Effect of Education on Myopia: Evidence from the United Kingdom ROSLA 1972 Reform

Abstract

Purpose Cross-sectional and longitudinal studies have consistently reported an association between education and myopia. However, conventional observational studies are at risk of bias due to confounding by factors such as socioeconomic position and parental educational attainment. The current study aimed to estimate the causal effect of education on refractive error using regression discontinuity analysis. Methods Regression discontinuity analysis was applied to assess the influence on refractive error of the raising of the school leaving age (ROSLA) from 15 to 16 years introduced in England and Wales in 1972. For comparison, a conventional ordinary least squares (OLS) analysis was performed. The analysis sample comprised 21,548 UK Biobank participants born in a nine-year interval centered on September 1957, the date of birth of those first affected by ROSLA. Results In OLS analysis, the ROSLA 1972 reform was associated with a −0.29 D (95% confidence interval [CI]: −0.36 to −0.21, P < 0.001) more negative refractive error. In other words, the refractive error of the study sample became more negative by −0.29 D during the transition from a minimum school leaving age of 15 to 16 years of age. Regression discontinuity analysis estimated the causal effect of the ROSLA 1972 reform on refractive error as −0.77 D (95% CI: −1.53 to −0.02, P = 0.04). Conclusions Additional compulsory schooling due to the ROSLA 1972 reform was associated with a more negative refractive error, providing additional support for a causal relationship between education and myopia.

IMI Risk Factors for Myopia

“…37 , 38 The quantitative technique of regression discontinuity analysis can be applied to data of this kind, and a recent study has examined the impact of increasing the mandatory length of schooling on development of myopia in the United Kingdom. 39 This policy resulted in a marked decrease in mean SER. Overall, policy innovations that have led to more children experiencing more intense educational pressures have led to an increase in the prevalence and severity of myopia, providing strong evidence of causality.…”

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

“… 101 Recent studies have gone beyond simply observing an association of myopia and education to providing evidence for a causal role. 126 – 128 However, it is challenging to disentangle the risk of myopia due to education and less time outdoors.…”

Hyperopia Is Not Causally Associated With a Major Deficit in Educational Attainment

“…A potential reason for the conflicting results of the observational analysis results and the nonlinear MR results is a causal effect of education on refractive error. 20 , 21 , 31 In other words, the observational association between refractive error and education may be dominated by the pathway education → refractive error, whereas the nonlinear refractive error → education pathway may have much less influence.…”

“…Quality control procedures followed those reported previously. 29 – 31 An ophthalmic examination was included as part of the baseline visit physical assessment test battery from 2009 onward. 32 Approximately 23% of participants underwent the ophthalmic assessment, which included non-cycloplegic autorefraction (RC 5000 autorefractor; Tomey, Aichi, Japan) performed after removal of spectacles or contact lenses.…”