Association Between Global Myopia Prevalence and International Levels of Education.

SIGNIFICANCE:The Global Myopia Prevalence and International Levels of Education study models national trends in educational performance with myopia prevalence in children; it examines the association of near work with myopia in the form of an ecologic analysis and also discusses how this may relate to educational frameworks.PURPOSE:This study aimed to investigate the relationship between myopia prevalence and national educational performance.METHODS:The prevalence of myopia in the 15- to 19-year age group in 35 regions was obtained from a meta-analysis by Holden et al. (Ophthalmology 2016;123:1036-1042) and matched with educational performance quantified by the Organisation for Economic Cooperation and Development Programme for International Student Assessment (PISA) testing from 2000 to 2018. A generalized estimating equation was used to describe the relationship between PISA scores and myopia prevalence. Clustering effects of country and chronological year were accounted for in the analysis. Linear and nonlinear terms of PISA scores using lines of best fit were further explored.RESULTS:There is a significant positive relationship between Organisation for Economic Cooperation and Development PISA educational performance and myopia prevalence in teenagers with higher PISA scores correlating with higher myopia prevalence, even after accounting for chronological year (generalized estimating equation model: P = .001, .008, and .005 for math, science, and reading, respectively). Scatterplots with cubic and logistic fits indicated that PISA math showed the strongest relationship with myopia prevalence ( r2 = 0.64), followed by science ( r2 = 0.41) and reading ( r2 = 0.31).CONCLUSIONS:These results strongly suggest that educational achievement at a national level is associated with higher myopia prevalence. Programme for International Student Assessment scores are a significant driver of many countries' education policies, and countries that have a balance between high PISA scores and lower myopia prevalence may be good models of educational policies to address the myopia public health issue.