Impact of visual acuity on developing literacy at age 4–5 years: a cohort-nested cross-sectional study

Abstract

ObjectivesTo estimate the prevalence of poor vision in children aged 4–5 years and determine the impact of visual acuity on literacy.DesignCross-sectional study linking clinical, epidemiological and education data.SettingSchools located in the city of Bradford, UK.ParticipantsPrevalence was determined for 11 186 children participating in the Bradford school vision screening programme. Data linkage was undertaken for 5836 Born in Bradford (BiB) birth cohort study children participating both in the Bradford vision screening programme and the BiB Starting Schools Programme. 2025 children had complete data and were included in the multivariable analyses.Main outcome measuresVisual acuity was measured using a logMAR Crowded Test (higher scores=poorer visual acuity). Literacy measured by Woodcock Reading Mastery Tests-Revised (WRMT-R) subtest: letter identification (standardised).ResultsThe mean (SD) presenting visual acuity was 0.14 (0.09) logMAR (range 0.0–1.0). 9% of children had a presenting visual acuity worse than 0.2logMAR (failed vision screening), 4% worse than 0.3logMAR (poor visual acuity) and 2% worse than 0.4logMAR (visually impaired). Unadjusted analysis showed that the literacy score was associated with presenting visual acuity, reducing by 2.4 points for every 1 line (0.10logMAR) reduction in vision (95% CI −3.0 to −1.9). The association of presenting visual acuity with the literacy score remained significant after adjustment for demographic and socioeconomic factors reducing by 1.7 points (95% CI −2.2 to −1.1) for every 1 line reduction in vision.ConclusionsPrevalence of decreased visual acuity was high compared with other population-based studies. Decreased visual acuity at school entry is associated with reduced literacy. This may have important implications for the children's future educational, health and social outcomes.

Oculomotor-related measures but not distance visual acuity are predictive of reading ability in first graders

“…Bruce et al report finding a correlation between dVA and developing literacy skills at the age of 4-5. In their study they used the Woodcock Reading Mastery Tests-Revised (WRMTS-R) 31 , perhaps due to the young children's pre-reading age. The correlation that they report is based on a subtest of the WRMTS-R that demands letter recognition and not whole word or sentence reading.…”

Do reduced visual acuity and refractive error affect classroom performance?

“…There are diverse findings regarding the role of visual acuity on reading or academic performance. While many studies have reported that habitual distance visual acuity is unrelated to academic ability, a number of studies have demonstrated a link between habitual visual acuity and reading or school performance . Direct comparisons between studies can be difficult due to inconsistencies in terminology, with some authors considering uncorrected vision to be a measure of visual acuity .…”

“…In another study of Grade 2 children, significantly more students whose academic performance was rated as low (scoring less than 50 per cent on school‐based examinations), failed a distance visual acuity test (worse than 0.20 logMAR) compared to children who passed; 12 per cent and four per cent respectively failed the visual acuity criteria . A recent study of a large UK cohort of children aged 4–5 years also found that reduced visual acuity at school entry was linked with reduced school literacy (Woodcock Reading Mastery Tests‐Revised [WRMT‐R] subtest: letter identification) . This latter finding is particularly relevant given that early literacy has been shown to be a key indicator of future reading and educational ability .…”

Weighing in on Canadian school-based vision screening: A call for action

“…For example, children who enter school with decreased visual acuity at age 4-5 have reduced literary and academic capabilities. 31 For amblyopia, screening at ages 4, 5, 7, and 10 has indicated that visual pathology was, indeed, detected at age 4, and this detection may have positively contributed in the early treatment of the condition, before progression throughout the child's life. 32 In this case, it is important to consider the harms associated with later screening and the potential irreversible nature of more severe conditions, such as amblyopia, leading to the possibility of reduced academic and learner capabilities.…”

“…31 If universal screening programs were established for school-aged children (6+), this could compromise how long a child may go with decreased literacy secondary to visual defects. This may have future implications for educational health and social outcomes.…”