Correlation analysis between visual factors and academic performance in Chinese children

Vision plays a crucial role in children’s education, particularly the visual factors related to academic performance, which have been the subject of long-standing research. In a cross-sectional school-based study in Shandong Province, China, we assessed 1,766 primary school children aged 8.98 ± 1.23 years (grades 2–5) to identify key visual factors associated with academic performance. We assessed presenting visual acuity (PVA), astigmatism, binocular accommodative facility (AF) and amplitude of accommodation (AA). Myopia undercorrection was defined as PVA > 0.1 logMAR in myopic children, which could be improved by at least two lines using subjective refraction by increasing the minus lenses correction. Among the 26.1% (461/1,766) myopic children, 51.0% (235/461) were undercorrected. Compared to fully corrected children, those with undercorrected myopia scored significantly lower in Chinese (P = 0.011), Mathematics (P = 0.009), and average scores (P = 0.004). After adjusting for gender and intelligence quotient (IQ), multifactorial GLM analyses revealed that PVA (β = -7.03, 95% CI: -10.63 to -3.43; P < 0.001) and astigmatism (β = -1.44, 95% CI: -2.33 to -0.55; P = 0.001) were significantly negatively correlated with academic performance. In contrast, binocular AF (β = 0.16, 95% CI: 0.06 to 0.26;P = 0.002) and AA (β = 0.18, 95% CI༚0.05 to 0.30༛P = 0.006) were significantly positively correlated with academic performance. After excluding children with premyopia and hyperopia and adjusting for relevant factors, myopia undercorrection remained significantly negatively correlated with academic performance (β = -2.88, 95% CI: -4.68 to -1.09; P = 0.002). These results show that poorer visual acuity, higher astigmatism, reduced accommodative function, and myopia undercorrection are all associated with lower academic performance in children. Our findings support the implementation of regular visual acuity and functional assessments, as well as full correction of myopia in children.