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Ian Morgan, Kathryn Rose; International educational performance and myopia - a role for cram schools?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5700.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the relationship between international educational performance in the PISA surveys of educational outcomes for 15 year-olds and the prevalence of myopia at a country level.
Data were taken from the 2009 PISA report on international educational outcomes, which covered 65 locations. Prevalence rates for myopia were obtained from published research. High myopia locations were defined as those in which the prevalence of myopia was >70% in those completing secondary school, while low myopia locations were defined as those in which the prevalence was estimated to be <40%.
Six locations from the 2009 PISA participants were identified as high myopia locations - Shanghai-China, Hong Kong-China, Taiwan, Singapore, Japan and South Korea. All were in the top quartile in terms of educational outcomes. Other countries in the top performance quartile included Australia, Finland, Norway, Poland and Denmark, in which sometimes limited data suggested that the prevalence of myopia is low. For others, insufficient data was available. PISA also reports on the amount of time children spend on cram schools classes outside of school hours. Where comparison was possible, in high myopia locations such as Shanghai-China and South Korea, under 50% of students reported doing no additional classes, whereas in Finland and Australia, over 90% of students reported doing no additional classes. In the high myopia locations, approaching 20% of students did more than 4 hours per week of additional classes across four subject areas, while in the low myopia locations, only 1-2% reported such high levels.
In locations which achieve high educational outcomes in the PISA surveys, those with a high prevalence of myopia report extensive involvement of students in cram school classes. In contrast locations with high educational outcomes but low levels of myopia report only limited involvement in additional classes out of school hours. We suggest that participation in additional classes may be a measure of educational pressures on children, perhaps preventing them from spending time outdoors. Future epidemiological surveys on refractive error should collect information on participation in cram schools as well as homework hours, to complement information on nearwork hours and time spent outdoors.
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