Sonia Mavi1, Ving Fai Chan1, Gianni Virgili1,2, Ilaria Biagini2, Nathan Congdon1,3,4, Prabhath Piyasena1, Ai Chee Yong1, Elise B Ciner5, Marjean Taylor Kulp6, T Rowan Candy7, Megan Collins8, Andrew Bastawrous9,10, Priya Morjaria9,10, Elanor Watts11, Lynett Erita Masiwa12, Christopher Kumora13, Bruce Moore14, Julie-Anne Little15. 1. Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK. 2. Department NEUROFARBA, University of Florence, Florence, Italy. 3. Orbis International, New York, NY, US. 4. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. 5. Pennsylvania College of Optometry, Salus University, Elkins Park, PA, US. 6. The Ohio State University College of Optometry, Columbus, OH, US. 7. School of Optometry, Indiana University, Bloomington, IN, US. 8. Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, US. 9. International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK. 10. Peek Vision, London, UK. 11. Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. 12. Optometry Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. 13. Zimbabwe Optometric Association, Harare, Zimbabwe. 14. New England College of Optometry, Boston, MA, US. 15. Centre for Optometry and Vision Science, School of Biomedical Sciences, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK.
Abstract
PURPOSE: To assess the impact of uncorrected hyperopia and hyperopic spectacle correction on children's academic performance. DESIGN: Systematic review and meta-analysis. METHODS: We searched 9 electronic databases from inception to July 26, 2021, for studies assessing associations between hyperopia and academic performance. There were no restrictions on language, publication date, or geographic location. A quality checklist was applied. Random-effects models estimated pooled effect size as a standardized mean difference (SMD) in 4 outcome domains: cognitive skills, educational performance, reading skills, and reading speed. (PROSPERO registration: CRD-42021268972). RESULTS: Twenty-five studies (21 observational and 4 interventional) out of 3415 met the inclusion criteria. No full-scale randomized trials were identified. Meta-analyses of the 5 studies revealed a small but significant adverse effect on educational performance in uncorrected hyperopic compared to emmetropic children {SMD -0.18 [95% confidence interval (CI), -0.27 to -0.09]; P < 0.001, 4 studies} and a moderate negative effect on reading skills in uncorrected hyperopic compared to emmetropic children [SMD -0.46 (95% CI, -0.90 to -0.03); P = 0.036, 3 studies]. Reading skills were significantly worse in hyperopic than myopic children [SMD -0.29 (95% CI, -0.43 to -0.15); P < 0.001, 1 study]. Qualitative analysis on 10 (52.6%) of 19 studies excluded from meta-analysis found a significant (P < 0.05) association between uncorrected hyperopia and impaired academic performance. Two interventional studies found hyperopic spectacle correction significantly improved reading speed (P < 0.05). CONCLUSIONS: Evidence indicates that uncorrected hyperopia is associated with poor academic performance. Given the limitations of current methodologies, further research is needed to evaluate the impact on academic performance of providing hyperopic correction.
PURPOSE: To assess the impact of uncorrected hyperopia and hyperopic spectacle correction on children's academic performance. DESIGN: Systematic review and meta-analysis. METHODS: We searched 9 electronic databases from inception to July 26, 2021, for studies assessing associations between hyperopia and academic performance. There were no restrictions on language, publication date, or geographic location. A quality checklist was applied. Random-effects models estimated pooled effect size as a standardized mean difference (SMD) in 4 outcome domains: cognitive skills, educational performance, reading skills, and reading speed. (PROSPERO registration: CRD-42021268972). RESULTS: Twenty-five studies (21 observational and 4 interventional) out of 3415 met the inclusion criteria. No full-scale randomized trials were identified. Meta-analyses of the 5 studies revealed a small but significant adverse effect on educational performance in uncorrected hyperopic compared to emmetropic children {SMD -0.18 [95% confidence interval (CI), -0.27 to -0.09]; P < 0.001, 4 studies} and a moderate negative effect on reading skills in uncorrected hyperopic compared to emmetropic children [SMD -0.46 (95% CI, -0.90 to -0.03); P = 0.036, 3 studies]. Reading skills were significantly worse in hyperopic than myopic children [SMD -0.29 (95% CI, -0.43 to -0.15); P < 0.001, 1 study]. Qualitative analysis on 10 (52.6%) of 19 studies excluded from meta-analysis found a significant (P < 0.05) association between uncorrected hyperopia and impaired academic performance. Two interventional studies found hyperopic spectacle correction significantly improved reading speed (P < 0.05). CONCLUSIONS: Evidence indicates that uncorrected hyperopia is associated with poor academic performance. Given the limitations of current methodologies, further research is needed to evaluate the impact on academic performance of providing hyperopic correction.