title: Myopia and international educational performance.
abstract: OBJECTIVE
  To analyse the relationship between myopia, educational performance and engagement in after-school tutorial classes.
  
  
  METHODS
  Educational performance data and data on engagement in after-school tutorial classes were taken from the results of the Organisation for Economic Cooperation and Development (OECD) Program in Secondary Assessment (PISA) reports for 2009, which tested educational outcomes in representative samples of 15 year-old school children from 65 jurisdictions. High prevalence of myopia (>70%) and low prevalence of myopia (<40%) locations were identified by systematic literature search.
  
  
  RESULTS
  Six locations with a high prevalence of myopia were identified from among the participants in PISA 2009 - Shanghai-China, Hong Kong-China, Taiwan, Singapore, Japan and South Korea. All were ranked in the top quartile on educational performance. Other participants in the top educational performance quartile were identified as locations with a low prevalence of myopia, including Australia and Finland. The locations with a high prevalence of myopia combined high educational performance and high engagement in after-school tutorials, whereas the locations with a low prevalence of myopia combined high educational performance with little engagement in tutorials.
  
  
  CONCLUSIONS
  These results show that it is possible to achieve high educational outcomes without extensive engagement in after-school tutorials, and that the combination of high educational outcomes with extensive use of tutorials is associated with high prevalence rates of myopia. We suggest that extensive use of after-school tutorials may be a marker of educational environments which impose high educational loads. Further quantification of educational loads to include after- school educational activities, such as homework, tutorials and other after-school classes, as well as formal school classes, is desirable. Policy initiatives to decrease these loads may contribute to the prevention of myopia, perhaps, at least in part, by enabling children to spend more time outdoors.
authors.affiliation: Research School of Biology, ARC Centre of Excellence in Vision Science, Australian National University, Canberra, Australia. ian.morgan@anu.edu.au
authors.forename: Ian G
authors.initials: IG
authors.lastname: Morgan
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Rose
mesh_terms: D000124:Achievement; D000293:Adolescent; D001208:Asia / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D009216:Myopia / Q000453:epidemiology*; D012574:Schools