New Missouri Legislation Mandates Eye Exams For Children Entering Kindergarten, First Grade

Main Category: Eye Health / Blindness
Also Included In: Pediatrics / Children's Health
Article Date: 12 Jul 2008 - 1:00 PDT

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Beginning July 1, all children in kindergarten or first grade entering Missouri schools for the first time are required to have a comprehensive eye exam. According to Missouri Senate Bill No. 16, these exams must include:

-- complete case history

-- visual acuity at distance (aided and unaided)

-- external examination and internal examination (ophthalmoscopic examination)

-- subjective refraction to best visual acuity

Although a bill advocating eye exams for children may not seem prone to controversy, Lawrence Tychsen, M.D., professor of ophthalmology and visual sciences at Washington University School of Medicine and ophthalmologist-in-chief at St. Louis Children's Hospital, explains why it was opposed by the American Academy of Pediatrics, the American Academy of Ophthalmology and the Missouri Ophthalmological Society.

"Pediatricians regularly perform vision screenings for their patients, and they are entirely capable of identifying problems requiring referral to a pediatric ophthalmologist. They act as gatekeepers for their patients' care, which is absolutely appropriate," he says. "Of the four elements required by the new Senate bill, pediatricians can perform the first three, but subjective refraction requires expensive, specialized equipment that pediatricians' offices do not have.

In effect, the bill forces pediatricians from their gatekeeper's role, which we believe is doing a disservice to the patients. In addition, it adds yet another responsibility to an already-long list of requirements parents have to meet before their children may attend school."

Still to be seen is whether schools will accept the state's eye exam form completed by a pediatrician that provides information on the first three exams but not the fourth. The bill does stipulate, however, that a child's participation in the comprehensive eye exam or the eye screening program will be excused upon receipt by the appropriate school administrator of a written request by the child's parent or legal guardian.

Because the bill doesn't go into effect until July 1, through January 2009 only children entering kindergarten or first grade for the very first time are required to have a comprehensive eye examination.

Children in kindergarten during the 2007-08 school year are not required to have a comprehensive eye exam when entering the first grade in the 2008-09 school year. However, children who did not attend kindergarten in 2007-08 but who are entering first grade in 2008-09 are required to have the exam.

Generally, the bill stipulates that evidence of the exam shall be submitted to the school no later than January 1 of the first year in which the student is enrolled at a school.

The bill also establishes the Children's Vision Commission, whose responsibilities include analyzing data generated regarding the eye exams and tracking the frequency with which children need to be referred to pediatric ophthalmologists.

"Hopefully the information gathered by the commission will demonstrate that the screenings performed by pediatricians are more than adequate to meet the needs of their patients," says Tychsen. "Everyone involved in children's health is concerned about discovering vision problems early. But we need to approach this concern in the most effective and efficient way possible."

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

Washington University in St. Louis
One Brookings Dr., Campus Box 1070
St. Louis, MO 63130
United States
http://www.wustl.edu

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