Abstract
Purpose :
Myopia is associated with years of schooling in schoolchildren and adults. However, it is not clear whether a similar association exists in kindergarten. In this study, we aimed to evaluate the educational effect on prevalence of myopia and refractive development among children in kindergarten and lower grades of primary school.
Methods :
This is a population-based, cross-sectional study. A total of 11,543 kindergarten and primary school children who received standardized ocular examinations before COVID-19 pandemic were included. Cycloplegic autorefraction and axial length (AL) were measured for all children. Parental myopia, family income and children's lifestyle including time spent on outdoor activities and near work were obtained by a standardized questionnaire.
Results :
2525 children from kindergartens (413 in grade 2 (K2) and 2112 in grade 3 (K3), mean age 5.76±0.62 years, 53.4% boys) and 9018 children from primary schools (4250 in grade 1 (P1) and 4768 in grade 2 (P2), mean age 7.36±0.74 years, 46.6% boys) were recruited. The myopia prevalence significantly increased with academic grades, 7.6% in K2, 8.7% in K3, 17.3% in P1 and 29.1% in P2 (P for trend<0.001). Years of education were significantly associated with myopia prevalence (OR=1.41, P<0.001), SE (β=-0.18, P<0.001), and AL (β=0.11, P<0.001) after adjusting for age, sex, outdoor time, near work, family income and parental myopia. For kindergarten students, myopia prevalence only associated with parental myopia (OR=1.50, P<0.001), but not with years of schooling. Similarly, only parental myopia was associated with SE (β=-0.26, P<0.001) and AL (β=0.06, P=0.01). For primary school students, time of schooling in P1, age, sex, family income, and parental myopia were significantly associated with myopia prevalence (all P values<0.01), SE (all P values<0.01), and AL (all P values<0.05).
Conclusions :
Education has a significant effect on myopia development in primary school students, especially in P1, but not in kindergarten. Interventions including more outdoor activities and less near work may be considered for the lower primary school students.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.