Cognitive Function May Predict Visual Acuity in Pediatric Patients

An albino boy has her eyes tested at a clinic run by the NGO, Standing Voice, on Ukerewe Island in Victoria lake during International Albinism Awareness day on June 13, 2016. Albinism affects the development of human eyes so eye checks are a vital service needed by Albinos. Ukerewe island is home to many albinos. Many of the first albinos to live on the island were taken there and abandoned by their families as children or fled from violence they had faced on the mainland. Ukerewe island is now seen as a safer place for Albinos to live and integrate, as supersperstition has caused the practice of mutilation and killing of albinos by some witchdoctors for many years both in Tanzania and other African countries. / AFP / CARL DE SOUZA (Photo credit should read CARL DE SOUZA/AFP via Getty Images)
Clinicians may wish to consider the role of cognitive function in pediatric patients when creating a treatment plan, a study suggests.

Cognition and age are both important predictors of visual acuity in children, according to research published in Optometry and Vision Science.

“From a clinical point of view, a strong relationship between vision and cognition should encourage practitioners to take both into account—preferably by better multidisciplinary collaboration to fulfill the patient’s needs,” the researchers said.

The assessment took into account 81 children (age 5-11 years, 41 girls). Mean spherical equivalent was +0.82±0.10 for 162 eyes.

Investigators assessed participant visual acuity by means of a LEA chart and analyzed cognitive functioning via a Raven’s Colored Progressive Matrices (RCPM) test, which has children complete patterns by providing missing pieces. 

The researchers found acuity increases as children age until the age of 8 years, at which point, it changes less. The associations were linear (logMAR VA = -0.031× age + 0.18: R2 = 0.26, P <.001) and asymptotic (logMAR VA = β0 _ 2(β1/age); β0 = -0.16; β1=3.18).

RCPM score and acuity were linearly associated (logMAR VA = -0.0084 ×RCPM raw score + 0.15: R2 = 0.32, P <.001), along with age and cognition (RCPM = 3.05 × age + 1.95: R2 = 0.55, P <.001).

When controlling for age, the researchers found that cognition predicted changes in visual acuity. However, when controlling for cognition, age did not predict changes in visual acuity.

Regression analysis of variance indicated cognition affected acuity (F1,78 = 7.37, P =.008; B = -0.005), but the effect of age on acuity did not reach significance (F1,78 = 3.57, P =.063; B = -0.015).

“Analysis of resulting trajectories showed that, although age indeed was a good predictor, development of visual acuity was equally well predicted by cognition,” according to the investigators. “Moreover, partial correlations showed a strong correlation between cognition and acuity when controlling for age but no significant correlation between age and acuity when controlling for cognition.”

Study limitations include small sample size, ethnic homogeneity, and the exclusive use of RCPM to determine cognitive ability without consideration of other factors.


Myklebust AK, Riddell PM. Development of visual acuity in children: assessing the contributions of cognition and age in LEA chart acuity readings. Optom Vis Sci. 2022;99(1):24-30. doi:10.1097/OPX.0000000000001822