A Comprehensive Review of State Vision Screening Mandates for Schoolchildren in the United States.

SIGNIFICANCE: Methods and frequency of vision screenings for school-aged children vary widely by state, and there has been no recent comparative analysis of state requirements. This analysis underscores the need for developing evidence-based criteria for vision screening in school-aged children across the United States. PURPOSE: The purpose of this study was to conduct an updated comprehensive analysis of vision screening requirements for school-aged children in the United States. METHODS: State laws pertaining to school-aged vision screening were obtained for each state. Additional information was obtained from each state's Department of Health and Education, through their websites or departmental representatives. A descriptive analysis was performed for states with data available. RESULTS: Forty-one states require vision screening for school-aged children to be conducted directly in schools or in the community. Screening is more commonly required in elementary school (n = 41) than in middle (n = 30) or high school (n = 19). Distance acuity is the most commonly required test (n = 41), followed by color vision (n = 11) and near vision (n = 10). Six states require a vision screening annually or every 2 years. CONCLUSIONS: Although most states require vision screening for some school-aged children, there is marked variation in screening methods and criteria, where the screening occurs, and grade levels that are screened. This lack of standardization and wide variation in state regulations point to a need for the development of evidence-based criteria for vision screening programs for school-aged children.

Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program: Expiration of Coverage of Children of Same-Sex Domestic Partners; Federal Flexible Benefits Plan: Pre-Tax Payment of Health Benefits Premiums: Conforming Amendments. Final rule.

On October 30, 2013, OPM published final regulations in the Federal Register to expand coverage for children of same-sex domestic partners under the Federal Employees Health Benefits (FEHB) Program and the Federal Employees Dental and Vision Insurance Program (FEDVIP). The regulation allowed children of same-sex domestic partners living in states that did not allow same-sex couples to marry to be covered family members under the FEHB and the FEDVIP. Due to a subsequent Supreme Court decision legalizing same-sex marriage in all states, OPM published an interim final regulation on December 2, 2016, that created a regulatory exception that only allowed children of same-sex domestic partners living overseas to maintain their FEHB and FEDVIP coverage until September 30, 2018. OPM recognized that there were additional requirements placed on overseas federal employees that did not apply to other civilian employees with duty stations in the United States making it difficult to travel to the United States to marry their same-sex partners. Understanding that we have provided agencies with additional time for compliance given that overseas federal employees may not have been able to marry immediately following the Supreme Court decision, OPM is issuing a final rule removing references to domestic partners and domestic partnerships from the regulations. Based on the Supreme Court decision and the two additional year's lead time for domestic partners overseas to marry, the current language in the CFR is not needed and may be somewhat confusing. There is no change in coverage for children whose same-sex partners are married.

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits.

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p<0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p<0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p<0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p<0.01) less likely to have a functional limitation due to vision.

Through our children's eyes--the public health impact of the vision screening requirements for Indiana school children.

BACKGROUND: The vision screening of preschool and school children is a widely accepted procedure to detect vision problems that can interfere with learning. The Indiana General Assembly requires the annual vision screening with the Modified Clinical Technique (MCT) of all children upon their enrollment in either kindergarten or the first grade, with the exception of schools that apply for and receive waivers to conduct only a distance Snellen chart screening. METHODS: In association with the Indiana State Department of Health, the Indiana University School of Optometry conducted an analysis of statewide school screening data on 36,967 grade 1 children from 139 of the 294 Indiana school corporations that submitted data for the 2000-2001 school year to examine differences in referral rate by screening method, the socioeconomic status of children screened, and academic performance. RESULTS: The MCT was used by 125 of the school corporations, and some other technique was used by 14 school corporations. Significant differences were seen when comparing the mean referral rates of school corporations that conduct the MCT against school corporations that do not conduct the MCT (P = 0.001) and in the rate of referral by median family income of the children screened (P = 0.050). A median family income of $46,500 was identified as the level at which the income-specific difference in referral rates ceased to be significant (P = 0.074). In spite of an observed tendency toward a higher referral rate for children who performed below average on the standardized Indiana Statewide Testing for Educational Progress Plus (ISTEP+) exam, results were found to be not significant (P = 0.116) when comparing the percentage of grade 1 children referred to an eye care provider in 2000-2001 with their percentages of passing both the English/language arts and mathematics components of the 2002-2003 ISTEP+ exam (in grade 3). CONCLUSION: Schools using the highly sensitive and specific MCT identified more visually at-risk children than schools using alternative, less sensitive vision screening techniques, and the percentage of grade 1 children referred to an eye care provider was higher for school corporations with lower median family incomes. Although statistically insignificant, the results indicate that students who fail the vision screening in grade 1 tend to be more at risk for poorer academic performance on standardized testing in grade 3.

