TY - JOUR
T1 - Visual impairment and cognitive performance
T2 - A nationwide study of 1.4 million adolescents
AU - Nitzan, Itay
AU - Derazne, Estela
AU - Afek, Arnon
AU - Einan-Lifshitz, Adi
AU - Morad, Yair
AU - Yahalom, Claudia
AU - Peled, Alon
N1 - Publisher Copyright:
© 2024 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.
PY - 2024/7
Y1 - 2024/7
N2 - Purpose: Previous research highlights the adverse effects of visual impairment (VI) on academic achievement in children, yet its impact on cognitive performance among adolescents and young adults remains under-studied. Therefore, this investigation aimed to analyse this association in a nationwide sample of Israeli adolescents. Methods: A retrospective population-based cross-sectional study was conducted among 1,410,616 Israeli-born adolescents aged 16–19 years, who were assessed before mandatory military service between 1993 and 2017. The definition of VI was based on best-corrected visual acuity (BCVA) measurements using a standard Snellen chart. Adolescents with BCVA worse than 6/9 in either or both eyes were classified as having unilateral or bilateral VI, respectively. Cognitive performance was measured using the General Intelligence Score (GIS), based on a validated four-domain test. Relationships were analysed using regression models yielding adjusted odds ratios (ORs) for low (<−1 standard deviation [SD]) and high (≥1 SD) cognitive Z-scores. Results: Of 1,410,616 adolescents (56.1% men), 13,773 (1.0%) had unilateral and 3980 (0.3%) had bilateral VI. Unilateral VI was associated with adjusted ORs for low and high cognitive Z-scores of 1.24 (1.19–1.30) and 0.84 (0.80–0.89), respectively. ORs were accentuated for bilateral VI, reaching 1.62 (1.50–1.75) and 0.81 (0.74–0.90) for low and high cognitive Z-scores, respectively. Cognitive performance subscores mirrored these results, with the visual–spatial functioning subtest demonstrating the greatest effect size. These associations persisted in sub-analyses restricted to adolescents with amblyopia-related VI, mild VI and unimpaired health status. Conclusions: Visual impairment, including mild and unilateral cases, is associated with reduced cognitive performance scores assessed in late adolescence. Further research is required to gain a comprehensive understanding of the dynamics underlying this relationship.
AB - Purpose: Previous research highlights the adverse effects of visual impairment (VI) on academic achievement in children, yet its impact on cognitive performance among adolescents and young adults remains under-studied. Therefore, this investigation aimed to analyse this association in a nationwide sample of Israeli adolescents. Methods: A retrospective population-based cross-sectional study was conducted among 1,410,616 Israeli-born adolescents aged 16–19 years, who were assessed before mandatory military service between 1993 and 2017. The definition of VI was based on best-corrected visual acuity (BCVA) measurements using a standard Snellen chart. Adolescents with BCVA worse than 6/9 in either or both eyes were classified as having unilateral or bilateral VI, respectively. Cognitive performance was measured using the General Intelligence Score (GIS), based on a validated four-domain test. Relationships were analysed using regression models yielding adjusted odds ratios (ORs) for low (<−1 standard deviation [SD]) and high (≥1 SD) cognitive Z-scores. Results: Of 1,410,616 adolescents (56.1% men), 13,773 (1.0%) had unilateral and 3980 (0.3%) had bilateral VI. Unilateral VI was associated with adjusted ORs for low and high cognitive Z-scores of 1.24 (1.19–1.30) and 0.84 (0.80–0.89), respectively. ORs were accentuated for bilateral VI, reaching 1.62 (1.50–1.75) and 0.81 (0.74–0.90) for low and high cognitive Z-scores, respectively. Cognitive performance subscores mirrored these results, with the visual–spatial functioning subtest demonstrating the greatest effect size. These associations persisted in sub-analyses restricted to adolescents with amblyopia-related VI, mild VI and unimpaired health status. Conclusions: Visual impairment, including mild and unilateral cases, is associated with reduced cognitive performance scores assessed in late adolescence. Further research is required to gain a comprehensive understanding of the dynamics underlying this relationship.
KW - adolescents
KW - cognitive performance
KW - intelligence
KW - visual impairment
UR - http://www.scopus.com/inward/record.url?scp=85191793279&partnerID=8YFLogxK
U2 - 10.1111/opo.13323
DO - 10.1111/opo.13323
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C2 - 38682438
AN - SCOPUS:85191793279
SN - 0275-5408
VL - 44
SP - 819
EP - 828
JO - Ophthalmic and Physiological Optics
JF - Ophthalmic and Physiological Optics
IS - 5
ER -