Myopia and Level of Education: Results from the Gutenberg Health Study

doi:10.1016/j.ophtha.2014.04.017

Ophthalmology

Volume 121, Issue 10, October 2014, Pages 2047-2052

Presented as a poster at: American Academy of Ophthalmology Annual Meeting, November 2012, Chicago, Illinois; and Association for Research in Vision and Ophthalmology Annual Meeting, May 2012, Fort Lauderdale, Florida.

https://doi.org/10.1016/j.ophtha.2014.04.017 Get rights and content

Purpose

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

Design

Population-based cross-sectional study.

Participants

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

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Methods

The Gutenberg Health Study (GHS) is a multidisciplinary, population-based, prospective, observational cohort study in the Rhine-Main Region in mid western Germany with a total of 15 010 participants and follow-up after 5 years. According to the state law of Rhineland-Palatinate, it is mandatory for every person to register his or her personal and residential data within 1 week after moving to or from any place in Germany. The study population, consisting of persons aged between 35 and 74 years

Results

Of the 5000 participants we examined, data from 4658 participants were analyzed (complete case analysis; 2367 men and 2291 women). Their mean age was 55.2±10.9 years (median, 55 years; range, 35–74 years). In the 4658 participants, the median SE was −0.06 D (range, −21.5 to 8.5 D). One thousand seven hundred eighty participants (38.2%) were myopic (mean SE, ≤−0.5 D). Study sample characteristics are presented in Table 1. Genome-wide analysis data were available for a subset of 3593 participants.

Discussion

To the best of our knowledge, this large European, population-based study provides strong evidence of the association between prevalence and magnitude of myopia and levels of school education as well as post-school professional training. The association remained significant after adjusting for age, gender, and currently known myopia-associated SNPs in multivariate models. Our results showed a considerable effect of education (from 0.2 D in those who did not complete secondary education to −0.56

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Variants in FLRT3 and SLC35E2B identified using exome sequencing in seven high myopia families from Central Europe
2021, Advances in Medical Sciences
High myopia (HM) is an eye disorder with both environmental and genetic factors involved. Many genetic factors responsible for HM were recognized worldwide, but little is known about genetic variants underlying HM in Central Europe. Thus, the aim of this study was to identify rare sequence variants involved in HM in families from Central Europe to better understand the genetic basis of HM.
We assessed 17 individuals from 7 unrelated Central European families with hereditary HM using exome sequencing (ES). Segregation of selected variants in other available family members was performed using Sanger sequencing.
Detected 73 rare variants were selected for verification. We observed 2 missense variants, c.938C>T in SLC35E2B - encoding solute carrier family 35 member E2B, and c.1642G>C in FLRT3 - encoding fibronectin leucine rich transmembrane protein, segregating with HM in one family.
FLRT3 and/or SLC35E2B could represent disease candidate genes and identified sequence variants might be responsible for HM in the studied family.
Characteristics of accommodative behavior during sustained reading in emmetropes and myopes
2006, Vision Research
Accommodation has long been suspected to be involved in the development of myopia because near work, particularly reading, is known to be a risk factor. In this study, we measured several dynamic characteristics of accommodative behavior during extended periods of reading under close-to-natural conditions in 20 young emmetropic and stable myopic subjects. Accommodative responses, errors, and variability (including power spectrum analysis) were analyzed and related to accommodative demand and subject refractive error. All accommodative behaviors showed large inter-subject variability at all of the reading demands. Accommodative lags and variability significantly increased with closer demands for all subjects (ANOVA, p < 0.05). Myopes had significantly greater variability in their accommodation responses compared to emmetropes (ANOVA, p < 0.05) and had larger accommodative lags at further reading distances (unpaired t test p < 0.05). Power spectrum analysis showed a significant increase in the power of accommodative microfluctuations with closer demands (ANOVA, p < 0.05) and with increasing myopia at the closest reading demand (ANOVA, p < 0.01). The difference in the stability of the accommodative behavior between individuals with different refractive states suggests a possible relationship between variability in accommodation and the development of myopia.
How genetic is school myopia?
2005, Progress in Retinal and Eye Research
Myopia is of diverse aetiology. A small proportion of myopia is clearly familial, generally early in onset and of high level, with defined chromosomal localisations and in some cases, causal genetic mutations. However, in economically developed societies, most myopia appears during childhood, particularly during the school years. The chromosomal localisations characterised so far for high familial myopia do not seem to be relevant to school myopia. Family correlations in refractive error and axial length are consistent with a genetic contribution to variations in school myopia, but potentially confound shared genes and shared environments. High heritability values are obtained from twin studies, but rest on contestable assumptions, and require further critical analysis, particularly in view of the low heritability values obtained from parent–offspring correlations where there has been rapid environmental change between generations. Since heritability is a population-specific parameter, the values obtained on twins cannot be extrapolated to define the genetic contribution to variation in the general population. In addition, high heritability sets no limit to the potential for environmentally induced change. There is in fact strong evidence for rapid, environmentally induced change in the prevalence of myopia, associated with increased education and urbanisation. These environmental impacts have been found in all major branches of the human family, defined in modern molecular terms, with the exception of the Pacific Islanders, where the evidence is too limited to draw conclusions. The idea that populations of East Asian origin have an intrinsically higher prevalence of myopia is not supported by the very low prevalence reported for them in rural areas, and by the high prevalence of myopia reported for Indians in Singapore. A propensity to develop myopia in “myopigenic” environments thus appears to be a common human characteristic. Overall, while there may be a small genetic contribution to school myopia, detectable under conditions of low environmental variation, environmental change appears to be the major factor increasing the prevalence of myopia around the world. There is, moreover, little evidence to support the idea that individuals or populations differ in their susceptibility to environmental risk factors.
The influence of the environment and lifestyle on myopia
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: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: The Gutenberg Health Study is funded through the government of Rhineland-Palatinate, Germany (“Stiftung Rheinland-Pfalz für Innovation,” contract no.: AZ 961-386261/733); the research programs “Wissen schafft Zukunft” and “Schwerpunkt Vaskuläre Prävention” of the University Medical Center Mainz, Mainz, Germany, and its contract with Boehringer Ingelheim, Germany, and Philips Medical Systems, including an unrestricted grant for the Gutenberg Health Study. The sponsors (Boehringer Ingelheim, Ingelheim am Rhein, Germany, and Philips Medical Systems, Böblingen, Germany) and funding organizations played no role in the design or conduct of this research.

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Original articleMyopia and Level of Education: Results from the Gutenberg Health Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Lancet

Prog Retin Eye Res

Ophthalmology

Ophthalmology

Brain Res Cogn Brain Res

Epidemiology of myopia

Eye (Lond)

Refractive errors in twin studies

Twin Res Hum Genet

Genome-wide analysis points to roles for extracellular matrix remodeling, the visual cycle, and neuronal development in myopia

PLoS Genet

Heritability of myopia and ocular biometrics in Koreans: the healthy twin study

Invest Ophthalmol Vis Sci

Genome-wide meta-analyses of multiancestry cohorts identify multiple new susceptibility loci for refractive error and myopia

Nat Genet

Heritabilities of ocular biometrical traits in two Croatian isolates with extended pedigrees

Invest Ophthalmol Vis Sci

The increased prevalence of myopia in Finland

Acta Ophthalmol

Increased prevalence of myopia in the United States between 1971–1972 and 1999–2004

Arch Ophthalmol

Near work, education, family history, and myopia in Greek conscripts

Eye (Lond)

Original article
Myopia and Level of Education: Results from the Gutenberg Health Study