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Missouri lawmakers, physicians debate eye exam law

Saturday, February 4, 2012 | 4:54 p.m. CST

JEFFERSON CITY — Four years ago, Missouri became one of the first states in the nation to require incoming kindergartners to get a comprehensive eye exam by an optometrist or physician. The goal was to catch problems early, perhaps heading off diseases that could lead to vision loss and improving academic performance.

But a Children's Vision Commission, appointed under that law to study the mandate's effectiveness, found that only a third of students were actually getting the required exams and recommended the mandate be eliminated. Now a debate ongoing in the Missouri State Capitol about whether eye exams should stay or go. This past week, a Missouri House of Representatives committee endorsed legislation that would continue the mandate.

The law requiring the examinations allows parents to opt out of the requirement simply by submitting a form to their child's school. The commission found that most parents are doing just that. From July 2008 to June 2011, 61 percent of parents either opted out of the eye exam requirement or ignored them altogether, according to a report the commission put out last year.

The commission recommended that lawmakers drop the full exam requirement and instead increase the use of eye screenings —which are faster and cheaper— in public schools. Children who fail those screenings should be referred to an optometrist or physician for a full examination, with no ability to opt out, the commission said.

Now lawmakers are faced with a deadline — the full exam mandate is due to expire in June. And they are faced with competing proposals about how to examine students' eyes.

One proposal, sponsored by Rep. Don Wells, would extend indefinitely the mandate for full examinations before kindergarten. It would not do anything about the expiration of the state's screening program. Wells, R-Cabool, said the requirement is necessary because vision problems can hinder a child's ability to learn important concepts, such as letters and numbers.

He said his support for the mandate is partially driven by his two grandchildren, who he said have vision problems that were not detected in screenings but only later in full examinations.

"It is not acceptable for one child to fall through the cracks," Wells told a House health insurance committee this past week. "If it's one child in every classroom, I want you to consider if that was your child."

Another idea, from Rep. David Sater, would put into law the recommendations from the vision commission. It would allow the full exam requirement to expire and would instead mandate vision screenings for students in kindergarten, first grade and third grade. A law that expired at the end of last school year only required the two screenings after kindergarten.

"I think that they should continue, I think that they're doing a very good job," said Sater, R-Cassville. "And I'm concerned about the cost to parents in this economy. This is a very difficult time."

The vision commission's report said the average cost of a full examination was just under $100. It said the materials school nurses use in vision screenings could be purchased by a school district for about the same cost and can be used to screen "thousands" of students.

The House Health Insurance Committee gave its backing to Wells' legislation this past week and sent it to the full House for debate. Sater's bill has not even been referred to a committee by House Speaker Steven Tilley, R-Perryville, who is an optometrist.

Tilley did not respond to requests for comment about the eye exam legislation.

The issue appears to have sharply divided eye care and school professionals. At a committee hearing on Wells' bill, more than a dozen witnesses testified about both methods. Optometrist Jeffrey Gamble, of Columbia, said full examinations are less likely to miss a diagnosis because most optometrists use the same standard for examining patients.

"Screenings vary, whether from school district to school district or pediatrician's office to pediatrician's office," he said.

The Missouri School Boards' Association and the Missouri Association of School Nurses agreed that full examination would be more likely to find vision problems in children. But they said increased screenings would be more cost-effective and said the high rate of opt-outs undermines the effectiveness of the current examination mandate.

Oscar Cruz, a pediatric ophthalmologist at St. Louis University who was chairman of the vision commission this year, said opinions vary even among eye doctors about which method is best. Optometrists — who perform eye examinations and basic treatments — favor full examinations because of the lower rate of missed diagnoses. Ophthalmologists — who perform eye surgeries and more advanced treatments — support increased screenings because they ensure that almost every child gets some type of eye testing.

Cruz said he strongly favors increased vision screenings and feels that the eye exam mandate might actually be detrimental because it enables schools to justify screening program cuts as their budgets tighten.

"My fear is that this is going to hurt the kids in the long run," he said of the exam mandate.


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