Association between Type of Educational System and Prevalence and Severity of Myopia among Male Adolescents in Israel

Importance: A 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. Objective: To 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 Participants: A 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. Exposures: The 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 Measures: The odds ratio (OR) for the association between educational system and the prevalence and severity of myopia. Results: Among 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 Relevance: This 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.