RD22 - Review of Eye Examinations Prior to School Enrollment

  • Published: 2003
  • Author: Joint Commission on Health Care
  • Enabling Authority: Letter Request (2002)

Executive Summary:

HB 517 would add a comprehensive eye examination by a licensed optometrist or ophthalmologist to the physical examination requirements for a pupil entering a public elementary school for the first time. The rationale for the bill is that current screening requirements do not identify many vision problems (such as near vision and amblyopia) that may affect learning. HB 517 was continued to 2003 in the House Committee on Education and referred to the Joint Commission on Health Care (JCHC) for study.

Students are required to submit a physical examination report prior to entering a public elementary school for the first time. The visual examination only requires testing distance vision at 20 feet. In addition, public schools are required to complete periodic vision screenings in grades 3, 7, 10 related to Virginia Administrative Code requirements (8 VAC 20-80-50).

Twelve states have considered legislation that would require a preschool eye exam but only Kentucky has enacted the law (effective in July 2000).

Kentucky officials do not have comprehensive information on eye exam results.

Kentucky Optometric Association data on 5,316 children indicated 13.9% needed glasses, 13.7% required professional follow-up, 3.4% had symptoms of amblyopia, and 2.3% of strabismus.

According to Prevent Blindness America, screening identifies those at high risk or in need of a professional exam; may detect disorders in early, treatable stage; provides public with valuable information and education about eye care; and may result in a referral to an eye professional or PCP. Eye exams are completed to look for eye disorders/diseases; diagnose eye disorders/diseases; and prescribe treatment.

HB 517 would require a comprehensive eye examination by an optometrist or ophthalmologist rather than the screening that is required prior to school enrollment now. A comprehensive eye examination requirement is supported by the American Foundation for Vision Awareness, American Academy of Optometry, American Optometric Association, College of Optometrists in Vision Development, Eye Care Council, and Optometrists Extension Program Foundation.

The American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, and American Academy of Ophthalmology issued this joint statement: "The examination of millions of children [nationwide] to possibly detect the very few who would slip through the system is not cost effective ...we believe it is a lamentable waste of resources that should be used to address real preventable health concerns."

In 1998, Congress directed the Maternal and Child Health Bureau and the National Eye Institute (NEI) to develop recommendations regarding preschool vision screening; the work is being continued under two separate initiatives.

• Project Universal School Vision Screening (PUPVS) involves 5 demonstration projects including Prevent Blindness Virginia to test vision screening guidelines and "establish links between vision screening and the medical home and to ensure appropriate follow-up...."

• NEI has a 3-phase project known as Vision in Preschoolers (VIP) which will specifically compare the results of screenings versus examinations in identifying vision problems.

Virginia School Boards Association, VASN, and 6 school divisions contacted by JCHC staff noted concerns including that HB 517 might be burdensome for parents and schools, conflict with compulsory school attendance law, and be difficult in terms of alerting parents some who do not speak English of the requirement.

A number of policy options were offered by the Joint Commission on Health Care regarding a comprehensive eye examination requirement for public comment. The policy options are shown on page 39. A summary of public comments received is included in Appendix C.

Actions Taken by JCRC

JCHC voted to accept Option 1, to take no action.