The Impact of School Education on High Myopia in Children and Adolescents

To investigate the effect of school education on the prevalence of high myopia.

This prospective cross-sectional study, conducted in schools across Hubei Province, included 1,017,622 students from 103 county-level administrative regions between October 2021 and November 2023. Refractive measurements and basic demographic data were collected for all participants. The prevalence of high myopia and the differences in prevalence across grade levels were calculated. Regression discontinuity was used to assess the effects of age and education on high myopia prevalence.

A total of 1,017,622 students participated, with 540,860 (53.15%) boys, and an average age of 11.93 ± 3.06 years. Over three years, the average prevalence of high myopia was 4.75%. Prevalence increased with grade level, with the largest difference observed between grades 9 and 10. Age showed no significant effect on high myopia prevalence. Each additional year of education led to an increase in prevalence by 1.26% (95% CI: -1.87, -0.65, P=0.000) in 2021, 1.20% (95% CI: -1.88, -0.52, P=0.001) in 2022, and 1.26% (95% CI: -2.49, -0.04, P=0.04) in 2023.

Increased grade, rather than age, is the key factor driving the rise in high myopia prevalence. Interventions targeting myopia risk factors during schooling could potentially reduce the growing prevalence of high myopia.