Association of visual acuity with educational outcomes

49 Background/Aim: To quantify the impact of baseline presenting visual acuity (VA), 50 refractive error, and spectacles wear on subsequent academic performance among Chinese 51 middle school children. 52 Methods: A prospective, longitudinal, school-based study on grade 7 Chinese children (age, 53 mean ± SD, 12.7 ± 0.5 years, range= 11.1, 15.9) at 4 randomly-selected middle schools in 54 Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were 55 performed at baseline, and information on demographic characteristics, known risk factors 56 for myopia, and spectacle wear was collected. Academic test scores for all subjects in the 57 curriculum were obtained from the local Bureau of Education. Main outcome measure was 58 total test scores for 5 subjects at the end of grade 9, adjusted for total scored at the 59 beginning of grade 7. 60 Results: Among 2363 eligible children, 73.1%(1728/2363) had 7th grade test scores 61 available. 93.9%(1623/1728) completed eye examinations, and 98.5%(1599/1623) of these 62 had 9th grade test scores. Adjusting only for baseline test score, the following were 63 significantly associated with higher 9th grade scores: younger age, male sex, less time 64 outdoors, better baseline presenting VA and higher parental education, myopia and income, 65 but refractive error and spectacle wear were not. In the full multivariate model, baseline test 66 score (p<0.001), presenting VA (p=0.006), age (p<0.001), quality of life (p=0.036), and 67 parental education (p<0.001) and myopia (either: p=0.03; both: p=0.03) remained 68 significantly associated with better 9th grade scores. 69 Conclusions: In this longitudinal study, better presenting VA, but not cycloplegic refractive 70 error or spectacle wear, was a significant predictor of subsequent academic performance. 71