title: Academic achievement, close up work parameters, and myopia in Singapore military conscripts.
abstract: OBJECTIVE
  To determine the relation of refractive error to environmental factors, including close up work, in Singapore military conscripts.
  
  
  METHODS
  A cross sectional study was conducted on 429 Singapore military conscripts. Non-cycloplegic refraction and A-scan biometry were performed in both eyes. A detailed questionnaire was administered by in-person interview to obtain information about current and past near work activity, extra tuition lessons, educational experiences, and family demographics.
  
  
  RESULTS
  Myopia associated with the conscript having been educated in the (gifted, special, or express) educational streams (adjusted odds ratio (OR) = 3.8, 95% confidence interval CI 2.0-7.3), and having completed pre-university education (OR=4.1, 95% CI 1.9-8.8). The reported close up work activity at age 7 years did correlate with age of onset of myopia (p<0.001). In parallel, supplemental tuition lessons in primary school has (OR=2.6, 95% CI 1.4-4.9) associated with conscript myopia. Parental myopia was positively associated with myopia (p<0.001), but this relation disappeared when adjusted for environmental factors. Current (p=0.83) and past close up work activity at age 7 years (p=0.13) did not correlate with myopia.
  
  
  CONCLUSIONS
  Educational level and educational stream positively related to myopia. A relation was observed with reported close up work activity in early childhood and with tuition classes during elementary school, but not with current close up work activity. These results underscore the strong influence of environment in myopia pathogenesis but a role for close up work activity remains indeterminate.
authors: Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore. cofsawsm@nus.edu.sg
authors: S M
authors: SM
authors: Saw
authors: H M
authors: HM
authors: Wu
authors: B
authors: B
authors: Seet
authors: T Y
authors: TY
authors: Wong
authors: E
authors: E
authors: Yap
authors: K S
authors: KS
authors: Chia
authors: R A
authors: RA
authors: Stone
authors: L
authors: L
authors: Lee
mesh_terms: D000328:Adult; D017668:Age of Onset; D003430:Cross-Sectional Studies; D004522:Educational Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D009216:Myopia / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D010290:Parents; D011932:Reading; D012846:Singapore