• Israeli Education System and Myopia Risk

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, August 2019

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    In a large population-based study of adolescent males in Israel, Bez et al. looked for correlations between the type of education system and the pre­ponderance of myopia. They found that ultra-Orthodox education is associated with the highest odds of both myopia and high myopia.

    For this nationwide study, the re­searchers evaluated 22,823 young Israeli men (mean age, 17.7 years) who were candidates for military service, had participated in the military draft board in 2013, and had undergone medical and visual assessments.

    Participants had studied in one of the three predominant Israeli education systems: secular, Orthodox Judaism, or ultra-Orthodox Judaism.

    The main outcome measure was the odds ratio (OR) for associations be­tween the type of education system and the prevalence and severity of myopia. Myopia severity was classified as low (−0.50 to −2.99 D), moderate (−3.00 to −5.99 D), or high (−6.00 D or more). Statistical methods included univari­able logistic regression (to assess links between myopia and independent vari­ables and covariates), the χ2 test (for categorical variables), one-way analysis of variance (for continuous variables), and multivariable logistic regression (to estimate associations between educa­tion systems and myopia severity).

    The Orthodox educational systems require extensive reading starting in early childhood; this is most intensive in ultra-Orthodox schools. This study found that myopia was most common among the students who received ultra-Orthodox education (82.2%), followed by those with standard Orthodox edu­cation (50.3%). In contrast, myopia was present in less than 30% of students in the secular system. Compared with secular education, standard Orthodox education was linked to greater odds of myopia (OR, 2.3; p < .001), as was ultra-Orthodox education (OR, 9.3; p < .001). Compared with the secular system, the multivariable adjusted OR for high myopia was 4.6 in the stan­dard Orthodox system (p < .001) and 38.5 (p < .001) in the ultra-Orthodox system.

    These findings suggest an inde­pendent link between the structure of educational systems and the prevalence and severity of myopia and thus sup­port the belief that near-work activities contribute to myopia development and progression.

    The authors emphasized that their study is strictly observational; as a result, causal relationships cannot be inferred. They encouraged research on strategies that may minimize myo­pia development in students, such as reducing reading time and increasing font sizes of textbooks. (Also see related commentary by Maria A. Woodward, MD, MSc, Lev Prasov, MD, PhD, and Paula Anne Newman-Casey, MD, MS, in the same issue.)

    The original article can be found here.