Uncorrected Refractive Error and Distance Visual Acuity in Children Aged 6 to 14 Years

This study investigates the relationship between uncorrected refractive errors and distance visual acuity in children, emphasizing its significance in clinical eye care, especially for identifying children needing corrective eyewear. The research includes data from 2,212 children aged 6 to 14 over a decade, measuring uncorrected distance visual acuity and cycloplegic refractive errors. The results reveal that myopic spherical and astigmatic refractive errors significantly reduce distance visual acuity, with approximately 0.5 minutes of MAR (minimum angle of resolution) decline per 0.30 to 0.40 D of myopia and 0.60 to 0.90 D of astigmatism. In contrast, hyperopic refractive errors have a minimal effect on visual acuity. Receiver operating characteristic curve analysis suggests that logMAR distance acuity of 0.20 to 0.32 is optimal for detecting refractive errors other than hyperopia. However, distance acuity alone is ineffective for detecting hyperopia. The study provides valuable insights into the relationship between refractive errors and visual acuity in children, offering improved understanding through statistical methods and contemporary acuity charts. It also highlights the importance of early detection and correction of refractive errors in children to support healthy vision and development. However, the variability in this relationship emphasizes that specific refractive errors cannot reliably predict visual acuity, particularly for low myopia and hyperopia. For hyperopia detection, alternative methods such as cycloplegic refraction are recommended.

Publication date

January 2, 2021


Optometry and Vision Science

Sponsor Institution

National Eye Institute and the Office of Minority Research; Ohio Lions Eye Research Foundation; and E F Wildermuth Foundation


Robert N. Kleinstein; Donald O. Mutti; Loraine T. Sinnott; Lisa A. Jones-Jordan; Susan A. Cotter; Ruth E. Manny; J. Daniel Twelker; Karla Zadnik; for the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group
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