ArticleInvestigative ophthalmology & visual science2023
The Causal Effect of Education on Myopia: Evidence That More Exposure to Schooling, Rather Than Increased Age, Causes the Onset of Myopia.
Article in Investigative ophthalmology & visual science, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 24 citations in OpenAlex.
- Risk assessment and prediction of myopia among school-age children in South China: protocol for a longitudinal follow-up study.BMJ open · 2026Article
- Understanding the effect of educational attainment on the risk of retinal detachment: a Mendelian randomization mediation analysis.International journal of retina and vitreous · 2026Article
- Highland environment and genetic background are associated with myopia risk in Tibetans and Hans.Eye (London, England) · 2026Article
- Comparative effects of orthokeratology and defocus incorporated multiple segment lenses on axial length elongation in children with bilateral myopic anisometropia.International journal of ophthalmology · 2026Article
- Myopia Control Efficacy of Grid Dimension Multiregion Spectacle Lenses: A One-Year Randomized Double-Masked Controlled Trial.Journal of ophthalmology · 2026Article
- Combined and interaction effects of outdoor and reading time on myopia onset: evidence from over 210 000 schoolchildren in China.Journal of global health · 2025Article
- Acceleration of Myopic Shifts in Refraction and Axial Elongation Begins in the Premyopia Stage.Investigative ophthalmology & visual science · 2025Article
- IMI-2025 Digest.Investigative ophthalmology & visual science · 2025Article
- A nomogram for identifying premyopia and myopia candidates in Chinese children: focusing on those with cycloplegic spherical equivalent refraction ≤ + 0.75D.BMC ophthalmology · 2025Article
- Prevalence of myopia in Europe: a systematic review and meta-analysis of data from 14 countries.The Lancet regional health. Europe · 2025Article
- Myopia is predominantly genetic or predominantly environmental?Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) · 2025Article
- Trends in myopia prevalence among children and adolescents: a large-scale cross-sectional study in Shihezi, China.BMC public health · 2025Article
- Reference Values of Non-Cycloplegic Spherical Equivalent for Screening and Predicting Myopia Among Children and Adolescents - China, 2020-2024.China CDC weekly · 2025Article
- The Impact of School Education on High Myopia in Children and Adolescents.International journal of general medicine · 2025Article
- The Onset and Progression of Myopia Slows in Chinese 15-Year-Old Adolescents Following Vocational Rather Than Academic School Pathways.Investigative ophthalmology & visual science · 2024Article
- Socioeconomic disparities and green space associated with myopia among Chinese school-aged students: A population-based cohort study.Journal of global health · 2024Article
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Authors and funding
14 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: To distinguish the effects of age and grade on the development of myopia. Methods: Grade 1 (n = 1465, mean age 6.71 ± 0.29 years; 53.5% male) and Grade 2 students (n = 1381, mean age 7.76 ± 0.30 years; 52.5% male) were examined in 2018, with a follow-up examination in 2019. Cycloplegic spherical equivalent (SE) in diopter (D) was measured. Regression discontinuity (RD) analysis was used to assess the causal effects on refraction at each visit. Results: The sample in a grade was divided into three 4-month age blocks according to their birth month, the youngest, middle, and the oldest. At the 2018 visit, within each grade, there were no significant differences in SE among age blocks (all P > 0.05), despite an age range of 12 months. However, comparing the youngest block in Grade 2 to the oldest block in Grade 1, an average age difference of four months, a significant difference in SE was found (0.82 ± 0.69 D vs. 1.05 ± 0.55 D, t-test P < 0.01). Formal RD analysis found a significant casual effect of grade increase on myopic refraction shift (β = -0.32 D; 95% CI, -0.73 to -0.01; P = 0.042). Consistent results were found using the 2019 data. Conclusions: Increased grade, rather than increasing age, is the major cause of myopic shifts in refraction. A causal link implies that interventions aimed at reducing the myopigenic exposures experienced during a school year have the potential to markedly reduce the myopic shifts in refraction associated with a grade of schooling.
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