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Introduction Children born preterm often have anatomical and functional visual abnormalities, even in the absence of retinopathy of prematurity. This includes suboptimal visual acuity (VA), defined as binocular VA between 5–6.3/10 and 8/10. We examine relationships between suboptimal VA and neurodevelopment in children born preterm.Methods Secondary analysis of the French EPIPAGE-2 cohort with children born between 24+0 weeks and 31+6 weeks of gestation, eligible for follow-up at 5.5 years. Children were classified into three VA groups: 5–6.3/10, 8/10 and 10/10 as reference group. Neurodevelopment was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, the Movement Assessment Battery for Children-II (MABC-2) and the Strengths and Difficulties Questionnaire (SDQ). Comparisons between groups were adjusted for neonatal and socioeconomic characteristics using generalised estimating equations models.Results Among 1787 included children, 62% had suboptimal VA. Compared with the 10/10 VA group, the mean full-scale IQ decreased by −3.09 (95 % CI −4.75 to −1.42) and −4.97 (95 % CI −6.47 to −3.46) points, the mean MABC-2 total score by −0.66 (95 % CI −0.71 to −0.61) and −1.06 (95 % CI −1.09 to −1.00), and the mean total SDQ scores increased by 0.40 (95 % CI −0.16 to 0.94) and 0.60 (95 % CI 0.10 to 1.1) in groups with VA groups at 8/10 and 5–6.3/10, respectively.Discussion In this French population-based cohort of children born preterm, suboptimal VA was frequent and associated with increased risk of neurodevelopmental difficulties. A comprehensive neurodevelopmental and neurovisual assessment is warranted in children born preterm with suboptimal VA.