Eye exam bill provokes sharp split among specialists

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A bill that would require a comprehensive eye exam, rather than basic vision screening, for some schoolchildren has sharply divided the experts: California's Board of Optometry backs the measure, while an official with a national pediatric ophthalmologists' group says such a shift would be "a tremendous waste of resources."

California already requires kids in certain grades to have their vision tested by a school nurse or other qualified staffer. The legislation, AB 1110,  would require a comprehensive test by a physician, optometrist or ophthalmologist. Children would be tested for a range of different things, including glaucoma. 

Although the bill requires the comprehensive exam, schools would not be allowed to turn children away if they hadn't received it. If parents fail to provide the school with the results of the extensive test, the measure says the school shall give the student the standard basic vision screening.

Assemblywoman Autumn Burke (D-Inglewood) said she co-authored the bill because "we found in our district a lot of young people who had been deemed bad kids weren’t bad kids - they were just having difficulties seeing the board."

The California Board of Optometry, which sponsored the bill, said in an email that existing vision screenings "cannot be relied upon to discover and diagnose eye conditions including eye coordination problems and certain detrimental refractive conditions."

Dr. Sage Hider, President of the California Optometric Association, said comprehensive testing can identify eye problems that might affect a child's ability to learn. "If they have a vision problem that’s not allowing them to learn then that’s not going to allow them to be successful in school," he said.

But Dr. Kenneth Cheng, Chair of the Legislative Committee at the American Association for Pediatric Ophthalmology and Strabismus, said a comprehensive eye exam for every child is "absolutely not" necessary. "It’s not only not necessary but it’s a tremendous waste of resources," said Cheng.

Basic screening can detect the "overwhelming majority" of vision problems in children, he said. Comprehensive eye exams could cost parents time and money, and "especially in a state like California that has a fairly large Medicaid population the burden financially on the state would be tremendous and wasteful," Cheng said.

Choosing Wisely, an initiative that strives to help patients identify evidence-supported care, says children should have comprehensive eye exams if they fail a routine vision screening, been diagnosed with a vision problem or have a family history of vision problems. It also suggests that, in addition to expensive and unnecessary testing, children are sometimes prescribed glasses when they do not need them.

Cheng said he suspects that those backing the bill are supporting it because "it will fill their offices." Hider said his organization is behind the measure "because we think it is very good for the public."

Under the Affordable Care Act, all health plans must cover pediatric vision care. Medi-Cal covers regular eye exams and glasses up until the age of 21. Burke said that while parents with private insurance would probably have to pay for the tests, "most parents if there’s a small copay are happy to have it in lieu of a child that’s then alienated from school because they can’t see."

Cheng said instead of passing the bill, California should expand vision screening to younger children to enable earlier detection of eye problems.