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The Impact of Hyperopia on Academic Performance Among Children: A Systematic Review


Mavi, Sonia BSc (Hons); Chan, Ving Fai MSc, PhD; Virgili, Gianni MD, MSc; Biagini, Ilaria CO, MSc; Congdon, Nathan MD, MPH; Piyasena, Prabhath MBBS, PhD; Yong, Ai Chee BOptom (Hons), MPH; Ciner, Elise B. BS, OD; Kulp, Marjean Taylor OD, MS; Candy, T. Rowan BSc (Hons), PhD; Collins, Megan MD, MPH; Bastawrous, Andrew MBChB, PhD; Morjaria, Priya MSc, PhD; Watts, Elanor BMBCh, MSc; Masiwa, Lynett Erita BSc Optom, MSc; Kumora, Christopher BOptom; Moore, Bruce OD; Little, Julie-Anne MOptom, PhD





Asia-Pacific Journal of Ophthalmology


  • The purpose of this systematic review is to assess the impact of uncorrected hyperopia and hyperopic spectacle correction on children's academic performance.

  • The authors 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).

  • 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).

  • 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.