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

Key PointsQuestionWhat is the association between the prevalence and severity of myopia and different study styles? FindingsIn this nationwide cross-sectional study that included 22823 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. MeaningThese 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. ImportanceA 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. ObjectiveTo 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 ParticipantsA nationwide, population-based study was conducted of 22823 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. ExposuresThe 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 MeasuresThe odds ratio (OR) for the association between educational system and the prevalence and severity of myopia. ResultsAmong the 22823 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 17358 [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 RelevanceThis 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. This cross-sectional study analyzes the association between studying in different educational systems and the prevalence and severity of myopia among Jewish male adolescents in Israel.