Steinberg) 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 1172 is scheduled to be heard in the
Assembly Health Committee on June 24.
SB 430 (Wright) requires a pupil to 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.
SB 430 is in the Assembly Health Committee.
7) Prior legislation . AB 1095 (Wright, 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 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.
SB 606 (Vasconcellos, 2001) would have required the existing
student eye examination to include screening for
binocular function, ocular alignment, ocular motility,
and near visual acuity. SB 606 was held on the Assembly
Appropriations Committee's suspense file.
SUPPORT
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None on file.
OPPOSITION
None on file.