Policymakers should look for ways to balance high educational attainment and lower myopia prevalence, study argues. A concerted effort to incorporate more outdoor time in the curriculum or even delaying the start of formal school education could be considered, particularly in more vulnerable countries in Asia. Photo: Getty Images.

Long before epidemiological work on myopia began in earnest, at least one trait that rings true had made its way into the stereotype of an eyeglasses wearer: someone on the nerdy side with their face buried in a book, invariably presented as particularly smart. Turns out there is indeed a strong correlation between educational level and myopia prevalence. In a new study, researchers investigated the relationship between myopia prevalence and national educational performance matched for age and time and found a strong relationship between the two based on quantitative evidence that educational achievement is a risk factor for myopia.

The prevalence of myopia in a 15-to-19-year age group in 35 regions was matched with educational performance quantified by the Organization for Economic Cooperation and Development (OECD) Program in Secondary Assessment (PISA) testing from 2000 to 2018. A generalized estimating equation was used to describe the relationship between PISA scores and myopia prevalence, and clustering effects of country and chronological year were accounted for.

A significant positive relationship between educational performance and myopia prevalence in teenagers with higher PISA scores correlating with higher myopia prevalence was found, even after accounting for chronological year. PISA math showed the strongest relationship with myopia prevalence followed by science and reading.

“The PISA scores indicate that there is a growing gap in top levels of achievement where the East Asian regions with high prevalence of myopia (China, Singapore, Chinese Taipei, Hong Kong, Macau (China), are generally outperforming the Western countries (Iceland, Finland, Australia, New Zealand and Netherlands) increasingly over time,” the authors explained in their paper for Optometry & Vision Science.

They also found that Finland, Germany, Australia and the United Kingdom achieved good educational outcomes but were not associated with a high prevalence of myopia. These countries achieved PISA scores above 500 across mathematics, science and reading, with an estimated myopia prevalence for 15-to 19-years-olds between 26% to 35% for the years 2000 to 2018.

“Finland notably achieves PISA scores similar to Japan in all areas, while its prevalence in 15- to 19-year-olds is between 26% to 32% compared with that of Japan which was 68% to 71%,” the authors noted.

The top PISA ranking and high myopia prevalence countries tend to be East Asian, which didn’t come as a complete surprise given East Asian ethnicity is a known risk factor for myopia, with those of East Asian origin more likely to develop myopia earlier and progress at faster rates, previous studies show. It may be due attributed to cultural differences in how they run education and schooling, such as having an earlier age of formal schooling, longer school hours and tutoring outside of school for many children in Singapore, Japan, China Taiwan, Hong Kong and South Korea.

The authors noted it should be considered how high educational outcomes can be balanced with the risk of myopia. “Our results show that it is possible to have good PISA scores while maintaining a lower myopia prevalence in high-income economies as was the case in Finland, Germany, Australia and the United Kingdom,” the authors explained. “Many students in these countries engage in formal education at a slightly later age compared to East Asia. Moreover, many East Asian regions tend to have additional classes outside of school.

“In South Korea only one-third of students did not have additional classes, with 15.8% spending more than four hours a week on them,” the authors noted in that same study. “Understanding how an educational system is able to produce excellent educational outcomes without the concurrent high myopia prevalence is necessary to address the myopia epidemic in Asia and to reduce the risk of this occurring in other parts of the world.”

Educational policies of Finland and the Netherlands, which have a strong focus on quality and equity, should be something other countries consider following, as they consistently score high on PISA while having relatively low myopia prevalence, the authors wrote.

“PISA scores are a significant driver of many countries’ education policies, and countries that have a balance between high PISA scores and lower myopia prevalence may be good models of educational policies to address the myopia public health issue,” the authors concluded.

Jong M, Naduvilath T, Saw J, et al. Association between global myopia prevalence and international levels of education. Optom Vis Sci. August 1, 2023. [Epub ahead of print.]