Schedule for rating disabilities; eye. Final rule.

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (Rating Schedule) by updating the portion of the schedule that addresses disabilities of the eye. These amendments ensure that the schedule uses current medical terminology, provides unambiguous criteria for evaluating disabilities, and incorporates pertinent medical advances.

The impact of a vision screening law on older driver fatality rates.

OBJECTIVE: To evaluate the impact of the Florida visual acuity licensing standard for drivers 80 years and older on fatal motor vehicle collision (MVC) involvement. METHODS: Motor vehicle collision fatality rates for all Florida residents and for drivers 80 years and older were compared before and after the visual acuity licensing standard was implemented in January 2004. RESULTS: From 2001 to 2006, there was a nonsignificant (P = .06) increase in MVC fatality rates in Florida; in contrast, fatality rates among drivers 80 years and older demonstrated a significant downward linear trend (P = .01). When comparing prelaw (2001-2003) and postlaw (2004-2006) periods, the fatality rate among all-aged occupants increased by 6% (rate ratio, 1.06; 95% confidence interval, 0.99-1.14); conversely, fatalities among drivers 80 years and older decreased significantly by 17% (rate ratio, 0.83; 95% confidence interval, 0.72-0.98). CONCLUSIONS: Despite little evidence for an association between visual acuity and MVC involvement, the results of this study suggest that a vision screening law targeting Floridians 80 years and older resulted in a reduction in the MVC fatality rate among such drivers. The exact mechanism responsible for this association is unclear and future research should attempt to identify what might explain this relationship.

Survey of older drivers' experiences with Florida's mandatory vision re-screening law for licensure.

PURPOSE: To document the license renewal experiences of Florida drivers ages 80 and older who must pass a visual acuity test when renewing their driver's license. METHODS: Study participants (n = 1,242 drivers) were contacted via telephone and completed a survey regarding their experiences with the license renewal process. RESULTS: The majority (80.2%) of those eligible for license renewal reportedly attempted to do so and 88.0% succeeded the first time they tried. A large percentage of drivers (88%) who failed the vision test said they sought treatment, and 77.6% of drivers who reattempted renewal reportedly passed the test. About half of drivers who did not seek renewal said they thought they would fail the vision test. The majority of those choosing not to renew their license (99.5%) reported using transportation alternatives. CONCLUSIONS: This study suggests that the Florida vision screening re-licensure law is not a deterrent to seeking license renewal for the > or = 80-year-old population. Furthermore, only a small percentage of Florida drivers ages > or = 80 years and older reported that they failed the visual acuity screening test and were denied license renewal.

Legislative issues facing pediatric ophthalmology in 2006.

PURPOSE OF REVIEW: There has been a surge in legislative activity concerning children's vision in recent years. This review will summarize and compare newly enacted state statutes and review legislation that has been introduced at both the state and federal level. Detailed reference sites are provided and may be a useful resource for those involved in legislative advocacy. RECENT FINDINGS: The legislative arena has often mirrored the disparate views of ophthalmology and optometry regarding the most appropriate methods for identifying vision problems in young children. While state legislation mandating comprehensive eye examinations for all asymptomatic and risk free children was passed in Kentucky in 2000, no other state since has successfully enacted and implemented similar legislation. In contrast, numerous states, have enacted mandatory preschool vision screening legislation. Federal legislation, introduced separately by ophthalmology and optometry, would provide funds for uninsured children's eye exams, but the two bills have important differences in eligibility requirements. Issues such as eye safety and retinoblastoma detection have also been addressed through the legislative process. SUMMARY: There has been a myriad of state and federal legislative activity in the area of children's vision. The momentum is likely to continue as additional states file new legislation.

A review of preschool vision screening for strabismus and amblyopia in France: 23 years experience in the Alsace region.

The authors report their experience in preschool vision screening in the east of France, involving the Mother and Child Welfare Service and the School Health Service, under the administration of the National Ministry of Education. The review underlines the importance of early diagnosis of visual disorders in children before they reach three years of age. They recommend screening of every child at least once before the age of four years.

How often are spectacles prescribed to "normal" preschool children?

