Alireza Mirshahi1, Katharina A Ponto2, René Hoehn2, Isabella Zwiener3, Tanja Zeller4, Karl Lackner5, Manfred E Beutel6, Norbert Pfeiffer2. 1. Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany. Electronic address: alireza.mirshahi@unimedizin-mainz.de. 2. Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany. 3. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany. 4. University Heart Center Hamburg, Hamburg, Germany. 5. Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany. 6. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
Abstract
PURPOSE: To analyze the association between myopia and educational level in an adult European cohort. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A cohort of the Gutenberg Health Study, including 4658 eligible enrollees between 35 and 74 years of age. METHODS: We applied a standardized protocol entailing a comprehensive questionnaire; thorough ophthalmic, general, cardiovascular, and psychological examinations; and laboratory tests, including genetic analyses. We documented achievement levels in school education and post-school professional education. The spherical equivalent (SE) was determined by noncycloplegic autorefractometry. We fitted mixed linear models including age, gender, and 45 myopia-associated single nucleotide polymorphisms (SNP) as covariates. MAIN OUTCOME MEASURES: Prevalence and magnitude of myopia in association with years spent in school and level of post-school professional education. RESULTS: Individuals who graduated from school after 13 years were more myopic (median, -0.5 diopters [D]; first quartile [Q1]/third quartile [Q3], -2.1/0.3 D) than those who graduated after 10 years (median, -0.2 D; Q1/Q3, -1.3/0.8 D), than those who graduated after 9 years (median, 0.3 D; Q1/Q3, -0.6/1.4 D), and than those who never finished secondary school (median, 0.2 D; Q1/Q3, -0.5/1.8 D; P<0.001, respectively). The same holds true for persons with a university degree (median, -0.6 D; Q1/Q3, -2.3/0.3 D) versus those who finished secondary vocational school (median, 0 D; Q1/Q3, -1.1/0.8 D) or primary vocational school (median, 0 D; Q1/Q3, -0.9/1.1 D) versus persons without any post-school professional qualification (median, 0.6 D; Q1/Q3, -0.4/1.7 D; P<0.001, respectively). Of persons who graduated from school after 13 years, 50.9% were myopic (SE, ≤-0.5 D) versus 41.6%, 27.1%, and 26.9% after 10 years, in those who graduated after 9 years, and in those who never graduated from secondary school, respectively (P<0.001). In university graduates, the proportion of myopic persons was higher (53%) than that of those who graduated from secondary (34.8%) or primary (34.7%) vocational schools and than in those without any professional training (23.9%; P<0.001, respectively). In multivariate analyses: higher school and professional levels of education were associated with a more myopic SE independent of gender. There was a small effect of age and SNPs. CONCLUSIONS: Higher levels of school and post-school professional education are associated with a more myopic refraction. Participants with higher educational achievements more often were myopic than individuals with less education.
PURPOSE: To analyze the association between myopia and educational level in an adult European cohort. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A cohort of the Gutenberg Health Study, including 4658 eligible enrollees between 35 and 74 years of age. METHODS: We applied a standardized protocol entailing a comprehensive questionnaire; thorough ophthalmic, general, cardiovascular, and psychological examinations; and laboratory tests, including genetic analyses. We documented achievement levels in school education and post-school professional education. The spherical equivalent (SE) was determined by noncycloplegic autorefractometry. We fitted mixed linear models including age, gender, and 45 myopia-associated single nucleotide polymorphisms (SNP) as covariates. MAIN OUTCOME MEASURES: Prevalence and magnitude of myopia in association with years spent in school and level of post-school professional education. RESULTS: Individuals who graduated from school after 13 years were more myopic (median, -0.5 diopters [D]; first quartile [Q1]/third quartile [Q3], -2.1/0.3 D) than those who graduated after 10 years (median, -0.2 D; Q1/Q3, -1.3/0.8 D), than those who graduated after 9 years (median, 0.3 D; Q1/Q3, -0.6/1.4 D), and than those who never finished secondary school (median, 0.2 D; Q1/Q3, -0.5/1.8 D; P<0.001, respectively). The same holds true for persons with a university degree (median, -0.6 D; Q1/Q3, -2.3/0.3 D) versus those who finished secondary vocational school (median, 0 D; Q1/Q3, -1.1/0.8 D) or primary vocational school (median, 0 D; Q1/Q3, -0.9/1.1 D) versus persons without any post-school professional qualification (median, 0.6 D; Q1/Q3, -0.4/1.7 D; P<0.001, respectively). Of persons who graduated from school after 13 years, 50.9% were myopic (SE, ≤-0.5 D) versus 41.6%, 27.1%, and 26.9% after 10 years, in those who graduated after 9 years, and in those who never graduated from secondary school, respectively (P<0.001). In university graduates, the proportion of myopic persons was higher (53%) than that of those who graduated from secondary (34.8%) or primary (34.7%) vocational schools and than in those without any professional training (23.9%; P<0.001, respectively). In multivariate analyses: higher school and professional levels of education were associated with a more myopic SE independent of gender. There was a small effect of age and SNPs. CONCLUSIONS: Higher levels of school and post-school professional education are associated with a more myopic refraction. Participants with higher educational achievements more often were myopic than individuals with less education.
Authors: Alexander K Schuster; Laura Krause; Clara Kuchenbäcker; Franziska Prütz; Heike M Elflein; Norbert Pfeiffer; Michael S Urschitz Journal: Dtsch Arztebl Int Date: 2020-12-11 Impact factor: 5.594