Association Between Visual Acuity and Cycloplegic Refractive Error in 3- to <10-Year-Old Children.

Area of Science:

• Ophthalmology
• Pediatric Optometry
• Refractive Error Research

Background:

• Distance visual acuity (VA) is linked to refractive error in older children.
• Limited data exists for children under 6 and those without prior refractive correction.
• Understanding VA in young children is crucial for early detection and intervention.

Purpose of the Study:

• To assess the utility of VA testing in children aged 3 to <10 years without a history of refractive correction.
• To examine the relationship between VA and refractive error (myopia, hyperopia, astigmatism) in this age group.
• To determine if VA testing can effectively classify refractive error types in young children.

Main Methods:

• Unaided monocular distance and near VA testing were performed using age-appropriate charts.
• Cycloplegic autorefraction categorized participants into myopic, hyperopic, astigmatic, or emmetropic groups.
• Receiver operating characteristic curves and linear regressions analyzed the relationship between VA and refractive error magnitude, controlling for age.

Main Results:

• Reduced distance VA was significantly associated with myopia (AUC=91%) and astigmatism (AUC=87%).
• Hyperopia showed a weaker association with distance VA (AUC=63%) and near VA (AUC=70%).
• Each 0.36 D increase in myopia correlated with a 0.10 logMAR decline in distance VA; no such prediction was found for hyperopia or astigmatism magnitude.

Conclusions:

• Distance VA reduction in children aged 3 to <10 without correction is primarily associated with myopia and astigmatism.
• Hyperopia did not show a significant association with reduced distance VA in this cohort.
• Myopia demonstrated a dose-dependent relationship with declining distance VA, highlighting its impact on visual function.