Myopia is associated with education: Results from NHANES 1999-2008

PURPOSE: Myopia is increasing worldwide and possibly linked to education. In this study, we analyse the association of myopia and education in the U.S. and investigate its age-dependency. METHODS: We conducted a secondary data analysis using the public use files from the cross-sectional study National Health and Nutrition Examination Survey of the period from 1999 to 2008. 19,756 participants aged 20 to 85 years were included with data on education and ophthalmic parameters (distance visual acuity, objective refraction and keratometry). Spherical equivalent, astigmatism, corneal power and corneal astigmatism were evaluated for an association with education using linear regression analysis with adjustment of potential confounders. RESULTS: Analysis revealed an association between spherical equivalent and educational level in the univariate analysis (P < .001), and in the adjusted model (P < .001). Subjects who attend school to less than 9th grade had a mean spherical equivalent of 0.34 D, subjects with 9-11th grade -0.14 D, subjects that finished high school -0.33 D, subjects with partial college education -0.70 D, subjects that graduated from college or a higher formal education -1.22 D. Subjects that graduated from college or above were -1.47 D more myopic compared to subjects that completed less than 9(th) grade school in the adjusted analyses. Astigmatism and corneal curvature was not associated with education. CONCLUSIONS: Myopia is associated with higher education in the U.S. Our analysis shows that corneal curvature does not contribute to this association, therefore axial elongation or lens power are likely to contribute to myopia.