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. 2019 Aug 1;137(8):887-893.
doi: 10.1001/jamaophthalmol.2019.1415.

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

Dana Bez  1   2 , Jacob Megreli  1   2 , Maxim Bez  2 , Eva Avramovich  2 , Adiel Barak  3 , Hagai Levine  1
Affiliations

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

Dana Bez et al. JAMA Ophthalmol. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Barak reported receiving personal fees from Nanoretina and grants from Cellcure, Byonics, Novartis, and MicroSert outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram Summarizing the Process of Identifying the Study Population
Please note that here is an overlap in the numbers between adolescents not aged 17 to 18 years and female adolescents. If we exclude female adolescents who are not aged 17 to 18 years from the total female group, we are left with 9145 female adolescents. This makes a total of 65 052 excluded adolescents.
Figure 2.
Figure 2.. Crude Prevalence of Myopia
The prevalence is subcategorized by severity (low, moderate, and high), and compared between secular, Orthodox, and ultra-Orthodox educational systems in Israel (N = 22 823).
See this image and copyright information in PMC

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