Uncorrected hyperopia may negatively affect children’s academic performance
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Children with uncorrected hyperopia were reported to have worse educational performance and reading skills, according to a systematic review and meta-analysis in the Asia-Pacific Journal of Ophthalmology.
“Vision is a crucial component of a child’s learning and education,” Sonia Mavi, BSc (Hons), of the School of Medicine, Dentistry and Biomedical Sciences at Queen’s University Belfast, and colleagues wrote. “Studies have reported that uncorrected and under-corrected refractive errors can affect a child’s academic performance, social participation and future economic productivity.”
To determine the effect of uncorrected hyperopia and hyperopic spectacle correction on children’s learning experience, Mavi and colleagues conducted a search for observational and interventional studies using Medline All (Ovid), Embase (Ovid), PsycINFO (Ovid), Cumulative Index to Nursing and Allied Health Literature, Web of Science, PubMed, International Clinical Trials Registry Platform, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials in the Cochrane Library.
Researchers identified participants as children aged 4 to 17 years who were attending school and had been diagnosed with hyperopia. The primary outcome was academic performance, with cognitive skills, educational performance, reading skills and reading speed as outcome domains.
Of 3,415 studies identified, only 25 met the researchers’ criteria and were included in the review, of which 21 were observational studies and four were interventional studies. Five studies were ultimately included in the meta-analysis.
According to results, children with uncorrected hyperopia had poorer educational performance in four studies (standard mean difference [SMD] = –0.18; P < 0.001) and poorer reading skills in three studies (SMD = –0.46; P = .036).
One study revealed that children with uncorrected hyperopia had significantly worse reading skills compared with myopic children (SMD = –0.29; P < 0.001).
A qualitative analysis performed on 10 of 19 studies not included in the meta-analysis revealed that uncorrected hyperopia had a significantly negative effect on academic performance (P < .05). Reading speed was found to improve with hyperopic spectacle correction, based on two interventional studies (P < .05).
“We found an association between uncorrected hyperopia and children’s poor educational performance and reading skills,” Mavi and colleagues wrote. “However, firm conclusions are difficult to draw due to considerable heterogeneity in study design features and methodology, definitions of hyperopia used, assessment of academic performance and the small number of hyperopic children recruited in some studies.”
They continued, “Standardized definitions, survey methodologies and practical screening methodologies, together with randomized controlled trials, are required to determine the magnitude of the issue and develop evidence-based solutions to tackle it.”
Perspective
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School-aged children with uncorrected hyperopic refractive error may show decreased academic performance compared to their myopic and emmetropic peers, according to a literature review of 25 studies.
Five of the studies analyzed showed a statistically significant relationship between uncorrected hyperopia and poor academic performance, but there were mixed results overall when comparing all 25 studies. Some studies showed reduced academic performance in hyperopic children compared to their emmetropic or myopic peers, and some studies didn't provide a comparator group to contrast with the hyperopic study population. Where some studies showed a statistically significant difference in the performance of these groups, others demonstrated no differences. This variability in results is likely due to the wide array of study designs, including small sample sizes and a lack of consistency in the methods used to determine levels of refractive error. These findings further support the need for full-scale randomized trials to explore this topic.
Uncorrected hyperopia can have a significant impact on a child’s ability to learn, but there is no clear study data available to eye care providers about when and what to prescribe to maximize academic performance. For children with uncorrected hyperopia who show no signs of amblyopia or binocular vision disruption, what to prescribe is largely determined by the clinical experience of the individual practitioner.
However, knowing that uncorrected hyperopia could negatively impact a child’s education should be at the front of the clinician’s mind when examining school-aged children. Cycloplegic refraction should be used to accurately measure refractive error. It may also be beneficial to ask more questions about a child’s academic performance during an eye exam and to consider prescribing correction for lesser degrees of hyperopia. Large-scale randomized clinical trials are needed to determine more practical rules for practitioners, including what levels of hyperopia should be corrected and at what age.
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