Advocacy groups laud child vision screening legislation

Federal grants to states would fund comprehensive eye exams, treatment and educational materials on eye health issues.

Issue: November 1, 2007

ByMatt Hasson

The U.S. House of Representatives has passed bipartisan children’s vision care legislation backed by various advocacy organizations.

The Energy and Commerce Committee approved the Vision Care for Kids Act on Sept. 27 and the full House passed it Oct. 16.

Rep. Gene Green, D-Texas, introduced the bill in January. Sens. Christopher “Kit” Bond, R-Mo., and Christopher Dodd, D-Conn., introduced a similar Senate bill in April.

“To see the federal government taking action is a welcome sight,” Robert S. Gold, MD, Ocular Surgery News Pediatrics/Strabismus Section Editor, said in a telephone interview. The bill verifies the need for vision screening in pediatrician’s offices, schools, churches and community centers.

Congress recognizes the need to make children’s vision care a top health care priority, he said.

Unlike the bill aimed at reauthorizing and expanding the State Children’s Health Insurance Program that President Bush vetoed in early October, the Vision Care for Kids Act of 2007 is expected to pass easily and be signed into law, Dr. Gold said.

Fiscally prudent approach

Robert S. Gold

“Although it’s taken a long time for this to get going, to get passed in committee, it is an essential mechanism to identify children who have a high risk for vision problems,” Dr. Gold said.

The bill would address a critical need and allocate funds judiciously, said pediatric ophthalmologist Jean E. Ramsey, MD, a representative of the American Academy of Ophthalmology’s Secretariat for State Affairs.

“We certainly want to check all children to try and separate out the ones who may have a problem,” said Dr. Ramsey, who is also a pediatric ophthalmologist at Boston University School of Medicine. “It’s a good use of health care dollars, which we know are limited, and we want to use them wisely.”

As approved by the Committee on Energy and Commerce, the bill would allow the Secretary of Health and Human Services, acting through the director of the Centers for Disease Control and Prevention, to award grants to states to provide comprehensive eye examinations and follow-up care for children younger than 9 years who have been identified as possibly having a vision problem. The grants would also be used for educational materials on children’s vision problems.

The bill would authorize $65 million in grants over 5 years for comprehensive eye examinations and treatment for uninsured children who fail a vision screening, according to an AAO news release. States may use up to 20% of grant funds to pay for educational materials, according to the bill text.

The AAO, American Association for Pediatric Ophthalmology and Strabismus (AAPOS), American Optometric Association, Lighthouse International, Prevent Blindness America and the Vision Council of America actively support the legislation, according to an AAO news release.

Statewide efforts

“Hopefully, all states will have vision screening as part of the requirements for children entering kindergarten,” Dr. Gold said. “Obviously, the No. 1 issue with all of this is money. There needs to be some funding for vision screening programs, and there needs to be some funding for those who cannot afford a comprehensive eye exam should they fail a mandated vision screening, not a mandated comprehensive exam.”

Dr. Ramsey praised the legislation for meeting a critical need within tight fiscal constraints.

Jean E. Ramsey

“It’s great to have these funds for uninsured children,” she said. “Also, because of the way the bill is written, it ensures that the money will go to the children who most need it, not only because they’re uninsured but also because they’ve been identified as possibly having a problem. Those are the big pluses of this bill.”

The legislation may also move states to launch vision screening programs, Dr. Ramsey said.

“Over the last couple of years, a lot of states, including my state, Massachusetts, have developed mandatory vision screening laws,” she said. “But a state will have to determine what identification they will use. Here in Massachusetts, we use preschool vision screening methodology that we developed to identify children who may have a problem.”

About 34 states and the District of Columbia have vision screening laws, according to the AAO.

In 2006, the North Carolina legislature passed a law requiring vision screening for all children entering kindergarten and comprehensive follow-up exams for children who fail screening. It provides $500,000 in state funds to cover comprehensive exams for children who cannot afford them, according to an AAO news release.

The North Carolina law reversed a 2005 mandate that required comprehensive eye exams for every child entering kindergarten. The AAO, AAPOS and other groups mustered “very big public sentiment” against the mandate and had it overturned, Dr. Gold said.

Opponents contended that comprehensive eye exams, which cost up to $120, were unnecessary and prohibitively expensive, Dr. Gold said.

Also in 2006, Oklahoma adopted a law that requires vision screening for all school-aged children entering kindergarten, first and third grades. Children who fail screenings are referred for further vision evaluation by an ophthalmologist or optometrist.

Early screening can make the treatment of amblyopia somewhat easier, Dr. Gold said.

“My feeling is that if they’re going to do it before kindergarten, they’re doing it before the age of 5, which is much more preferred because it’s much easier to treat amblyopic kids before that age,” he said. “Now, we can still treat them up to the age of 8, 9, even older, but even though it is never an easy condition to treat, it’s much easier when they’re younger.”

For more information:

Robert S. Gold, MD, can be reached at 225 W. State Road 434, Suite 111, Longwood, FL 32750; 407-767-6411; fax: 407- 767-8160; e-mail: rsgeye@aol.com.

Jean E. Ramsey, MD, can be reached at Yawkey Ambulatory Care Center, 850 Harrison Ave., Boston, MA 02118; 617-414-4020; fax: 617-414-4028; e-mail: jean.ramsey@bmc.org.

Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.