Impact of the Pressure-Free Yutori Education Program on Myopia in Japan

Abstract

This study aimed to investigate the influence of educational pressure on myopia. A less-intense school curriculum was introduced nationally in Japan beginning in 2012 based on a pressure-free education policy. In this retrospective observational study, a total of 1025 Japanese medical students of Asahikawa Medical University underwent measurements of the cycloplegic refractive error and axial length (AL), from 2011 to 2020. The spherical equivalent (SE) and AL were correlated significantly with the fiscal year of births (p = 0.004 and p = 0.034, respectively) only during enforcement of the system of high-pressure education. The SE and AL regression rates during the two educational approaches differed significantly (p = 0.004 and p = 0.037, respectively). The prevalence of high myopia was correlated significantly (p < 0.001) only during the system of high-pressure education. The regression of the prevalence rate of high myopia during the two education approaches differed significantly (p = 0.010). The progression rates of myopia and increased prevalence of high myopia were observed only during high-pressure education, suggesting that not only ophthalmologists but also educators and the government should work on together to control the progression of myopia.

Keywords: Yutori education; degree of myopia; high-pressure education; pressure-free education; prevalence of myopia.

Figure 1

Study flowchart.

Figure 2

Spherical equivalent and axial length. y = 42.07 − 1.81x, r² = 0.687, p < 0.001. ○, data of eyes in each student.

Figure 3

The fiscal year (FY) of birth and mean spherical equivalent. ●, data during the FYs of birth before 1987. ○, data during the FYs of birth of 1987 and after. During the FYs of birth before 1987, y = 310.0 − 0.158x, r = 0.213, p = 0·004. During the FYs of birth of 1987 and after, p =0.441. The regression of spherical equivalent by FYs of birth before 1987 and after, p = 0.004 (analysis of covariance (ANCOVA)).

Figure 4

The fiscal year (FY) of birth and mean axial length. ●, data during the FYs of birth before 1987. ○, data during the FYs of birth of 1987 and after. During the FYs of birth before 1987, y = −78.9 + 0.0527x, r = 0.157, p = 0.034. During the FYs of birth of 1987 and after, p = 0.599. The regression of spherical equivalent by FYs of birth before 1987 and after, p = 0.004 (ANCOVA).

Figure 5

The fiscal years (FYs) of birth and prevalence of myopia and high myopia. ●, the prevalence of myopia during the FYs of birth before 1987. ○, the prevalence of myopia during the FYs of birth of 1987 and after. ■, the prevalence of high myopia during the FYs of birth before 1987. □, the prevalence of high myopia during the FYs of birth of 1987 and after. The prevalence of myopia: during the FYs of birth before 1987, p = 0.428; during the FYs of birth of 1987 and after, p = 0.080. The prevalence of high myopia: during the FYs of birth before 1987, y = −4826 + 2.45x, r = 0.851, p < 0.001; and during the FYs of birth of 1987 and after, p = 0.692. The regressions of the spherical equivalent by FYs of birth before 1987 and after, p = 0.010 (analysis of covariance).