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"As much money as we spend on early intervention for children, the most meaningful thing you can do is make sure a child can see comfortably," he said.

Motive questioned

Optometrists have been some of Black's most reliable backers and campaign funders. He said the law has nothing to do with money or funneling business to optometrists.

"It's ridiculous that you would ask that," he said.

Medicaid will pay for exams for poor children, and legislators set up a $2 million fund to pay for eye exams for about 10,000 children whose families' incomes are too high to qualify for the federal health insurance program. Other parents will have to pay out of pocket or have their private insurance cover the tests.

Black said he is encouraging his professional colleagues to do the exams at the lowest possible cost, or for free.

The legislature for years has struggled with what kinds of tests are necessary before children start school. Periodically, questions arise about whether routine eye screenings are complete and done correctly.

"They miss a lot of things," Black said. "That's what this is about. The gold standard is a complete eye examination by an eye care professional."

A 2004 legislative advisory group on poor children's vision recommended ways to make sure more are screened and referred to doctors if problems are discovered. The group recommended that doctors check children's vision at every visit, starting when they are newborns, and that children who cannot be screened during the pre-kindergarten check-up be referred to eye doctors.

The group did not recommend making doctors' eye exams a condition for getting into kindergarten. North Carolina is one of a handful of states that now require such tests by optometrists or ophthalmologists. Rhode Island and Kentucky are two others.

Dr. Jeffrey Board, a pediatric ophthalmologist in Raleigh, said children should have a complete eye exam at age 3. If doctors don't find problems then, having another test a year or two later is not necessary, he said. Most kids' vision problems are discovered in those early eye exams or in vision screenings, Board said. And problems not found before kindergarten are soon caught within six months by school nurses, teachers or parents.

The most common childhood eye problem, nearsightedness, probably won't be picked up by the pre-kindergarten exams because trouble seeing at a distance usually doesn't start until children are 6 to 12 years old, Board said.

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