Prevent Blindness recommends using the following model template when developing state legislation that supports children’s vision screening. This template may be modified to align with existing state laws, regulations, administrative requirements, and local needs.
Section 1 Preamble
The legislature recognizes that:
- Good vision in children contributes to school readiness, mental and emotional wellness, social connection, recreational engagement, and educational success through learning. Early detection practices, including vision screening, should be evidence-based, age appropriate,, include a process for referral and follow-up to ensure that eye care was received, and include data collection practices that promote accountability.
- Vision disorders are common among infants, children, and adolescents and can emerge throughout childhood and adolescence.
- Undetected and untreated vision disorders may adversely affect a child’s development, school readiness, academic performance, health, and lifelong quality of life.
- Early detection, referral, comprehensive eye examinations, follow-up, timely treatment, and access to services such as assistive technologies and support resources can improve visual, developmental, educational, social-emotional, mental health and behavioral, and health outcomes for children.
- Vision screening is an important and proven public health strategy for identifying children who may have vision disorders and who should receive a comprehensive eye examination.
- Vision screening does not diagnose vision disorders and is not a substitute for a comprehensive eye examination performed by a licensed optometrist or licensed ophthalmologist.
Section 1. In General
The purpose of this bill is to establish school-based public health processes that promote early detection and intervention practices to optimize children’s vision and eye health.
Section 2. Establishment of a School-Based Vision Screening System
- Each school as defined in section x shall provide vision screening for enrolled students in accordance with evidence-based and age-appropriate guidelines.
- Evidence-based vision screenings shall be conducted by a school nurse or a designee trained and certified in approved techniques in accordance with rules adopted by the [insert appropriate state administrative department].
Any public, charter, private, or parochial school district that provides vision screening services shall submit annual data as outlined in [Section x] to the [governing entity] in an approved format that shall contain no personally identifiable information and comply with applicable student privacy laws.
Section 3. Beneficiaries of Vision Screening Services
The beneficiaries of vision screening services shall include the following:
- Students enrolled in public and private preschools shall be screened annually.
- Students enrolled in kindergarten, grades 1, 3, 5, 7, and 11, and those who enter school at any grade level if they have not previously received a vision screening or can demonstrate having received a vision screening or eye examination in the past year.
- Students who, at the discretion of the school nurse or health personnel, are enrolled in grade levels not otherwise noted or required by this section.
- Students for whom a teacher or another member of the school staff has requested a vision screening.
- Students for whom a parent or guardian has expressed a concern or requested a vision screening to be performed by a school nurse or health personnel.
Students whose demonstrated reading proficiency is not at grade level by the time the student reaches the third grade.
Section 4. Vision Screening Tools and Procedures
Trained and certified school nurses or their designees shall use evidence-based vision screening tools and procedures to include, at a minimum:
Vision Screening Procedures
- Observation (appearance signs, behavior signs, and complaint signs);
- Recognition distance visual acuity screening using age-appropriate optotypes in a standardized format for preschool- and school-age children; LEA SYMBOLS® or HOTV optotypes shall be used for preschool children, and Sloan letters shall be used for school-age children;
- Binocular critical line near visual acuity screening for preschool children, including when validated instrument-based vision screening devices are used;
- Referral criteria for distance and near visual acuity screening shall be 20/50 for 3-year-old children, 20/40 for 4-year-old children, and 20/32 for children aged 5 years and older;
- Stereopsis screening for preschool children when conducting distance and near vision screening, but not when validated instrument-based vision screening devices are used; and
- Validated instrument-based vision screening devices appropriate for the child’s age may be used in place of recognition distance visual acuity screening for children younger than 6 years of age.
Schools shall also implement appropriate follow-up and data collection procedures.
Referral for Comprehensive Eye Examination
Children who meet one or more of the following criteria shall be referred for a comprehensive eye examination performed by a licensed optometrist or licensed ophthalmologist, regardless of vision screening results, as selected by the child’s parent or guardian:
- Students receiving or being considered for special education services who have not received an eye examination within the preceding 12 months;
- Children who do not pass a vision screening;
- Children with readily observable eye abnormalities, regardless of whether the child passes a vision screening;
- Children with systemic medical conditions or medication use associated with eye disorders, including, but not limited to, diabetes mellitus, juvenile idiopathic arthritis, and neurofibromatosis;
- Children with neurodevelopmental disorders, including, but not limited to, autism spectrum disorder, cerebral palsy, Down syndrome, hearing impairment, developmental delay, cognitive impairment, or speech delay;
- Children with a family history of strabismus or amblyopia; or
- Children who were born prematurely (prior to 32 weeks’ gestation).
