Reading Fluency in School-Aged Children with Bilateral Astigmatism

Abstract

Purpose To compare oral reading fluency (ORF) in students with no/low astigmatism and moderate/high astigmatism and to assess the impact of spectacle correction on ORF in moderate and high astigmats. Methods Subjects were 3rd–8th grade students from a highly astigmatic population. Refractive error was determined through subjectively refined cycloplegic autorefraction. Data from students with ocular abnormalities, anisometropia, symptomatic binocular vision disorders, or refractive error that did not meet study criteria (no/low (cyl < 1.00 both eyes, no significant myopia/hyperopia), moderate (cyl ≥ 1.00 D both eyes, mean ≥ 1.00 D and < 3.00 D), or high astigmatism group (cyl ≥ 1.00 D both eyes, mean ≥ 3.00 D)) were excluded. ORF was tested with a modified version of the DIBELS Next test of ORF. No/low astigmats were tested without spectacles; astigmats were tested with and without spectacles. Mean ORF was compared in no/low astigmats and astigmats (with and without correction). Improvement in ORF with spectacles was compared for moderate and high astigmats. Results The sample included 130 no/low, 67 moderate, and 76 high astigmats. ORF was lower in uncorrected astigmats than in no/low astigmats (p=0.011). ORF did not significantly differ in no/low astigmats and corrected astigmats (p=0.10). ORF significantly improved with spectacle correction in high astigmats (p=0.001, mean improvement 6.55 words per minute (WPM)), but not in moderate astigmats (p=0.193, mean improvement 1.87 WPM). Effects of spectacle wear were observed in students who read smaller text stimuli (older grades). Conclusions ORF is significantly reduced in students with bilateral astigmatism (≥ 1.00D) when uncorrected, but not when best-corrected, compared to their non-astigmatic peers. Improvement in ORF with spectacle correction is seen in high astigmats, but not in moderate astigmats. These data support the recommendation for full-time spectacle wear in astigmatic students, particularly those with high astigmatism.

The effect of adherence to spectacle wear on early developing literacy: a longitudinal study based in a large multiethnic city, Bradford, UK

“…In native American children bilateral uncorrected astigmatism (≥1.00 DC) has been reported to reduce reading fluency, and children with moderate astigmatism are reported to have lower VA and fluency than those with no or low astigmatism. 11 The findings reported from both the above studies may indicate that moderate to high degrees of uncorrected hypermetropia or astigmatism which reduce VA is associated with a reduction in literacy scores.…”

“…Our findings differ from previous studies reporting an association between refractive error and literacy. 11 12 …”

Do reduced visual acuity and refractive error affect classroom performance?

“…In studies from populations known to have a high prevalence of astigmatism, lower reading scores in children with uncorrected astigmatism (both ≥ 1.00 D and ≥ 2.00 D) have been compared to non‐astigmatic children from the same population . Interestingly, spectacle correction improved oral reading rates only in those with astigmatism of at least 3.00 D, with the beneficial effects becoming greater with increasing grade level (which is likely to be associated with the corresponding decrease in text size that occurs with increasing grade levels) …”

Choosing appropriate tools and referral criteria for vision screening of children aged 4–5 years in Canada: a quantitative analysis

“…Risk factors for amblyopia include clinically significant, untreated refractive errors, which occur in roughly 10% of children aged 3–6 years 17–22. Timely prescription of glasses can be all that is necessary to prevent amblyopia and the learning difficulties 23–29. For example, in 4-year-old children with hyperopia (far-sightedness) who wore glasses for as little as 6 weeks, IQ scores improved to a level comparable with the control group, with a significant improvement in visual motor subtest scores 30…”