Myopia and Level of Education

Results from the Gutenberg Health Study


      To analyze the association between myopia and educational level in an adult European cohort.


      Population-based cross-sectional study.


      A cohort of the Gutenberg Health Study, including 4658 eligible enrollees between 35 and 74 years of age.


      We applied a standardized protocol entailing a comprehensive questionnaire; thorough ophthalmic, general, cardiovascular, and psychological examinations; and laboratory tests, including genetic analyses. We documented achievement levels in school education and post-school professional education. The spherical equivalent (SE) was determined by noncycloplegic autorefractometry. We fitted mixed linear models including age, gender, and 45 myopia-associated single nucleotide polymorphisms (SNP) as covariates.

      Main Outcome Measures

      Prevalence and magnitude of myopia in association with years spent in school and level of post-school professional education.


      Individuals who graduated from school after 13 years were more myopic (median, −0.5 diopters [D]; first quartile [Q1]/third quartile [Q3], −2.1/0.3 D) than those who graduated after 10 years (median, −0.2 D; Q1/Q3, −1.3/0.8 D), than those who graduated after 9 years (median, 0.3 D; Q1/Q3, −0.6/1.4 D), and than those who never finished secondary school (median, 0.2 D; Q1/Q3, −0.5/1.8 D; P<0.001, respectively). The same holds true for persons with a university degree (median, −0.6 D; Q1/Q3, −2.3/0.3 D) versus those who finished secondary vocational school (median, 0 D; Q1/Q3, −1.1/0.8 D) or primary vocational school (median, 0 D; Q1/Q3, −0.9/1.1 D) versus persons without any post-school professional qualification (median, 0.6 D; Q1/Q3, −0.4/1.7 D; P<0.001, respectively). Of persons who graduated from school after 13 years, 50.9% were myopic (SE, ≤−0.5 D) versus 41.6%, 27.1%, and 26.9% after 10 years, in those who graduated after 9 years, and in those who never graduated from secondary school, respectively ( P<0.001). In university graduates, the proportion of myopic persons was higher (53%) than that of those who graduated from secondary (34.8%) or primary (34.7%) vocational schools and than in those without any professional training (23.9%; P<0.001, respectively). In multivariate analyses: higher school and professional levels of education were associated with a more myopic SE independent of gender. There was a small effect of age and SNPs.


      Higher levels of school and post-school professional education are associated with a more myopic refraction. Participants with higher educational achievements more often were myopic than individuals with less education.

      Abbreviations and Acronyms:

      CI ( confidence interval), D ( diopters), GHS ( Gutenberg Health Study), SE ( spherical equivalent), SNP ( single nucleotide polymorphism)
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