As of April 2007, 19 states do not require children to receive any preventive vision care before starting school or while enrolled in school; and of the 31 states that do require vision screening, only one (Arkansas) currently insists that children who fail the screening must receive an eye examination by an eye doctor.

That’s a grim statistic that leaves two in three children without any preventive vision care before they enter elementary school, according to the Centers for Disease Control and Prevention, which points out that untreated vision problems can affect a child’s cognitive, emotional, neurologic, and physical development by limiting the range of experiences and the kinds of information to which the child is exposed.

A first-ever “vision summit” convened in April by the Virginia-based Vision Council of America described in detail the requirements, or lack of requirements, state-by-state, for vision screening and treatment of schoolchildren. And in an article published in The Journal of School Nursing in June 2006, school nurse Linda Kimmel looked at contributing factors that often prevent children from receiving full eye examinations after problems are detected in screening.

Both Kimel and the Council make clear the distinction between vision screening, which may be conducted by school nurses or volunteers in schools, and diagnostic examinations that must be conducted by eye care professionals. But they also point out that screening without follow-up is of little value.

In a survey of families in which children did not receive professional eye care after the families were informed that their children had failed a screening, Kimel found that cost and money were lesser barriers than logistics (appointment problems, no car, all adults working), and doubts on the part of parents about the screening results. (Cited as reasons for those doubts were that the child did not understand the screening task, school screening instruments are inaccurate, allergies or illness altered results, and the school nurse was not trusted.)

Lack of follow-up means that “Even states that have vision screening may not be doing enough,” according to the Vision Council. “Of the 31 states that require a vision screening for children, 29 (93 percent) do not require children who fail to receive an eye exam from an eye doctor. Because multiple studies have shown that children who fail a screening often do not receive follow-up care, neglecting to include a mandatory follow-up eye exam provision greatly minimizes the impact of these well-intended laws.”

In a summary of state laws concerning vision screening and examinations of schoolchildren, the Vision Council notes a range of requirements, from no statewide mandates for screening in Idaho, Iowa, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Wisconsin, and Wyoming to Arkansas’ comprehensive law, which reads: “Beginning with the 2006-2007 school year, all children in pre-kindergarten (pre-K), kindergarten (k), grades one (1), two (2), four (4), six (6), and eight (8) shall receive an eye and vision screening. A child who does not pass the eye and vision screening tests, except for the color perception test, shall be required to have a comprehensive eye and vision examination conducted by an optometrist or ophthalmologist within sixty (60) days of receipt of the vision screening report identifying the need for an examination.”

Legislation introduced in the current session of Congress focuses on providing children the follow-up needed after vision problems are identified in a vision screening, according to the Council. The Vision Care for Kids Act of 2007 can be read and tracked at http://thomas.loc.gov.

Further information, including an April 2007 update of state laws on vision screening,  is available at the Vision Council of America, ezb@visionsite.org.