Purpose. This study investigated the relationship between uncorrected astigmatism and early academic readiness in at-risk preschool-aged children. Methods. A vision screening and academic records review were performed on 122 three- to five-year-old children enrolled in the Philadelphia Head Start program. Vision screening results were related to two measures of early academic readiness, the teacher-reported Work Sampling System (WSS) and the parent-reported Ages and Stages Questionnaire (ASQ). Both measures assess multiple developmental and skill domains thought to be related to academic readiness. Children with astigmatism (defined as >|0.25| in either eye) were compared with children who had no astigmatism. Associations between astigmatism and specific subscales of the WSS and ASQ were examined using parametric and nonparametric bivariate statistics and regression analyses controlling for age and spherical refractive error. Results. Presence of astigmatism was negatively associated with multiple domains of academic readiness. Children with astigmatism had significantly lower mean scores on Personal and Social Development, Language and Literacy, and Physical Development domains of the WSS, and on Personal/Social, Communication, and Fine Motor domains of the ASQ. These differences between children with astigmatism and children with no astigmatism persisted after statistically adjusting for age and magnitude of spherical refractive error. Nonparametric tests corroborated these findings for the Language and Literacy and Physical Health and Development domains of the WSS and the Communication domain of the ASQ. Conclusions. The presence of astigmatism detected in a screening setting was associated with a pattern of reduced academic readiness in multiple developmental and educational domains among at-risk preschool-aged children. This study may help to establish the role of early vision screenings, comprehensive vision examinations, and the need for refractive correction to improve academic success in preschool children. (author abstract)