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Original Investigation
May 30, 2019

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

Author Affiliations
  • 1Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
  • 2Medical Corps, Israel Defense Forces, Ramat Gan, Israel
  • 3Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv–Yafo, Israel
JAMA Ophthalmol. Published online May 30, 2019. doi:10.1001/jamaophthalmol.2019.1415
Key Points

Question  What is the association between the prevalence and severity of myopia and different study styles?

Findings  In this nationwide cross-sectional study that included 22 823 male adolescents, the odds of having myopia for those who were studying in the ultra-Orthodox and Orthodox educational systems were much higher compared with adolescents in the secular educational system.

Meaning  These findings suggest that educational systems that require extensive reading and other near-work activities (those done at a short working distance) are associated with increased prevalence and severity of myopia.

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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