Among Prevent Blindness America’s core visionary goals is the reduction of vision loss by ensuring all children receive appropriate vision care before entering school. Toward this end, Prevent Blindness America supports legislation in every state that would ensure all children are screened for vision problems, with appropriate follow-up eye examinations when necessary, prior to school entry.

Below is a listing of key policy considerations related to this legislation, elements that should be included in any model legislation on school entry vision screening, and a note on mandatory pediatric eye examination legislation.

Key Policy Considerations Related to the Legislation
Prevent Blindness America suggests the following key policy elements be taken into account when developing state school entry vision screening legislation:

• It is the express intent of this legislative concept that no child be deprived of their rightful educational opportunity due to the enactment of these requirements and recommendations.  To this end, the state should ensure adequate funding for this legislative enactment.

• Such legislation should not be intended to supersede existing legislation related to vision screening throughout the primary school years.  If not already in place, legislation mandating periodic vision screening throughout the child’s school years should be encouraged.

Elements to Include in Model Legislation

Prevent Blindness America recommends that each of the following elements be represented in any proposed school entry vision screening legislation:

• Creation of an oversight commission. Where an appropriate oversight body does not exist, a State Children’s Vision Health and School Readiness Commission (hereinafter referred to as “Commission”) should be established to ensure the enactment of this legislation.  The Commission should be appointed by the governor and be comprised of one optometrist, one ophthalmologist, one pediatrician or family practice physician, one representative of a nonprofit voluntary health organization dedicated to preventing blindness, one representative of the state department of education, one representative of the state department of public health, one school nurse, one public health nurse, one school superintendent, one local health commissioner, and other members as determined appropriate by the governor.  The Commission should be charged, at a minimum, with the following tasks:

• providing linguistically and culturally appropriate materials to be used in vision screening, to include forms, notifications, and other communications among the school, parents/guardians, and licensed optometrists/ physicians trained in the provision of comprehensive eye care;
• pursuing opportunities to offer free or low-cost eye exams, using a sliding scale, for students who fail vision screenings and are unable to afford an exam on their own;
• pursuing opportunities to provide geographically accessible opportunities for such examinations;
• designating an agency to collect data from school health personnel concerning the results of the original screenings, the reports from the comprehensive eye exam, efforts to reach out to unresponsive families, referrals to child protective agencies; and
• issuing an annual report to the secretary of the department of health, the secretary of the department of education, the governor, and the state legislature, with the key findings, including an evaluation of cost effectiveness, collected data and recommendations for possible modifications to the program.

• Required elements of an authorized pediatric vision screening. A vision screening authorized under this legislation should include, at a minimum, the following nationally recognized pediatric vision screening protocol:
  
  
  
• observation (ABCs: Appearance signs, Behavior signs, Complaint signs);
• distance visual acuity screening and, if necessary, refractive error screening;
• stereopsis screening; and
• appropriate follow-up.

• Requirements of authorized vision screeners. Lay screeners authorized to conduct a vision screening under this legislation should be required to have been trained in the above-mentioned nationally recognized pediatric vision screening protocol.  Medical professionals should also be required to follow these protocol when they perform vision screenings pursuant to the requirements of this law.

• Requirements of a follow-up comprehensive eye examination. The licensed optometrist or physician trained in the provision of comprehensive eye care who conducts the comprehensive eye examination of a child in response to a failed vision screening under this legislation should use a standardized reporting tool to be developed by the Commission.  The reporting tool should include, but not be limited to, the following:
  
  
  
• date of the report;
• name, phone number, and address of the child;
• name of the child’s school;
• type of examination;
• a summary of significant findings, including diagnoses, treatment, prognosis, whether or not a return visit is recommended and, if so when;
• recommended educational adjustments for the child, if any, which may include the following:  preferential seating in the classroom, eyeglasses for full-time use in school, eyeglasses for part-time use in school, or any other recommendations; and
• name, phone number, address, and signature of the examiner.

• Elements of a mandatory school vision screening program.  All schools should follow the process outlined below in implementing the mandatory school vision screening requirements.
  
  
  
• For every child enrolling in kindergarten (or the first year of school required by the state), a vision screening performed by an authorized vision screener and conducted within twelve months prior to the date that the child first enters the class should be required.  Documentation of a comprehensive eye exam within the previous twelve months should waive this requirement.
• Vision screening should be made available at the school site for all students who do not have documentation of a screening performed by an authorized screener or documentation of an eye examination performed within the previous twelve months.  Each school should be responsible for securing an authorized vision screener.  The school-based screenings should be conducted within a reasonable time from the date the child enters school, as determined by the state.
• All families of children should be notified of the results from the school-based vision screening via the school’s established parental communication mechanism.  The notification should include a statement indicating that the conducted vision screening does not substitute for a comprehensive eye exam by a licensed optometrist or physician trained in the provision of comprehensive eye care.  The notification to families of children who fail their screening should also include information regarding state funding to provide eye examinations for children whose families cannot afford them.  These communications should be provided in a linguistically and culturally appropriate manner.
• For those children who fail the required vision screening, a comprehensive eye examination, performed by a licensed optometrist or physician trained in the provision of comprehensive eye care, should be required.  State funding should be designated to provide eye examinations for children whose families cannot afford them.
• The family of the referred child must provide a copy of the comprehensive eye examination report to the school health personnel within a reasonable period from the date of parental notification, as established by the state.  If the eye exam does not take place within the established time period, a follow-up letter will be sent to the child’s family.

Note on Mandatory Pediatric Eye Examination Legislation

Though Prevent Blindness America supports efforts to ensure that children receive periodic professional eye care as a part of a continuum of preventive vision health services, as it relates to legislative mandates, we do not endorse efforts to mandate full eye examinations for all children prior to school entry, as they disregard the critical public health role that screenings can play and create an undue economic burden to the state.

However, should efforts to mandate professional eye examinations be undertaken over the vision screening-inclusive model, Prevent Blindness America believes these mandates must, at a minimum, 1) not withhold educational opportunities or otherwise penalize children; 2) include adequate additional fiscal and other resources for monitoring and enforcing compliance; 3) provide sufficient means to deliver the required eye care to children whose families cannot afford to purchase that care; 4) accept any examination that includes the appropriate procedures and that is performed by a healthcare provider acting within his or her legal scope of practice; 5) not undermine existing preventive eye health services such as community- or school-based vision screening nor in any way hinder the continuation or development of such programs; 6) not hinder safety net programs; and 7) include appropriate measures for the timely assessment of their effectiveness in terms of relative economic costs and benefits in order to determine whether or not they justify the burden placed on parents, school and public health systems, and the society at large.

Finally, Prevent Blindness America does support mandatory eye examinations for all children with special needs, as these children have higher rates of vision problems.