Documentation of a comprehensive eye examination conducted within the preceding 12 months shall satisfy the requirements of this subsection.
Section 5. Parental Notification of Vision Screening Results
Vision screening results shall be provided to the parent or guardian of each student who does not pass the screening within 2 weeks after the screening and include the following:
- Results shall be provided in both verbal and written formats, in the preferred language of the parent or guardian;
- The notification shall state that the student did not pass the vision screening and is recommended to receive a comprehensive eye examination by a licensed optometrist or licensed ophthalmologist, and
- The notification shall state that a vision screening is not a substitute for a comprehensive eye examination conducted by a licensed optometrist or licensed ophthalmologist.
- The notification shall comply with all applicable privacy laws and regulations.
Section 6. Follow-Up Procedures and Criteria Following a Referral from a Vision Screening
For a child referred for an eye examination following a vision screening conducted under [section x], the child’s parent or guardian and, when authorized by the parent or guardian and consistent with applicable federal and state privacy laws, the school nurse or designee can request the following information from the examining optometrist or ophthalmologist:
- Whether the child received a comprehensive eye examination;
- The date of the examination;
- Whether a vision or eye health condition requiring monitoring or treatment was identified;
- Whether treatment was prescribed or recommended, including eyeglasses, contact lenses, vision therapy, medication, surgery, and/or additional evaluation;
- Whether the recommended treatment was obtained, if known; and
- Whether additional follow-up care was recommended.
The administrative department shall develop a standardized system for collecting the status of referrals from vision screening and receipt of eye examination results and prescribed treatment and shall ensure that all information is maintained and reported in accordance with applicable federal and state privacy laws.
For families unable to financially obtain a comprehensive eye examination or treatment, including prescription glasses, for their children, … [Insert provision regarding state funding or financial assistance for families unable to obtain a comprehensive eye and vision examination and treatment.]
Section 7. Parental Opt-Out
A student shall not be required to undergo a vision screening if a parent or guardian opts out per school district procedures.
The opt-out statement may allow for any reason, including, but not limited to, the following criteria:
- The parent or guardian can demonstrate that the student has received a comprehensive eye examination within the preceding 12 months,
- The parent or guardian can supply a documented diagnosis made by a licensed optometrist or licensed ophthalmologist, or
- The parent or guardian does not wish for the child to receive a vision screening.
Section 8. Implementation of Vision Screening Requirements
To implement the vision and eye health requirements established in section 4, [the administrative department or its designee] shall:
- Develop, provide, or contract with an organization that offers evidence-based screening and certification training;
- Provide schools with parent education materials that are culturally appropriate and linguistically accurate about vision screening and follow-up care needed when a referral from a vision screening is received;
- Create a mandatory individual-level data system for school districts to complete and submit to the administrative department annually. The system shall contain no personal identifiable information. Data collected shall include the result of a school vision screening, presence of a referral to eye care, eye examination results, and receipt of eyeglasses or other treatment.
- The administrative department shall post annual reports available to the public summarizing aggregated statewide data on rates of screening, referrals for eye examinations, eye examinations, and treatment.
[The following section should be included where an appropriate oversight body does not exist.]
Section 9. State Children’s Vision and Eye Health and School Readiness Commission
A State Children’s Vision and Eye Health and School Readiness Commission (hereinafter referred to as the “Commission”) shall be established.
The purpose of the Commission is to improve children’s vision, eye health, and school readiness through the coordination, evaluation, and promotion of vision screening, eye care, and related services.
The Commission shall be appointed by the governor and consist of representatives as determined appropriate, including, but not limited to, a licensed optometrist, a licensed ophthalmologist, a pediatrician or family physician, a nurse practitioner, a representative of a nonprofit organization dedicated to preventing blindness or promoting children’s vision and eye health, a representative of the state department of education, a representative of the state department of public health, a school nurse, a public health nurse, a school superintendent, a local health commissioner, a parent of a child with a vision disorder, a Head Start representative, and a representative of a community health center or Federally Qualified Health Center.
The Commission shall:
- Provide linguistically and culturally appropriate materials to schools, Head Start programs, childcare programs, and preschools including vision screening information, forms, and communications to families;
- Identify and promote opportunities to increase access to affordable eye examinations and eyeglasses for children, including programs that provide services on a free or sliding-fee basis;
- Provide guidance and technical assistance on required reporting, analyze submitted reports, and develop recommendations to improve children’s vision, eye health, and school readiness within the state;
- Publish an annual report to the governor, legislature, relevant state agencies, and the public on the work of the Commission; and
- Perform other duties as assigned by the governor.
For more information, contact Donna Fishman, MPH, Executive Director, National Center for Children’s Vision and Eye Health at Prevent Blindness. [email protected]
