title: Myopia and level of education: results from the Gutenberg Health Study.
abstract: OBJECTIVE
  To analyze the association between myopia and educational level in an adult European cohort.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  A cohort of the Gutenberg Health Study, including 4658 eligible enrollees between 35 and 74 years of age.
  
  
  METHODS
  We applied a standardized protocol entailing a comprehensive questionnaire; thorough ophthalmic, general, cardiovascular, and psychological examinations; and laboratory tests, including genetic analyses. We documented achievement levels in school education and post-school professional education. The spherical equivalent (SE) was determined by noncycloplegic autorefractometry. We fitted mixed linear models including age, gender, and 45 myopia-associated single nucleotide polymorphisms (SNP) as covariates.
  
  
  METHODS
  Prevalence and magnitude of myopia in association with years spent in school and level of post-school professional education.
  
  
  RESULTS
  Individuals who graduated from school after 13 years were more myopic (median, -0.5 diopters [D]; first quartile [Q1]/third quartile [Q3], -2.1/0.3 D) than those who graduated after 10 years (median, -0.2 D; Q1/Q3, -1.3/0.8 D), than those who graduated after 9 years (median, 0.3 D; Q1/Q3, -0.6/1.4 D), and than those who never finished secondary school (median, 0.2 D; Q1/Q3, -0.5/1.8 D; P<0.001, respectively). The same holds true for persons with a university degree (median, -0.6 D; Q1/Q3, -2.3/0.3 D) versus those who finished secondary vocational school (median, 0 D; Q1/Q3, -1.1/0.8 D) or primary vocational school (median, 0 D; Q1/Q3, -0.9/1.1 D) versus persons without any post-school professional qualification (median, 0.6 D; Q1/Q3, -0.4/1.7 D; P<0.001, respectively). Of persons who graduated from school after 13 years, 50.9% were myopic (SE, ≤-0.5 D) versus 41.6%, 27.1%, and 26.9% after 10 years, in those who graduated after 9 years, and in those who never graduated from secondary school, respectively (P<0.001). In university graduates, the proportion of myopic persons was higher (53%) than that of those who graduated from secondary (34.8%) or primary (34.7%) vocational schools and than in those without any professional training (23.9%; P<0.001, respectively). In multivariate analyses: higher school and professional levels of education were associated with a more myopic SE independent of gender. There was a small effect of age and SNPs.
  
  
  CONCLUSIONS
  Higher levels of school and post-school professional education are associated with a more myopic refraction. Participants with higher educational achievements more often were myopic than individuals with less education.
authors.affiliation: Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany. Electronic address: alireza.mirshahi@unimedizin-mainz.de.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshahi
authors.affiliation: Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Ponto
authors.affiliation: Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Hoehn
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Zwiener
authors.affiliation: University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Lackner
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
authors.affiliation: Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004517:Education, Professional / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000453:epidemiology*; D020641:Polymorphism, Single Nucleotide; D012030:Refractive Errors / Q000453:epidemiology; D012737:Sex Factors