INTRODUCTION: Legislation to require formal eye examination prior to school entry is being considered in several states and is supported by optical trade organizations. Pediatric ophthalmologists cite anecdotal cases that suggest children receive spectacles unnecessarily, but data to support this are lacking. METHODS: Eye examination results from children referred to local eye doctors following a statewide preschool photoscreening program were reviewed to determine how often glasses were prescribed for children who did not have amblyogenic factors (those with false-positive screenings). RESULTS: Of 102,508 preschool children screened, 890 children did not have amblyogenic factors (false-positive screenings). Nevertheless, spectacles were prescribed for 174 (19.5%) of these children. Only 5/272 children (1.8%) were prescribed glasses following examination by a pediatric ophthalmologist, while glasses were prescribed for 24/205 children (11.7%) examined by comprehensive ophthalmologists and 145/413 (35.1%) of children seen by optometrists (P < 0.001). Eighty children were prescribed glasses for refractive error ranging from -0.75 sph to +2.00 sph, 32 of whom had spherical equivalent of 1D or less. CONCLUSIONS: While some preschoolers without amblyogenic factors may require spectacle correction, a significant percentage of children are probably prescribed glasses unnecessarily. Extrapolation of these data to the United States population suggests that a single mandatory eye examination prior to school entry could cost over 200,000,000 US dollars yearly for unnecessary spectacles. Vision screening programs with high referral rates, and health policy proposals supporting comprehensive preschool eye exams, must consider these unnecessary costs.

Vision screening for children: current trends, technology, and legislative issues.

PURPOSE OF REVIEW: The purpose of this review is to examine current trends in vision screening for children. RECENT FINDINGS: Literature within the past year regarding children's vision screening has been dominated by clinical validation studies of autorefractors or photoscreeners that allow the detection of amblyogenic refractive errors, misalignment of the eyes, or media opacities. New technologies reported include wave-front analysis for amblyogenic factors and a visual evoked potentials-based screening tool for the preverbal child. Studies evaluating the goals of the screening program, the target population, and the physical limitations of the screening environment have prompted multipronged or hybrid studies designed to more accurately detect vision problems, particularly in the preschool child, in whom cooperation and cognitive development affect reliability of results. State and federal legislation in the United States has been proposed or adopted to regulate and partially fund pediatric vision screening and comprehensive examinations. SUMMARY: Through improvements and new developments in technology, study design, the efforts of organized medicine, and legislative initiatives, vision screening for children continues toward the goal of bringing all children with eye disease or vision problems to treatment in a timely fashion.

Preschool vision screening in primary care after a legislative mandate for diagnostic eye examinations.

BACKGROUND: Kentucky legislation now requires that children entering public school receive a diagnostic eye examination. METHODS: Mail survey of randomly selected office-based primary care pediatricians (PDs, n = 221) and family physicians (FPs, n = 207) in Kentucky to assess the impact of the mandated eye examination. RESULTS: The response rate was 71% PDs and 51% FPs. Most offer preschool vision screening (PD 86%; FP 79%; P = 0.16), but many report they will be less likely to offer it in the future because of the mandated diagnostic eye examination (PD 61%; FP 50%; P = 0.09). Perceived barriers to the diagnostic eye examination include lack of parental knowledge about the requirement, belief by parents that they will need to pay, difficulty in getting an appointment, and lack of endorsement by primary care physicians. CONCLUSION: Most primary care physicians in Kentucky offer preschool vision screening, but many now are likely to reduce their screening effort. Until more data are available regarding the impact of the required eye examination, primary care providers should not change their screening practices.

Do video display units cause visual problems? - a bedside story about the processes of public health decision-making.

PURPOSE: Since the 1980s, it has been common for employers to provide eyesight testing for operators of screen-based equipment (SBE). This practice arose because many SBE operators reported symptoms of visual discomfort at work and there was apprehension that radiation emitted by SBE might be harmful to vision. Visual screening of SBE operators has been encouraged by government guidelines and in some countries, is required by legislation. This paper questions whether this practice should continue. METHOD AND RESULTS: A review of the literature shows: 1. SBE does not emit radiation in sufficient quantity to be harmful and there is no credible epidemiological evidence that work with SBE will damage the eyes; 2. SBE operators often report symptoms of visual discomfort but office workers who do not use SBE also report visual symptoms with the same or slightly lower frequency; 3. about 20 per cent of office workers have some uncorrected defect of vision that can contribute to the occurrence of visual discomfort at work and optometric intervention to correct these defects does reduce the occurrence of visual symptoms. However, defects of vision are not the only cause of visual symptoms at work. Other contributing factors are poor workplace ergonomics and psychosocial stress arising from poor work systems or poor inter-personal relationships at work. CONCLUSIONS: There is no compelling public health justification for requiring vision screening of SBE operators but it could be introduced as one element of a more comprehensive strategy to enhance visual comfort at work. If it is introduced, it should be for all employees engaged in visually demanding tasks, not just SBE users. An alternative to eyesight testing of employees is to encourage but not require employees to obtain eye care privately on their own initiative. This option has the advantage of restoring autonomy to employees to arrange their own eye care. Eyesight testing of employees in vision-critical occupations should be undertaken to ensure safety. In occupations in which there is a risk of eye injury, vision screening should be undertaken to provide a pre-injury record of vision.