High Myopia Prevalence in East Asia Linked to After-School Tutoring

A new academic study has linked the high prevalence of myopia in East Asian countries with extensive use of after-school tutoring. It found that countries with high prevalence of myopia combined high educational performance with high engagement in after-school tutoring. Other countries such as Australia with low levels of myopia achieve high education outcomes with little after-school tutoring.

….high participation in additional tutorial sessions is not essential to achieve high educational outcomes, but does seem to be specifically associated with the epidemic of myopia in those countries that achieve high educational outcomes. [p.335]

Shanghai-China, Hong Kong-China, Singapore, South Korea, Taiwan and Japan have high level international test results, being in the top 25 per cent of performance in the OECD’s Programme for International Student Assessment (PISA) for 15 year-olds. They all have epidemics of myopia. At least 70 per cent of children completing secondary school in these locations are short-sighted and need glasses. Around 20 per cent have high myopia which means that they are at markedly increased risk of severe ophthalmic complications later in life, and which can lead to irreversible loss of vision or even blindness.

Other countries, such as Australia, Finland and Canada are also in the top 25 per cent of PISA performance, but have much lower rates of myopia. About 30 per cent of children of school-leaving age in Australia are myopic, with only 3-4 per cent in the high risk category.

Myopia is not really a matter of genetic background, but involves very strong environmental and social factors. The prevalence of myopia in East Asia was much lower two or three generations ago. Moreover, in multicultural Singapore, the prevalence of myopia is very high in Singaporean Indians, whose genetic background is closer to that of Europeans than to East Asians, and amongst Malays and Chinese. This suggests that children of European genetic background growing up in the highly competitive educational environment of Singapore would also become highly myopic by the end of schooling.

There is a long established link between education and myopia. Adults with more schooling are generally more myopic. The new study, by researchers at the Australian National University and the University of Sydney, investigated the relationship between myopia, educational performance and engagement in after-school tutorial classes using PISA data.

It found that while all countries or cities with high myopia incidence have high educational performance, not all high-performing countries have high prevalence of myopia. Other top performing countries with much less incidence of myopia that East Asian countries and cities include Australia, Canada, Denmark, Finland, Netherlands, Norway and Poland.

One factor that correlates with the higher prevalence of myopia in East Asian countries is out-of-school tuition. Data from the PISA study show that over 50 per cent of 15 year-old students in Shanghai are engaged in additional language classes and nearly 15 per cent spend more than four hours a week on them. The situation is even more extreme in South Korea where two-thirds of students have additional classes and 16 per cent spend more than four hours a week on them.

This differs markedly from countries such as Australia and Finland where 90 per cent of 15 year-old students do no additional classes and only about two per cent do more than four hours a week.

A similar picture of additional tuition in mathematics and science is also shown by PISA.

The study notes that additional tutorial classes for students at age 15 are unlikely to be directly responsible for the myopia epidemic in East Asia, since high prevalence rates have emerged by that age. However, extensive use of tuition at this age may be a marker of an educational environment in which other factors, such as homework and home study also impose a large educational load.

One of the co-authors of the study, Dr. Ian Morgan (who is also a foundation member of Save Our Schools), said that East Asian countries make massive use of coaching schools and make an early start to intensive education.

Homework is being set in pre-school and children starting school receiving around two hours of homework per day. This contrasts with the much more relaxed pace of education in Australia, where homework is virtually non-existent at pre-school and minimal in primary school, and where use of coaching schools is really only a feature of the later years of high school.

One reason for the lower prevalence of myopia in countries such as Australia is that children spend more time outdoors instead of spending long hours inside doing homework and study. Other studies have shown that children who spend more time outdoors are less likely to be myopic due to the effect of brighter light on the retina.

Dr. Morgan said that the study has lessons for the Gillard Government’s goal for Australia to be in the top 5 countries in PISA performance.

It is important to ensure that we do not adopt the East Asian policies and practices which have led to the appearance of an epidemic of myopia. Australia is still a top-performing country in educational terms and we need to build on Australian policies and practices that have under-pinned our current success. We can learn from other countries that have achieved high educational achievements without creating an epidemic of myopia, rather than following the East Asian model which has created major health problems for children.

Ian G. Morgan & Kathryn A. Rose 2013. Myopia and international educational performance, Ophthalmic & Physiological Optics, 33 (3): 329–338.

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