Over the past period of time it was observed that along with the development of
civilization myopia is more and more common. This refractive error may lead to
the decrease of visual acuity or even blindness (1).
In the past myopia was rare (2). Currently, it occurs more frequently. So far,
the highest prevalence of myopia has been reported in medical students of the
National Taiwan University, where 95.8% of the students had myopia -4.94 ± 2.70
Most likely factors like intensive reading, writing or working on a computer
have an influence on such a state. Although, the occurrence of myopia also
depends on other environmental and genetic factors (4).
Thus, in this work it was decided to verify if there is a relationship between
education and myopia.
The aim of this paper was to assess the level of education on the prevalence of
Material and methods
Existing literature concerning the relationship between education and myopia
was presented and discussed.
Education and myopia
It has long been known that reading and writing leads to a higher occurrence of
myopia. However, research on the effects of educational level on the occurrence
of myopia were launched in 1907 by Fleischer (2), who observed that in
Tuebingen, Germany 7.5% of students had myopia.
Richler and Bear (5) from Newfoundland after examining 971 people aged 5 years
and above showed that the level of education and near visual work lead to a
higher occurrence of myopia.
Ashton (6) obtained slightly different results, after examining 723 families
living in Hawaii. He found that higher levels of education leads to higher
occurrence of myopia. However, he did not observe the relationship between near
work and myopia.
The most widely-ranging research on this topic was conducted in 1987, by Rosner
and Belkin (7). The authors studied 157.748 17-19-year-old Israeli male
recruits. They demonstrated that an increase in the level of education leads to
increased prevalence of myopia.
Extensive research on the impact of educational level on the occurrence of
myopia was carried out in 1988 by Teasdale and Goldschmidt (8). After examining
7.950 men 18 years old appearing before the draft board in eastern Denmark,
they have found that myopia is more common in people with higher education.
However, the data was not statistically significant.
Saw et al. (9) among 429 18-23-year-old military conscripts from Singapore
found that myopia is more common in people with higher education, which they
explained by the increased near vision workload and the influence of genetic
Recent studies on the impact of educational level on the occurrence of myopia
were published in 2008 by Konstantopoulos et al. (10). After examining 200
17-31-year-old Greek conscripts, the researchers showed that those with higher
education tend to have myopia (tab. I).
Near work and myopia
Currently, it is assumed that the higher occurrence of myopia in people with
higher educational level is the result of intensive visual work, especially of
reading, writing and visual work at the computer.
Correlation between reading and writing and the occurrence of myopia has been
demonstrated in the works carried out in China (11), Hong Kong (12), Norway
(13), Poland (4), and the USA (14). It has not been demonstrated in studies
conducted in Singapore (15), and the USA (16,17). This was most likely caused
by conducting the research on different populations and by using different
However, the impact of using a computer on the development of myopia is
controversial. Some researchers believe that visual work on the computer leads
to a higher prevalence of myopia (4,18). However, other consider that there is
no such relation and the published results are the consequence of research on
adults in whom the eyeball is fully developed and does not come under the
influence of visual work on a computer (19-21) (tab. II).
Mechanism of changes
Despite intensive research the underlying mechanism that links myopia
development to near work is not ascertained. Retinal image-mediated ocular
growth is the most extensively proposed hypothesis for near work-induced human
myopia. The natural lags of accommodation found during near visual tasks and
the associated retinal blur during near work are regarded to operate as cues
for myopia development.
Recently, it was shown that lid forces during reading can change the lower and
higher order aberrations of the eye
and that these alterations are significantly larger in
progressing myopes than emmetropes. Similar reasoning can be applied to
computer work. While working on a computer, the user usually adopts only a
slight downward gaze (but at much less of an angle than in reading) and the
working distance to the monitor is 50-90 cm. As a result of the eyelid position
during computer tasks, the cornea shows the least changes in topography and
aberrations when compared with reading (4,22).
1. Level of education has an influence on the prevalence of myopia.
2. This is probably associated with intense near visual work: reading, writing
and visual work at the computer.
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