Dana Bez1,2, Jacob Megreli1,2, Maxim Bez2, Eva Avramovich2, Adiel Barak3, Hagai Levine1. 1. Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel. 2. Medical Corps, Israel Defense Forces, Ramat Gan, Israel. 3. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, 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.
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.
Authors: Samantha Sze-Yee Lee; Gareth Lingham; Seyhan Yazar; Paul G Sanfilippo; Jason Charng; Fred K Chen; Alex W Hewitt; Fletcher Ng; Christopher Hammond; Leon M Straker; Peter R Eastwood; Stuart MacGregor; Kathryn A Rose; Robyn M Lucas; Jeremy A Guggenheim; Seang-Mei Saw; Minas T Coroneo; Mingguang He; David A Mackey Journal: BMJ Open Date: 2020-03-25 Impact factor: 2.692