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Hyperopia and educational attainment in a primary school cohort


Background: Vision screening addresses the visual impairments that impact on child development. Tests of long-sightedness are not found in most school screening programmes. The evidence linking mild-moderate hyperopia and lack of progress in school is insufficient, although strengthened by recent findings of developmental problems in infants.

Aims: To report on the relation between hyperopia and education test results in a cohort of primary school children.

Methods: A total of 1298 children, aged 8 years, were screened for hyperopia on the basis of fogging test results. School test results (NFER and SATs) were compared between groups categorised by referral status and refractive error.

Results: A total of 166 (12.8%) fogging test failures were referred for ophthalmic assessment. Ophthalmic tests on 105 children provided an accurate diagnosis of vision defects, for reference to their education scores. Fifty per cent of the children examined by optometrists required an intervention (prescription change, glasses prescribed, or referral). Mean (95% CI) NFER scores of children with refractive errors (summed for both eyes) >+3D (98.4, 93.0–103.8, n = 32) or >+1.25D (best eye) (99.3, 93.0–105.6, n = 26) were lower than the respective scores of children with a less positive refractive state (104.8, 100.7–108.9, n = 43) (103.6, 99.7–107.4, n = 49), the non-referred group, and total sample. The SATs results followed a similar trend. A high proportion of the fogging test failures (16%) and confirmed hyperopes (29%) had been referred to an educational psychologist, and the latter group contributed substantially to the poor education scores.

Conclusions: The results of this study provide further evidence for a link between hyperopia and impaired literacy standards in children.

  • CSI, core subject indicator
  • NFER, National Foundation for Education Research
  • RE, refractive error
  • SAT, standardised assessment test
  • hyperopia
  • primary education
  • fogging test

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