Article Text

Download PDFPDF
Association of visual acuity with educational outcomes: a prospective cohort study
  1. Catherine Jan1,2,3,
  2. Shi-Ming Li2,
  3. Meng-Tian Kang2,
  4. Luoru Liu4,
  5. He Li4,
  6. Ling Jin5,
  7. Xuezheng Qin6,
  8. Nathan Congdon5,7,8,
  9. Ningli Wang2
  1. 1 The George Institute for Global Health, Faculty of Medicine, The University of New South Wale, Sydney, New South Wales, Australia
  2. 2 Beijing Tongren Hospital, Beijing Ophthalmology Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing Tongren Eye Center, Beijing, China
  3. 3 School of Psychological and Cognitive Sciences, Peking University, Beijing, China
  4. 4 Anyang Eye Hospital, Anyang, China
  5. 5 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  6. 6 School of Economics, Peking University, Beijing, China
  7. 7 ORBIS International, New York, New York City, USA
  8. 8 TREE Centre, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
  1. Correspondence to Professor Ningli Wang, Beijing Tongren Hospital, Beijing Ophthalmology Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing Tongren Eye Center, Beijing 100730, China; wningli{at}


Background/aim To quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children.

Methods A prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1–15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7.

Results Among 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (p<0.001), presenting VA (p<0.01), age (p<0.001), quality of life (p<0.05) and parental education (p<0.001) and myopia (either: p<0.05; both: p<0.05) remained significantly associated with better ninth grade scores.

Conclusions In this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance.

  • public health
  • vision
  • child health (paediatrics)
  • optics and refraction

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors CJ and SML contributed equally to this work. CJ contributed to design, cleaning and analysis of data, and drafting of the manuscript. MTK contributed to the collection and cleaning of data. LL and HL contributed to data collection and field supervision. LJ contributed to the statistical method for data cleaning and analysis. XQ contributed to the statistical method and socioeconomic content. NC contributed to design, data analysis and revision of the manuscript for important intellectual content. SML contributed to design, collection of data and revision of manuscript. NLW contributed to design, acquisition of funding and general supervision of the research group. All authors reviewed and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data of this study are available upon request. Please contact the corresponding author NW at

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas