Visual Motor and Perceptual Task Performance in Astigmatic Students

Impact of Astigmatism on Axial Elongation in School-Age Children: A Five-Year Population-Based Study in Tianjin, China

Purpose

To investigate the progression rates of axial length (AXL) among school-age children with baseline astigmatism and spherical ametropia.

Methods

Annual vision screenings were conducted at seven schools in Tianjin, China, from 2018 to 2022. Ocular biometry and non-cycloplegic autorefraction were collected. Children 5 to 16 years old without any myopia interventions were included and categorized by their baseline astigmatism magnitude (control, low, or high) and axis orientation (with the rule [WTR], against the rule [ATR], or oblique). Additionally, children were classified by baseline spherical ametropia (compound hyperopic, compound myopic, or other). Annual AXL progression rates of right eyes were calculated using regression models and compared across different types of astigmatism and spherical ametropia.

Results

A total of 10,732 Chinese children (baseline age, 9.26 ± 2.42 years; follow-up duration, 2.63 ± 1.01 years) were included and divided into a younger cohort (age < 11 years; n = 7880) and an older cohort (age ≥ 11 years; n = 2852). Across both age groups and all astigmatism magnitudes, ATR astigmatism exhibited the most rapid AXL progression, followed by oblique and WTR astigmatism. Two-way ANCOVA of the combined cohort revealed that both high-magnitude and ATR astigmatism were significantly associated with AXL progression (P ≤ 0.018). However, the impact of astigmatism on AXL progression varied depending on baseline spherical ametropia, as high-magnitude and ATR astigmatism increased AXL progression in compound myopic eyes but decreased progression in compound hyperopic eyes.

Conclusions

Both baseline magnitude and axis orientation of astigmatism are significantly associated with axial elongation in children. However, these associations may vary with spherical ametropia, with differential patterns being observed between compound hyperopic and myopic eyes.

Efficacy of Visual Training Program for Students with Visual Impairment

This pilot study investigated the effects of a visual training program for students with low vision. A pre and post design was used. The Beery-Buktenica Developmental Test of Visual-Motor Integration and the Test of Visual-Perceptual Skills were used to assess the perceptual and visual motor skills of fifteen students with low vision. Their mean age was (8.47 ± 1.12); and the mean of their visual acuity of was (0.12 ± 0.11). The three-part intervention program (physical worksheets, a computer-based intervention program, activities of visual perceptual skills) was implemented over four weeks (three sessions/week). Kruskal Wallis tests were used to examine the effect of visual acuity on the progress achieved, and the Wilcoxon-Signed Ranks test was used to identify differences in the scores pre-post intervention. Results showed statistically significant improvement in the visual perceptual and visual-motor integration skills. There was not any statistically significant effect of visual acuity on the progress achieved.

The effect of induced blur on the Beery-Buktenica developmental test of visual-motor integration and its supplemental tests

Background

The Beery-Buktenica Test of Visual-Motor Integration (Beery VMI) is a commonly used standardized test of visual-motor integration. Performance on the test is related to academic achievement, but the effect of reduced visual acuity on test results is unknown. This study determined the visual acuity demand and the spacing of the test forms for the Beery VMI and its supplemental tests and investigated the effect of induced optical blur on test results in both adults and children.

Methods

The overall size and critical detail size of each form and the distance between the center of each form and its adjacent crowding source were measured. The visual acuity demand and angular separation of forms were calculated. Two groups of participants (adults aged ≥18 years [n = 19] and children aged 7–12 years [n = 20]) completed four sessions in which they performed the Beery VMI and the supplemental tests under different blur conditions (habitual near correction, monocular spherical blur, binocular spherical blur and binocular astigmatic blur) in a randomized order.

Results

Stroke width, overall form size and box size remained constant throughout the Beery VMI, whereas these reduced with increasing difficulty for the supplemental tests. Reduced near visual acuity from simulated blur resulted in reduced mean scores for the Beery VMI and its supplemental tests, compared with habitual near vision in both adults and children. Binocular spherical blur had the most detrimental effect (p<0.001), followed by binocular astigmatic blur (p<0.001) then monocular spherical blur (p = 0.022).

Conclusions

In individuals with uncorrected spherical or astigmatic ametropia, reduced scores on the Beery VMI and its supplemental tests may be due to impaired near visual acuity and not reflect reduced visual-motor abilities. This highlights the importance of excluding reduced near visual acuity as a cause of reduced performance before diagnosing impairment and initiating treatment strategies for visual-motor integration.