AbstractIntroductionCognitive development is characterized by the structural and functional maturation of the brain. Diffusion‐weighted magnetic resonance imaging (dMRI) provides methods of investigating the brain structure and connectivity and their correlations with the neurocognitive outcome. Our aim was to examine the relationship between early visual abilities, brain white matter structures, and the later neurocognitive outcome.MethodsThis study included 20 infants who were born before 28 gestational weeks and followed until the age of 6.5 years. At term age, visual alertness was evaluated and dMRI was used to investigate the brain white matter structure using fractional anisotropy (FA) in tract‐based spatial statistics analysis. The JHU DTI white matter atlas was used to locate the findings. The neuropsychological assessment was used to assess neurocognitive performance at 6.5 years.ResultsOptimal visual alertness at term age was significantly associated with better visuospatial processing (p< .05), sensorimotor functioning (p< .05), and social perception (p< .05) at 6.5 years of age. Optimal visual alertness related to higher FA values, and further, the FA values positively correlated with the neurocognitive outcome. The tract‐based spatial differences in FA values were detected between children with optimal and nonoptimal visual alertness according to performance at 6.5 years.ConclusionWe provide neurobiological evidence for the global and tract‐based spatial differences in the white matter maturation between extremely preterm children with optimal and nonoptimal visual alertness at term age and a link between white matter maturation, visual alertness and the neurocognitive outcome at 6.5 years proposing that early visual function is a building block for the later neurocognitive development.