title: The role of educational attainment in refraction: the Genes in Myopia (GEM) twin study.
abstract: OBJECTIVE
  Educational attainment has been proposed as one of the most consistent environmental risk factors associated with myopia. The Genes in Myopia (GEM) twin study is the first myopia twin study to determine the relative genetic contribution in educational attainment as well as assessing the shared genetic and environmental factors between educational attainment and refraction through structural equation modeling.
  
  
  METHODS
  All twins from Victoria aged 18 years or older were invited to participate in this study through the Australian Twin Registry (ATR). Each twin completed a general questionnaire, and a comprehensive eye examination was undertaken. Education level was categorized to provide a level of attainment.
  
  
  RESULTS
  A total of 612 twin pairs with a mean age of 52.36 years were examined. Higher educational attainment was significantly associated with a more myopic refraction (r = -0.21, P < 0.01), with educational attainment explaining 4.41% of the total variance in refraction. Findings from the GEM twin study found that genes (additive genetic effects) explained 69% of the variance in educational attainment and common and unique environmental factors accounted for 20% and 11% of the variance, respectively. Of the genetic influences on refraction, 3.2% were common with those influencing educational attainment.
  
  
  CONCLUSIONS
  The GEM twin study has shown that educational attainment is strongly influenced by genes, and therefore this risk factor should not solely be considered as an environmental risk factor. The same genetic factors that influence an individual's educational attainment may also be involved in the development of refractive error.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia. m.dirani@pgrad.unimelb.edu.au
authors.forename: Mohamed
authors.initials: M
authors.lastname: Dirani
authors.forename: Sri N
authors.initials: SN
authors.lastname: Shekar
authors.forename: Paul N
authors.initials: PN
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000328:Adult; D004200:Diseases in Twins / Q000235:genetics*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000235:genetics*; D015995:Prevalence; D012029:Refraction, Ocular / Q000235:genetics*; D012042:Registries; D011795:Surveys and Questionnaires; D014429:Twins, Dizygotic / Q000235:genetics*; D014430:Twins, Monozygotic / Q000235:genetics*