Association Between Type of Educational System and Prevalence and Severity of Myopia Among Male Adolescents in Israel

Abstract

IMPORTANCE A substantial portion of the public is diagnosed with myopia, which increases the risk of potential sight-threatening complications. The association between study style and the development of myopia is unclear. OBJECTIVE To analyze the association between studying in different educational systems and the prevalence and severity of myopia among Jewish male adolescents in Israel. DESIGN, SETTING, AND PARTICIPANTS A nationwide, population-based study was conducted of 22 823 male candidates for military service in Israel aged 17 to 18 years attending the military draft board in 2013 who underwent a medical examination and a visual acuity assessment. Statistical analysis was performed from January 1 to March 31, 2018. EXPOSURES The participants studied in 1 of 3 Israeli educational systems: secular, Orthodox, or ultra-Orthodox. The ultra-Orthodox system and, to a lesser extent, the Orthodox system involve intensive reading starting in early childhood compared with the secular system. MAIN OUTCOMES AND MEASURES The odds ratio (OR) for the association between educational system and the prevalence and severity of myopia. RESULTS Among the 22 823 participants (mean [SD] age, 17.7 [0.6] years), there was a higher proportion of adolescents in the ultra-Orthodox educational system with myopia (1871 of 2276 [82.2%]) compared with adolescents in the Orthodox educational system (1604 of 3189 [50.3%]) and those in the secular educational system (5155 of 17 358 [29.7%]). Compared with adolescents in the secular educational system, those in the Orthodox educational system were more likely to have myopia (OR, 2.3; 95% CI, 2.1-2.5; P < .001), as were those in the ultra-Orthodox educational system (OR, 9.3; 95% CI, 8.2-10.7; P < .001), after adjustment for age, country of origin, socioeconomic status, years of education, and body mass index. The multivariable adjusted OR for high myopia (refractive error of at least −6.0 diopters) was 4.6 (95% CI, 3.8-5.5; P < .001) for adolescents in the Orthodox educational system and 38.5 (95% CI, 30.7-48.2; P < .001) for adolescents in the ultra-Orthodox educational system compared with adolescents in the secular educational system. CONCLUSIONS AND RELEVANCE This study provides evidence of the independent association between educational systems and the prevalence and severity of myopia. Male adolescents in the ultra-Orthodox educational system have higher odds of having myopia and high myopia. These findings suggest that study styles that involve intensive reading and other near-work activities (those done at a short working distance) play a role in the development of myopia and warrant consideration of prevention strategies.

Evolution of the Prevalence of Myopia among Taiwanese Schoolchildren

“…The ultraorthodox educational system involves intensive reading starting in early childhood and is similar to the educational system in Taiwan, is associated with the prevalence and severity of myopia. 41 Overall, emerging evidence suggests that near-work plays a major role in myopia development.…”

Myopia

“…In almost all studies, populations with higher levels of education tend to have higher rates of myopia than populations with lower rates of education. For example, a high prevalence of myopia has been reported in populations that receive intensive education at a young age, such as Jewish boys in Israel who received Orthodox or traditional Orthodox education 63 . By contrast, East Asian populations who receive less intensive education have a low and similar prevalence of myopia to that in most western countries 38 .…”

IMI Risk Factors for Myopia

“… 160 Similarly, the Liwan Eye Study reported that sex differences in older adults were marginal, 161 but in more recent cohorts in China, girls are more likely to be myopic than boys. 11 , 162 The extremely large difference in the prevalence of myopia in girls and boys in Orthodox Jewish communities in Israel, where the boys undergo very intensive education from an early age, shows this trend in reverse, 34 , 35 and contrasts with the similarity of boys and girls receiving more secular education. This variability does not suggest a direct biological link between sex and myopia, but rather suggests that the associations may be mediated by social factors, such as access to education for girls, which varies markedly between locations and has improved considerably in many places in recent decades.…”

“…13 The very high prevalence of myopia seen in Israeli Jewish boys attending Orthodox or Ultra-Orthodox schools, compared with that in their sisters, or other children receiving more secular education, is also difficult to explain in genetic terms. 34,35 Again, it is possible to postulate that there is a sex-linked gene variant that predisposes to myopia segregating at a high frequency in Orthodox or Ultra-Orthodox Jewish communities in Israel, and indeed there are examples of rare, sex-linked forms of high myopia. 36 With modern molecular genetic techniques it would be relatively straightforward to identify such a gene variant should it exist; but to date there is no evidence that this is the case.…”