Academic achievement, close up work parameters, and myopia in Singapore military conscripts

Aim-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 con scripts. Non-cycloplegic refraction and A-scan biometry were performed in b oth eyes. A detailed questionnaire was administered by in-person interview to obtain Information about current and past near work activity, extra tuit ion lessons, educational experiences, and family demographics. Results-Myopia associated with the conscript having been educated in the (g ifted, special, or express) educational streams (adjusted odds ratio (OR) = 3.8, 95% confidence interval CI 2.0-7.3), and having completed pre-univers ity 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 pa rallel, supplemental tuition lessons in primary school has (OR=2.6, 95% CI 1.4-4.9) associated with conscript myopia. Parental myopia was positively a ssociated with myopia (p <0.001), but this relation disappeared when adjust ed for environmental factors. Current (p=0.83) and past close up work activ ity at age 7 years (p=0.13) did not correlate with myopia. Conclusion-Educational level and educational stream positively related to m yopia. A relation was observed with reported close up work activity in earl y childhood and with tuition classes during elementary school, but not with current close up work activity. These results underscore the strong influe nce of environment in myopia pathogenesis but a role for close up work acti vity remains indeterminate.