A new bill (HB 914) requires schoolchildren in Missouri to have a comprehensive vision examnot just a vision screeningbefore entering grade school.

Eye exams will be required for all children before they enter kindergarten or first grade, and the exam must be performed by an optometrist or physician. It must include a complete case history, visual acuity at distance (aided and unaided), external examination and internal examination (ophthalmoscopic examination), and subjective refraction to best-corrected visual acuity. The exam wont take the place of vision screenings, which will continue to be given by school nurses.

Private health insurance or Medicaid is expected to pay for most childrens exams. However, HB 914 also creates the Blindness Education, Screening and Treatment Program Fund, which will set aside at least $99,000 a year to help low-income families pay for exams. The law also calls for publication of a list of sources of free or low-cost eye exams.

Parents can choose to forgo their childs exam by writing a note to their school administrator.

The legislation also establishes a Childrens Vision Commission to standardize the training of school screeners and vision-screening methods. The commissioncomprised of two optometrists, two ophthalmologists, two school administrators and one nurseis required to submit a report by December 2011 to determine the effectiveness of eye exams vs. vision screenings.

The Missouri state legislature approved HB 914 in mid-April. At press time, the bill awaited the governors signature to become law. Once signed, the law goes into effect in July 2008. This will make Missouri only the second state to require eye exams for schoolchildren; Kentucky is the other.