Refractive Error & Academic Achievement

Purpose : To investigate associations between refractive error and academic achievement in Northern Irish teenagers. Methods : Self-reported academic achievement and refractive error were evaluated in a subgroup (n=169) of participants from the NICER study. General Certificates of Seconday Education (GCSEs) are national standardised examinations taken at 16yrs. Results for Math and English were graded as HIGH (A*-B) or LOW (C-Ungraded). Refractive error (most ametropic meridian [MAM] and astigmatic error [AE]) at age 15-16yrs was determined by cycloplegic autorefraction. Habitual spectacle/contact lens wear, socioeconmic status (SES by post/ZIP code) and level of parental education (did/did not complete higher education) were recorded. Univariate logistic regression tested associations between GCSE grades (HIGH/LOW) and the variables MAM, AE, SES and parental education. A multivariate logistic regression model was constructed for factors showing significant associations. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and p<0.05 considered statistically significant. Results : Participants achieving LOW grades had significantly more hyperopic MAM (median=1.13D) compared to those achieving HIGH grades (median=0.63D). Significant univariate factors for achieving a LOW grade were increasing MAM (Math OR 1.36 CI 1.14, 1.62; English OR 1.54 CI 1.25, 1.88), mother not completing higher education (Math OR 0.26 CI 0.09, 0.77; English OR 0.25 CI 0.09, 0.69) and lower SES (Math OR 0.60 CI 0.49, 0.74; English OR 0.48 CI 0.38, 0.60). Increasing AE was also a significant factor for LOW grade Math (OR 2.08 CI 1.09, 3.94). Multivariate analysis showed lower SES to remain significant for LOW grade MATH (OR 0.55 CI 0.36, 0.85) and LOW grade English (OR 0.64 CI 0.42, 0.96). Increasing MAM also remained significant for LOW grade English (OR 1.55 CI 1.08, 2.22). A significant association was found between LOW grade (Math and English) and myopic participants (MAM≤-0.50D) who did not wear refractive correction but not for uncorrected hyperopes (MAM≥2D) or astigmats (AE≥1D). Conclusions : Hyperopes underperform in Math and English compared to myopes; however, once contributing factors are considered this association only persists for achievement in English. Astigmatic error is linked with poor Math achievement. Academic performance was worse in hyeropes and astigmats regardless of whether correction was habitually worn.